【摘要】 目的 本研究旨在探讨增强CT在肺癌患者中鉴别诊断肾上腺转移瘤和乏脂性腺瘤的价值。方法 本研究回顾性分析了118例（转移瘤组67例；乏脂性腺瘤组51例）伴有单侧肾上腺实性结节、且行胸部或腹部平扫和双期增强CT扫描的肺癌患者的临床及影像资料，包括性别、年龄、肺癌临床分期、肾上腺结节的大小、位置、平扫和双期增强CT值、囊变/坏死及强化峰值期。利用单变量分析筛选出在二组间差异有统计学意义的特征参数后，利用多元Logistic回归方法构建诊断模型。利用受试者操作特征（ROC）曲线下面积（AUC）、敏感性、特异性及准确率评价各特征参数及诊断模型的效能。结果 转移瘤组的平扫CT值高于腺瘤组（P<0.001），且其男性、形态不规则、囊变/坏死以及Ⅲ/Ⅳ肺癌临床分期的比例均高于腺瘤组（均P<0.05）。与转移瘤比较，乏脂性腺瘤呈相对更快的“快进快出”强化模式（P<0.001）。多元logistic回归显示性别（AUC=0.672）、平扫CT值（AUC=0.776）、囊变/坏死（AUC=0.580）、肺癌临床分期（AUC=0.671）和强化峰值期（AUC=0.671）是预测肺癌肾上腺转移瘤的独立风险因素。预测转移瘤的诊断模型效能最高，AUC为0.908(95%CI:0.846～0.969)，其敏感性、特异性和准确率分别为0.866(95%CI:0.784～0.947)、0.863(95%CI:0.768～0.957)和0.864(95%CI:0.862～0.866)。结论 基于增强CT的诊断模型可有效鉴别诊断肺癌肾上腺转移瘤和乏脂性腺瘤。更多还原

【Abstract】 Objective To investigate the value of enhanced CT in differential diagnosis of adrenal metastases and lipid-poor adenomas.Methods This retrospective study included one hundred and eighteen lung cancer patients with unilateral adrenal solid nodule(metastases, sixty-seven, lipid-poor adenomas, fifty-one) and all patients underwent chest or abdominal plain and biphasic enhanced CT scans.Clinical and radiological characteristics of two groups, such as gender, age, clinical stage of lung cancer, size, location, plain and biphasic enhanced CT values, cystic changes/necrosis, and peak enhancement phase of adrenal nodules, were compared using univariate analysis.A diagnostic model was developed using multivariable logistic regression.Areas under receiver operating characteristic curves(AUCs),sensitivity, specificity, and accuracy were used to evaluate the performances of each characteristic parameter and diagnostic model.Results CT values in plain phase of metastases were noticeably higher than that of adenomas(P<0.001) and the proportions of male, irregular in shape, cystic degeneration/necrosis and III/IV clinical stage of lung cancer were all significantly higher than adenoma group(P<0.05).Furthermore, compared to metastases, lipid-poor adenomas showed relatively faster wash-in and earlier wash-out enhancement pattern(P<0.001).Multivariate logistic analysis revealed gender(AUC=0.672),CT values in plain phase(AUC=0.776),cystic degeneration/necrosis(AUC=0.580),clinical stage of lung cancer(AUC=0.671) and peak enhancement phase(AUC=0.671) were risk factors for predicting adrenal metastases in lung cancer.The diagnostic model for predicting metastases had the highest performance, with an AUC of 0.908(95%CI:0.846～0.969),and its sensitivity, specificity, and accuracy were 0.866(95%CI:0.784～0.947),0.863(95%CI:0.768～0.957),and 0.864(95%CI:0.862～0.866),respectively.Conclusion The diagnostic model based on enhanced CT can effectively differentiate adrenal metastases from lipid-poor adenomas in lung cancer patients.更多还原