小儿肾母细胞瘤的CT诊断

CT DIAGNOSIS OF NEPHROBLASTOMA IN CHILDREN

目的:分析儿童肾母细胞瘤(Nephroblastoma,Willms’tumor)的CT表现,提高对该病CT表现的认识。方法:经手术和病理证实的肾母细胞瘤15例,男9例,女6例,年龄1岁2月～9岁,平均2.9岁。其中4例只作CT平扫,6例仅作CT增强扫描,5例平扫加增强。结果:发生于左肾者10例,右肾4例,发生于双肾者1例。肿瘤起源于肾脏上极者4例,下极者5例,累及肾脏上下极者6例,未受累部分残存肾脏实质均受压呈新月形,残存肾盂肾盏均出现不同程度扩张积水。15例16个肿瘤呈类圆形混杂密度软组织肿块,出现坏死液化15例,出现斑点状、弧形或片絮状钙化8例,未坏死区呈轻中度强化。病灶最大直径4cm～20cm,12个病灶直径大于10cm。包膜完整或大部完整光滑者13例,包膜不清楚者2例。出现病侧肾静脉和下腔静脉癌栓1例,出现头部多处转移1例。结论:儿童肾母细胞瘤CT表现具有一定特征性,CT平扫加增强对定性诊断及病变分期有较大帮助。

Objective：To Analyze the CT findings of nephroblastoma in children and to improve the CT diagnosis.Methods：Among fifteen cases of nephroblastoma comfirmed by operation and pathology, including 9 male and 6 female children,from 14 months to 9 years,average 2.9 years,four cases performed plain CT scan, six cases performed contrast enhancement CT scan, five cases performed plain and contrast enhancement CT scan. Results： Ten cases had tumor situated in the left kidney, four in the right, and one case involved two kidneys. Four cases originated form upper pole of the kidney, five cases originated from inferior pole, and six cases involved two poles. The normal kidney beside the tumor is pressed into crescent. The pelvis of ureter and the calices renales of normal kidney enlarged and urine retained. Plain CT scan showed that, sixteen tumors of the fifteen cases displayed round mixed density like parenchyma. All the tumors displayed putrescence and fluidify. Eight tumors displayed small spotted or cambered clouded calcification.Contrast enhancement CT scans showed that, the putrescence and fluidify place displayed mild or middling enhancement. The maximum diameters were from 4cm to 20cm,in 12 cases the tumor diameter was above 10cm. Thirteen cases showed rounded or half-baked envelope,the tumors＇ envelop was unclear in two cases.Cancer embolus occarred in one case＇s kidney vein and inferior vena cava.One case＇s head showed multi-metastasis tumor.COnclusion：There are some characteristics symptoms of the CT diagnosis of the children Nephroblastoma.CT plain and contrast enhancement scans are helpful to determine the nature and the stage of the tumor.