多排螺旋CT诊断儿童肾母细胞瘤18例分析

Clinical analysis of multi-detector row CT of children with nephroblastoma:on 18 cases report

目的探讨儿童肾母细胞瘤的多排螺旋CT表现及分期。方法 回顾分析18例经手术、病理证实为肾母细胞瘤患者的多排螺旋CT及临床资料。所有病例均采用Philips 16排螺旋CT机行常规平扫与增强扫描。结果 18例患者中,肿瘤最大直径3.2～23cm,平均11.5cm,10例(55.6%)肿块巨大跨越中线;16例(88.9%)肿块有假包膜;5例(27.8%)肿块内斑片状钙化灶;16例(88.9%)肿瘤内囊变、坏死;增强扫描18例(100.0%)肿瘤不同程度强化,11例(61.1%)残存肾实质轮廓不完整呈"新月征",14例(77.8%)肿瘤内血管丰富,10例(55.6%)肿瘤供血动脉显示,6例(33.3%)肾静脉或下腔静脉内瘤栓,4例(22.2%)远处转移,5例(27.8%)腹膜后淋巴结增大、腹膜后血管包埋及局部侵犯;4例(22.2%)肿瘤患侧肾盂、肾盏扩张积液。术前与术后临床病理分期基本一致,术前CT分期的准确率为83.3%。结论 多排螺旋CT增强扫描可清楚显示肿瘤的位置、轮廓、大小及组织特征,并可准确判断肿瘤的侵犯范围及转移灶,对肾母细胞瘤的分期、制订治疗方案、预后估计提供重要依据。

Objective To discuss the specific imaging findings and staging of multi-detector row CT of children with nephroblastoma.Methods Retrospectively analyzed the major clinical findings and CT findings of 18 cases patients with nephroblastoma.All patients underwent pre-and post-contrast enhanced CT scans on a sixteen-detector row CT scanner（Philips）.Results The mean maximum diameter of tumors was from 3.2 to 23cm,mean 11.5cm,10 cases（55.6%）acrossed the midline huge mass;The nephroblastoma with pseudocapsule（16 cases/88.9%）,intratumoral calcifications（5 cases/27.8%）,necrosis and cystic change（16 cases/88.9%）,different degree enhancement（18 cases/100.0%）,＂crescent sign＂（11 cases/61.1%）,vascularity（14 cases/77.8%）,prominent feeding artery sign（10 cases/55.6%）,inferior vena cava tumor thrombus（6 cases/33.3%）,distant metastasis（4 cases/22.2%）,retroperitoneal lymphadenopathy and encasement of retroperitoneal vesse and local invasion（5 cases/27.8%） and kidney pelvis and calices dropsy（4 cases/22.2%）.The clinical staging of preoperative and postoperative were consistent,the accurate rate of tumor staging was 83.3%.Conclusion The multi-detector row CT can detect the location,size and histological feature of nephroblastoma in children.The specific CT signs make for the staging of tumors and making up treatment protocols to nephroblastoma.