Study Of Multi-slice Computed Tomography Imaging Anatomy Of Normal Adrenal Gland And Adrenal Vein

PART1STUDY OF NORMAL ADRENAL MULTI-SLICECOMPUTED TOMOGRAPHY IMAGING ANATOMYObjective: Multi-slice spiral CT was used in the study of normaladrenal morphology, size, density, strengthen rules and characteristics, andto provide image anatomy data clinically.Method: To retrospectively analyze220hospitalized patients withenhanced rows abdomen scan, no hypertension, no clinically pathologicalchanges of hypothalamus-pituitary-adrenal axis, celiac lymph nodeswithout swelling, no history of abdominal surgery，but image displayedclearly from July2011to January2013. The different forms of normaladrenal location,adjacent structure,continuous plane scanning wereobserved and classified around the CT cross-section.The thickness ofadrenal gland and ipsilateral crura of diaphragm, plain scanning, and CTvalues in arterial and venous phase were measured.Results:①among the220cases, the right adrenal gland appeared earlier than the left accounted for70.9%(156/220), bilateral adrenal glandsappear at the same level accounted for7.27%(16/220),the left adrenalgland appeared earlier than the right accounted for21.8%(48/220). Inferiorpole of the right adrenal gland located in the front of upper pole of the rightkidney accounted for81.8%(180/220), inferior pole of the left adrenalgland located in the front of upper pole of the left kidney accounted for the80%(176/220)。②Bilateral adrenal morphology:"Y"/","人"or invertedright accounted for65.5%（144/220）,76.82%left (169/220);" V "orinverted right is24.1%(53/220),5.45%left side (12/220);"/"linear,"△"shapeon the right side is0.91%（2/220）, left side is6.36%(14/220);"/"linear on the right side is8.64%(19/220), left side is6.36%(14/220);"△"shape on the right side is0.91%(2/220), on the left side is5%(11/220).③The adjacent structure of right adrenal gland is fixed, and theleft adjacent structure is changeable.④As to the thickness of adrenal glandbody, medial limb,"/" linear，left side>right side (P<0.001，P<0.001,P=0.008); as to the thickness of lateral limb and "△" shape，left and rightside had no significant difference (P=0.382, P=0.166); no significantdifferences in thickness of the lateral and medial limbs of the right adrenalgland (P=1.315); thickness of medial limb of the left adrenal gland is abovelateral limb (P<0.001); thickness of the right crura of diaphragm is abovethe left side(P<0.001);assumed the thickness of the adrenal body, limbs isabove ipsilateral crura of diaphragm as abnormal, the body and limbs were false positive rate in different degrees; and the right adrenal thickness ofbody and the medial limb increase with age (P=0.030, P=0.0085), nosignificant difference in lateral limb (P=0.4628). The left adrenal body,medial and lateral limbs increased with age, no significant difference in thethickness(P=0.2368, P=0.2928, P=0.2630).⑤The95%confidence intervalassessment the left adrenal body (3.0mm,8.4mm), right side body(2.3mm,7.2mm), left medial limb (1.8mm,4.5mm),left laterallimb(1.3mm,4.2mm), right lateral and medial limbs (1.5mm,4.0mm) aresuspect as abnormal when exceed the scope of the above.⑥Of the totalsample, bilateral adrenal strengthen uniform, shape finishing. Right arteryperiod increase CT value> venous phase (P=0.005), no significantdifference in the left side (P=0.082). Scatter diagram of arteriovenousperiod increase CT value difference discovered that part of adrenalenhanced in the arterial phase than in the venous phase, part is belowvenous phase, difference range concentrated in-40~40HU; CT values ofplain scan on the left and right adrenal glands decreases with age(P<0.001,P<0.001); as to CT values of arterial phase, young group> aged group>middle-aged group (P<0.001, P<0.001), CT values in venous phase has nosignificant difference (P=0.233, P=0.242); CT values of artery phase in theleft and right side adrenal of the youth group are above venous phase (leftside:P<0.001;right side:P<0.001),in the middle and elderly age group,CTvalues in arteriovenous period has no significant difference between the left and right side (left side:P=0.348,P=0.245;right side:P=0.684,P=0.667).Conclusion: The normal thickness scope of adrenal gland can bemeasured through MSCT,95%confidence interval assessment the leftadrenal body(3.0mm,8.4mm), right side body(2.3mm,7.2mm), left mediallimb(1.8mm,4.5mm),left lateral limb(1.3mm,4.2mm), right lateral andmedial limbs(1.5mm,4.0mm). The thickness of the adrenal body and limbsexceeded the crura of diaphragm on the same side as the anomaly judgmentstandard is not reliable. CT values of the adrenal gland and kidney are thesame, moderately or significantly strengthened, the enhancement does nothave apparent regularities,but it strengthen uniform, shapefinishing.Bilateral adrenal unenhanced CT value is reduced with increasingage, arterial phase CT youth group> elderly> middle-aged group. Youthgroups bilateral adrenal glands increase in arterial phase CT> in veinphase. PART2MULTI-SLICE COMPUTED TOMOGRAPHY IMAGINGANATOMY STUDY OF ADRENAL VEINObjective: To study the display rate and variation of adrenal vein withMSCT angiography, and provide basis for clinical imaging. Methods:108patients with abdominal examination of CTA in ourhospital, adrenal and surrounding organs lesions no effects of the adrenalvein imaging were retrospectively analyzed. Observe the location of theadrenal vein and image post processing were observed in GE ADW4.5workstation. MIP/MPR technology was used to evaluate the principal veinimaging,anatomic location, analysis of variance, and measure the imagesanatomical data:①right adrenal vein:pipe diameter Rr; the length of glandoutside segment RD1; into the inferior vena cava timt T; the distance fromthe adrenal vein into the inferior vena cava to the right renal vein into intothe inferior vena cava RD2;the downwards angel of adrenal vein into theinferior vena cava RA.②left adrenal vein: adrenal vein pipe diameter Lr;diaphragmatic-adrenal vein dry pipe diameter LR; the length of glandoutside segment LD1;the distance from the point of diaphragmatic-adrenalvein dry to the point of it into the left renal vein LD2; the distance from thepoint of the diaphragmatic-adrenal vein dry into the left renal vein to theleft side of the inferior vena cava LD3;the inward angel of hediaphragmatic-adrenal vein dry into the left renal vein LA1;the downwardsangel of adrenal vein into the diaphragmatic-adrenal vein dry LA2.Results:①Right side:adrenal vein displayed rate64.81%(70/108);variation rate5.71%(4/70), of which4.29%(3/70) and right liveraccessory vein sinks intovenae cava inferior,1.43%(1/70) directly sinksinto opening paries superior of right kidney vein;66cases directly sinkingintontovenae cava inferior are located in right lower quadrant of watchesdisc in intontovenae cava inferior,the scale is located in6o’clock and8o’clock,6o’clock whole sinks into7.58%(5/66),6points to7points into19.7%(13/66), at7o’clock sharp into18.18%(12/66),7to8into the42.42%(28/66), at8o’clock sharp into12.12%(8/66), adrenal veinRr2.19±0.56mm,RD15.02±1.82mm,RD217.85±12.96mm,RA60.25± 40.69°.②Left side: adrenal vein displayed rate is97.22%(105/108);variation is14.29%(15/105), of which6.67%(7/105) single support sinksinto left kidney vein,0.952%(1/105) and left diaphragmatic vein samepoints sinks into left kidney vein,3.81%(4/105) diaphragmatic-adrenalvein dry and left kidney package film vein total dry sinks into left kidneyvein,2.86%(3/105) diaphragm-arenal vein dry and left renal capsule vein,into the left kidney vein.adernal vein Lr2.39±0.56mm,LR3.65±0.93mm,LD17.28±4.01mm,LD214.07±6.77mm,LD332.89±4.85mm,LA1118.06±18.49°, LA2156.15±13.81°.Conclusion:Combining on MSCT angiography of abdominaltreatment technology clearly shows that most of the adrenal vein, especiallythe left side, to analyze variations of vascular, measuring adrenal vein andvascular Imaging anatomical data related to them, so as to integrateAVS,MSCT in preoperative assessment of adrenal vein can achieve "pointto point" effect of guiding catheter and sampling smoothly.