應用影像學以偵測和定位嗜鉻細胞瘤病患之研究

Imaging Study of Detection and Localization in Patients with Pheochromocytoma

10.7023/TJFM.200409.0133

陳良光(Liang-Kuang Chen)；陳昱宏(Yu-Hung Chen)；沈業友(Yeh-Yu Shen)；張家千(Chia-Chien Chang)

pheochromocytoma ； localization ； computed tomography ； magnetic resonance imaging ； radionuclide imaging

台灣家庭醫學雜誌

14卷3期（2004 / 09 / 01）

133 - 141

繁體中文

嗜鉻細胞瘤是一種源自於交感神經系統的嗜鉻細胞，並分泌過多兒茶酚胺(catecholamine)的少見腫瘤。約占次發性高血壓成因的0.3%，但卻可經由手術而治癒的高血壓。早期發現、診斷、定位與治療是非常重要的，可避免嚴重的併發症和死亡率。本文主要在探討影像學診斷在嗜鉻細胞瘤的價值與重要性。此研究收集本院收集本院自1993年4月至2003年4月共13例，其中男性8例，女性5例，經病理切片診斷證實為嗜鉻細胞瘤病患的影像學檢查呈現結果，加以分析並比較電腦斷層攝影，磁振造影和I^131-MIBG全身同位素掃描對偵測定位嗜鉻細胞瘤之敏感性。結果分別為100%，100%和89%。本研究結果顯示臨床上初步偵測和定位嗜鉻細胞瘤時，無論使用電腦斷層攝影或磁振造影均可高達100%之敏感性，且是最佳非侵襲性之影像檢查方法。但磁振造影優於電腦斷層攝影，主要在於可避免游離輻射危險及藥物過敏情況，並提供更清晰之腫瘤大小及相關解剖位置，且能提供三度空間影像及數位化影像血管攝影檢查。因此在初步評估定位嗜鉻細胞瘤病患時，磁振造影和電腦斷層攝影是較佳之影像診斷定位技術。

Pheochromocytoma is a catecholamine-producing tumor that arises from the chromaffin cells of the sympathoadrenal system and can occur anywhere from the base of the skull to the epididymis. About 80% to 90% of pheochromocytomas are in the adrenal glands while the rest are intra-abdominal. It constitutes a rare cause of surgically correctable hypertension, but can be fatal if undetected. It is also associated with long-term morbidity. Therefore early recognition and correct localization of pheochromocytoma is critical to effective management of this tumor and to avoid significant morbidity and mortality. The purpose of our study was to identify the imaging diagnosis for pheochromocytoma. Thirteen patients, 8 males and 5 females with histologically proved pheochromocytoma encountered from April 1993 to April 2003 were reviewed. We compared and analyzed the sensitivity of CT, MRI and 1131-MIBG for localization of pheochromocytoma in clinical practice. The sensitivities of the localization examinations were 100, 100 and 89% for CT, MRI and 1131-MIBG, respectively. Our results suggest that CT and MRI are particularly useful in evaluating and diagnosing 100% of patients with pheochromocytoma. CT and MRI have emerged as the optimal noninvasive imaging methods for the tumors but MRI is superior to CT for anatomical localization and providing clearer and more precise images for surgical planning. Also MRI does not require an iodinated contrast medium or radiation. In conclusion, this study suggests that in the initial evaluations of patients with pheochromocytoma, MRI and CT should be preferred as imaging techniques to locate the tumor.

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