小儿成神经细胞瘤骨转移影像学特征及诊断价值

Value of Radiological Imaging on Detecting Bone Metastasis in Pediatric Neuroblastoma

目的:分析小儿成神经细胞瘤骨转移的影像学特征,并探讨X线平片、CT和MRI的诊断价值。方法:收集小儿成神经细胞瘤骨转移患者47例,分析骨转移在X线平片、CT和MRI上的特征,并比较其诊断价值。结果:成神经细胞瘤骨转移89.2%位于长管状骨、骨盆、头颅和脊柱。形态上包括溶骨型(71.4%)、混合型(28.6%)和单纯成骨型。X线和CT表现为虫蚀样、不规则、极小透光区,部分伴有硬化边缘或骨膜反应。CT在头颅、骨盆、椎体等部位显示更细微、更广泛的病变。MRI骨髓侵犯表现为T1WI低信号,T2WI高信号,MRI发现髓内转移的时间早于CT和X线,显示病变范围更大。结论:X线平片是诊断成神经细胞瘤骨转移的基本影像学方法,为观察长骨转移最佳方法;CT利于显示骨结构重叠较多部位的病变和细节;MRI早期发现髓内、椎管内转移。

Purpose： To compare the diagnostic value of X - ray computed tomography（CT） and magnetic resonance image（MRI） on detecting bone metastasis in pediatric neuroblastoma. Methods： Forty seven neuroblastoma with bone metastasis cases were evaluated and analyzed respectively on plain X - ray, CT and MRI. Results： In all the 47 cases with bone metastases, 89.2 % metastatic lesions were located in long tubular bones, iliac, cranium and vertebrae. Morphologically, the percentages of osteolytic and mixed pattern were 71.4% and 28.6% respectively, there was no sclerotic pattern in all the 47 cases. The features on plain X - ray and CT were moth - eaten, irregular and tiny lesions, part of the cases were with peripheral sclerosis or periosteal reactions. CT showed more tiny changes at cranium, vertebra and pelvis. It was low signal intensity on TlWI, high signal intensity on T2 WI. The MR images showed the infiltration earlier and further than CT. Conclusions： X - ray is mainly used for detecting bone metas- tasis in pediatric neuroblastoma, which especially demonstrates the lesions in long tubular bones. CT provides a detailed image, particularly in cranium, vertebra and pelvis. MRI is used for detecting bone marrow and intraspinal metastasis at an earlier stage.