Evaluation of quantitative parameters for distinguishing pheochromocytoma from other adrenal tumors.
Evaluation of quantitative parameters for distinguishing pheochromocytoma from other adrenal tumors.
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评估用于区分嗜铬细胞瘤与其他肾上腺肿瘤的定量参数。
DOI：
10.1038/s41440-017-0002-4
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发表时间：
2018
影响因子：
5.4
通讯作者：
Inagaki N.
中科院分区：
文献类型：
--
作者：
Ohno Y;Sone M;Taura D;Yamasaki T;Kojima K;Honda-Kohmo K;Fukuda Y;Matsuo K;Fujii T;Yasoda A;Ogawa O;Inagaki N.
肾上腺肿瘤越来越多是在影像学检查中偶然发现的。由于嗜铬细胞瘤有高血压危象的危险，因此将嗜铬细胞瘤与其他肾上腺肿瘤区分开来是很重要的。虽然儿茶酚胺及其代谢物通常用于诊断嗜铬细胞瘤，但假阳性检测结果很常见。需要一种有效的筛查方法来区分嗜铬细胞瘤和肾上腺偶发瘤。我们分析了297例连续的肾上腺偶发瘤患者。我们的研究结果包括162例无功能肿瘤、47例醛固酮分泌腺瘤、26例转移瘤、22例亚临床库欣综合征、21例嗜铬细胞瘤、12例库欣综合征和7例肾上腺皮质癌。我们检查了定量参数，如年龄、血液和尿液儿茶酚胺及其代谢物、神经元特异性烯醇化酶、大小和计算机断层扫描（CT）衰减值。在儿茶酚胺相关参数中，尿中肾上腺素和去甲肾上腺素（urineMNM）水平的总和在区分嗜铬细胞瘤和其他病变的受试者工作特征曲线下产生了最大的面积。大小和CT衰减值也有显著差异。然而，大小与儿茶酚胺水平相关。CT衰减与其他因素无关。CT衰减的最佳阈值为19 Hounsfield单位（HU）（灵敏度100%，特异性60%），尿emnm的最佳阈值为0.43 mg/24 h（灵敏度89%，特异性96%）。CT衰减值在19 HU以下时未见嗜铬细胞瘤。即使在CT衰减值≥19 HU的肾上腺肿瘤中，当尿尿emnm < 0.43 mg/24 h时，嗜铬细胞瘤的发生率仅为4.3%，当尿尿emnm≥0.43 mg/24 h时，嗜铬细胞瘤的发生率为93%，当尿尿emnm≥0.77 mg/24 h时，嗜铬细胞瘤的发生率为100%。CT衰减值和尿emnm是诊断嗜铬细胞瘤最有用的组合。
Adrenal tumors are increasingly found incidentally during imaging examinations. It is important to distinguish pheochromocytomas from other adrenal tumors because of the risk of hypertensive crisis. Although catecholamines and their metabolites are generally used to diagnose pheochromocytoma, false-positive test results are common. An effective screening method to distinguish pheochromocytoma from adrenal incidentalomas is needed. We analyzed 297 consecutive patients with adrenal incidentalomas. Our findings included 162 non-functioning tumors, 47 aldosterone-producing adenomas, 26 metastases, 22 cases of subclinical Cushing’s syndrome, 21 pheochromocytomas, 12 cases of Cushing’s syndrome, and 7 adrenocortical cancers. We checked quantitative parameters such as age, blood, and urine catecholamines and their metabolites, neuron-specific enolase, size and computed tomography (CT) attenuation values. Among catecholamine-related parameters, the sum of urine metanephrine and normetanephrine (urineMNM) levels produced the highest area under the receiver operating characteristic curve regarding discrimination of pheochromocytoma from other lesions. Size and CT attenuation values also differed significantly. However, size was correlated with catecholamine levels. CT attenuation was not correlated with other factors. The optimal thresholds were 19 Hounsfield units (HU) for CT attenuation (sensitivity, 100%; specificity, 60%) and 0.43 mg/24 h for urineMNM (sensitivity, 89%; specificity, 96%). No pheochromocytomas were evident when CT attenuation values were under 19 HU. Even in adrenal tumors with CT attenuation values ≥ 19 HU, when urineMNM was < 0.43 mg/24 h, the frequency of pheochromocytoma was only 4.3%, when urineMNM was ≥ 0.43 mg/24 h, the frequency of pheochromocytoma was 93% and when urineMNM was > 0.77 mg/24 h the frequency of pheochromocytoma was 100%. CT attenuation value and urineMNM represented the most useful combination for diagnosis of pheochromocytoma.