多层螺旋CT在小儿腹部神经母细胞瘤手术切除风险评估中的应用

Risk assessment of abdominal neuroblastoma resection using multi-slice computed tomography

目的：应用多层螺旋CT（MSCT）在小儿腹部神经母细胞瘤手术前进行切除风险评估，尝试提出新的术前判断肿瘤可否安全切除的影像分级标准，从而探讨多层螺旋CT在辅助和指导小儿腹部神经母细胞瘤的手术治疗中的应用价值。方法43例患儿均行多层螺旋CT增强扫描，并接受手术治疗。根据影像资料，所有患儿腹部肿瘤与毗邻重要血管的关系均归类于按事先确定的标准分为A、B、C、D、E五类中的一类，结合实际手术所见，分别计算以相应组别标准作为可切除标准时，CT术前诊断的各统计指标。找出拥有相对最佳指标的组别，作为CT在术前诊断的划分可切和不可切的界限。结果43例患儿的所有纳入统计的血管数为473条，按其在CT中与肿瘤的关系分为A级283条、B级65条、c级32条、D级76条及E级17条。结合手术情况，运用SPSS17．O软件绘制接受者工作特征（ROC）曲线，B组作为可切除标准时，肿瘤不可切除的敏感性、特异性、阳性预测值、阴性预测值及准确率分别为84．47％、89．73％、69．60％、95．40％、88．58％，因此将B组标准作为CT进行术前判断肿瘤可切除性最为合适。结论根据影像特点和手术情况所得的术前判断肿瘤可否安全切除的影像分级标准，以肿瘤包绕大血管超出周径1／2。

Objective To explore feasibility of using MSCT-assisted abdominal neuroblastoma resection and their assessment standard, as well as potential clinical values. Methods 43 patients as- sociated with neuroblastoma or ganglio-neuroblastoma in abdomen underwent preoperative MSCT. Based on imaging, they were classified into 5 types according to the relationship between the tumors and the important vessels. Then all patients underwent resection. Helical CT results were compared with intraoperative observation so as to find out the better cutoff point of respectability. Results 473 vessels were analyzed in this study. All the vessels were divided into 5 types, involving 283 vessels in grade A, 65 vessels in grade B, 32 vessels in grade C, 76 vessels in grade D and 17 vessels in grade E. The receiver operating characteristic （ROC） curve was drawn according to the images and the opera- tions. When grade B was reagarded as the criteria for resectability of neuroblastoma in abdomen, sen- sitivity was 84. 47%, specificity was 89. 73 %, a positive predictive value was 69. 60%, a negative pre- dictive value was 95.40% and accuracy was 88. 58% for unrepeatability of tumors. Conclusions Once exceling more than half of vessel circumference in tumor, the tumor is not suggested to be resected completely.