儿童副神经节细胞瘤的CT表现

Pediatric paraganglioma:CT characteristics

目的:探讨儿童副神经节细胞瘤的特征性CT表现,提高诊断符合率。方法:回顾性分析经手术病理确诊的5例副神经节细胞瘤患儿的影像资料,其中男2例,女3例,平均发病年龄12岁,5例患儿均行CT平扫及增强扫描。观察肿瘤的位置、大小、增强后的强化程度、瘤体内的血管分布、与周围组织及大血管的关系、瘤栓形成及有无转移和转移部位等。结果:本组副神经节细胞瘤的特征性CT表现为:①肿瘤均位于腹膜后;②肿瘤呈类圆形或椭圆形软组织包块影,边缘可呈分叶状,呈膨胀性生长,肿瘤体积较大;③平扫时瘤体密度略欠均匀,可见散在的小片状低密度灶(出血、坏死和囊变),瘤体内无明显钙化;④增强扫描动脉期瘤体实性部分呈明显强化,平扫低密度区强化不明显,瘤体内有大量血管穿行,瘤体血供丰富,静脉期瘤体强化程度未见明显降低,有时甚至强化更明显;⑤体动脉分支供血,供血血管可直接起自腹主动脉,也可起自腰动脉、肠系膜动脉、生殖血管、髂血管等;⑥瘤体占位效应明显,对周围的脉管及脏器有推移、挤压,也可对腹腔大血管有轻度包埋;⑦可见腔静脉瘤栓形成。试验室检查5例患儿的NSE和尿VMA测定均不同程度升高。结论:儿童副神经节细胞瘤的CT表现具有较高特异性,尤其是增强CT表现为明显的持续强化和富血供,结合代谢物的实验室检查和临床表现,可明显提高该病的诊断符合率。

Objective：To study the typical CT features of paraganglioma in children,and make the diagnosis more of fectively. Methods： Clinical and radiologic data of five children （3 males and 2 females） were reviewed retrospectively. All the cases were performed pre-contrast and contrast CT, and pathologically proved as paraganglioma. I.ocation, size, enhancement pattern,tumor vessels, the relationship with adjacent tissues and vessels, thrombus formation and metastasis of the tumors were observed and analyzed. Resnlts：CT features of paraganglioma in children included：@Located in retroperitoneal space; @Lobulated,round or oval soft tissue mass,growing in expansion pattern and having a large size;@Homogeneous in plain CT scan with scattered low-density lesions （hemorrhage, necrosis or cystic degeneration）, but no calcifications. @Rich tumor vessels,and marked enhancement both in arterial and venous phase. Sometimes the tumors were enhanced more obvi- ously in venous phase than arterial phase. @Tumors were directly supplied by aorta,lumbar artery, superior mesenteric ar tery, reproductive artery or iliac artery. @Surrounded organs, tissues and vessels were compressed or invaded by tumors. （7） Vena cava tumor thrombosis. Neuron specific enolase （NSE） and urinary catecholamine metabolites vanillylmandelic acid （VMA） were increased in all five children. Conclusion.. CT feature of paraganglioma is typical, especially the enhancement pattern. Rich tumor vessels and signficant enhancement both in arterial and venous phase are characteristics of paraganglio ma. Combined with NSE, VMA and clinical data,CT is a good tool for diagnosis.