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摘要: 在目前超声、CT等影像手段运用广泛的背景下，肾上腺区的钙化并不少见，良恶性病变中均可伴随。因此，如何综合CT特征和内分泌功能情况，进行正确合理的初步诊断以及治疗方案的选择(保守或手术治疗)是极其重要的。本文旨在从循证医学角度出发，在钙化类型、影像学特征、内分泌功能以及治疗等方面进行探讨，进而指导临床诊治方案的制定。Abstract: With the widespread use of ultrasound, CT, and other imaging modalities, adrenal calcification is not uncommon in benign and malignant lesions. Therefore, it is extremely important to combine CT features and endocrine function to make a correct and reasonable preliminary diagnosis and choice from conservative or surgical treatment. The purpose of this article is to discuss the type of calcification, imaging features, endocrine function, and treatment from the perspective of evidence-based medicine, so as to guide the formulation of clinical diagnosis and treatment plans.
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Key words:
- calcification /
- adrenal gland /
- CT /
- tumor
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表 1 肾上腺区钙化在CT影像上的特征及相关疾病的关系
钙化类型 钙化发生率 CT主要鉴别特征 原发疾病 边缘弧型钙化 69% 单发、单侧、壁薄、病变中心显示为较均匀的水样密度(0~10 HU) 真性囊肿 边缘厚壁型钙化 50% 壁厚，增强可强化，中心密度较高 假性囊肿 NA 外围增强中央低密度(50~60 HU) 血肿 内部点状型钙化 20% 病灶内大范围负衰减脂肪信号(-80~-100 HU) 髓样脂肪瘤 72.7% 含脂液平面、毛发和脂液混合体 畸胎瘤 42%~60% 界限清晰、有包膜的实性肿块，“伪足”，少见囊变坏死，延迟强化 节细胞神经瘤 NA 边界清晰，密度不均，直径通常>6 cm，中等程度强化 嗜酸细胞瘤 64% 增强扫描示“快进慢出”表现 血管瘤 NA < 3 cm，边界清楚，密度较均匀，衰减值< 10 HU 皮质腺瘤 10%~25% >6 cm，常呈分叶状，边缘模糊，密度不均，衰减值>10 HU，增强扫描示“渐进式”表现 皮质癌 < 10% 增强扫描动脉期迅速强化(110~120 HU)，静脉期瘤体强化稍减弱，洗脱率低于50% 嗜铬细胞瘤 50% 双侧肾上腺萎缩 肉芽肿性疾病 内部粗大型钙化 100% 未发现相关肾上腺疾病 单纯原发性钙化灶 NA 幼儿肾上腺增大伴肝脾肿大、淋巴结病变 沃尔曼氏病 不定型钙化 88.9% 较规则团块或结节状稍高密度影，边界清晰，密度较为均匀 钙化纤维瘤 NA 平扫CT上衰减值通常>10 HU，但在增强CT上造影剂洗脱速度低于嗜铬细胞瘤 肾上腺转移 80%~90% 多见囊变、坏死，包绕腹膜后大血管及向对侧延伸侵润，不均匀明显强化，幼儿多见 神经母细胞瘤 NA 单或双侧肾上腺肿大伴多器官受累 淀粉样变性 
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| 引用本文: |
阮小豪, 徐丹枫, 赵菊平. 肾上腺区钙化的诊治进展[J]. 临床泌尿外科杂志, 2022, 37(9): 718-722. doi: 10.13201/j.issn.1001-1420.2022.09.015
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| Citation: |
RUAN Xiaohao, XU Danfeng, ZHAO Juping. Advances in the diagnosis and treatment of adrenal calcification[J]. J Clin Urol, 2022, 37(9): 718-722. doi: 10.13201/j.issn.1001-1420.2022.09.015
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