课件：肾上腺肿块MR的特征及诊断.ppt

2，??肾上腺淋巴瘤淋巴瘤偶尔也可累及肾上腺，以非何杰金淋巴瘤多见，通常双侧受累， 占50%。肾上腺淋巴瘤T1WI上低信号和T2WI上不均匀高信号。增强后轻微强化。 Figure 15. (a, b) Axial T1-weighted in-phase and out-of-phase MR images show bilateral lymphomatous deposits. The deposits have low signal intensity, and the signal intensity does not decrease on the out-ofphase compared with the in-phase image.  3，转移转移病变是肾上腺最常见的恶性肿瘤，尸检发现27%患恶性上皮肿瘤有肾上腺转移。原发部位一般有：肺，肠道，乳腺，胰腺。 一般为双侧，也可单侧。MRI T1WI上低信号和T2WI上高信号。增强后逐渐强化。没有在out-of-phase上信号减低的特性（和腺瘤鉴别）。 Figure 16. (a, b) Axial T2-weighted MR image obtained with inversion recovery and contrast-enhanced T1-weighted MR image obtained with VIBE show metastasis from renal cell carcinoma, which has a central area of necrosis.  九，儿科肿瘤神经母细胞瘤是小儿最常见的颅外实性肿瘤，其他肾上腺肿瘤，如：嗜铬细胞瘤,皮质腺癌，淋巴瘤十分罕见。1，神经母细胞瘤神经母细胞瘤是第二常见腹部肿瘤（在Wilms tumor之后）。占小儿恶性肿瘤的5%-15%。 起源于肾上腺髓质的神经脊或沿交感神经连。神经母细胞瘤临床一般无症状，除非侵犯或压迫临近组织，转移或其他。神经母细胞瘤T1WI上不均匀低信号和T2WI上不均匀高信号。增强后强化。神经母细胞瘤80-90%有钙化，但MRI难以显示。出血区域引起T1WI高信号。坏死区域能够引起T2WI高信号。MRI在显示肿块上臂CT有优势，在于MRI高软组织分辨率，多方位成像，以及能清楚显示肿瘤成分。 Figure 17. (a, b) Coronal unenhanced T1-weighted MR image and axial T2-weighted MR image obtained with inversion recovery show a right adrenal tumor. The tumor is predominantly hypointense on the T1-weighted image and has areas of high-signal-intensity hemorrhage (arrow in a). The tumor is hyperintense on the T2-weighted image.  ，节细胞神经母细胞瘤 其潜在恶性度介于神经母细胞瘤和节细胞神经瘤之间。和神经母细胞瘤一样，起源于神经脊。节细胞神经母细胞瘤T1WI上中等信号和T2WI上不均匀高信号。增强后不均匀强化。 Figure 18. Axial in-phase T1-weighted MR image shows a heterogeneous mass with intermediate signal intensity involving the right adrenal gland. Photograph of the specimen shows a dark brown to tan lobulated ganglioneuroblastoma with areas of necrosis and compression of the adjacent kidney. There is a rim of residual yellow cortex 肾上腺占位可根据细胞内脂质，肉眼可见的脂肪，出血和囊变，血供情况和肿瘤形态进行分类 。这些特征可用于大部分肾上腺占位：腺瘤，增生，单纯或复杂囊肿，淋巴管瘤，髓样脂肪瘤，嗜铬细胞瘤,肾上腺出血，皮质腺癌，神经母细胞瘤，淋巴瘤和转移瘤。 一，组织学及解剖学肾上腺位于肾的上方，右侧肾上腺呈人字形，左侧呈半月形，右侧较左侧稍高。成人的每侧肾上腺重4～5g。肾上腺表面包以结缔组织被膜，少量结缔组织伴随血管和神经伸入腺实质内。肾上腺实质由