儿童纵膈神经母细胞瘤CT特征

CT features of pediatric mediastinal neuroblastoma

目的探讨儿童纵膈神经母细胞瘤CT表现特征。方法回顾性分析经病理证实的儿童纵膈神经母细胞瘤17例CT表现，观察肿瘤的生长方式、大小、密度、强化程度、侵犯周围组织及转移等特点，并与病理结果进行对照分析。结果17例中位于右后上纵膈2例，右后中上纵膈3例，右后中下纵膈3例，右后下纵膈1例，左后中纵膈3例，左后中下纵膈3例，左后下纵膈1例，双侧后中下纵膈1例。肿块平均大小6．3cnm×4．3cm（2．3cm×2．0cm～12．6cm×4．0cm），CT平扫显示肿块边界清楚8例，边界不清楚9例；肿块密度不均匀13例，密度均匀4例，肿块内见砂粒状或条片状钙化8例；邻近胸膜增厚10例，合并胸腔积液5例；邻近气管及主支气管受压6例，心脏受压4例，肺动脉受压7例，降主动脉受压1例；肿瘤越过中线6例，肿瘤向椎间孔生长5例，包绕主动脉3例，肋骨侵袭破坏3例，肋骨受压变形2例，胸椎受侵破坏2例，沿脊柱旁突入上腹部1例；纵膈淋巴结肿大10例，骨转移10例，颈部淋巴结肿大4例，肝转移1例，脑转移1例。CT增强扫描14例，不均匀强化11例，均匀强化3例；轻度强化3例，平均CT值36（20—56）HU；中度强化8例，平均CT值53（36～74）HU；明显强化3例，平均CT值70（56—88）HU。肿块内见点状血管影7例，肿块内见多囊状改变6例。结论儿童纵膈神经母细胞瘤具有一定特征，CT表现结合临床可作出较明确诊断。

Objective To investigate CT features of pediatric mediastinal nenroblastoma. Methods The CT performance of pediatric mediastinal neuroblastoma confirmed by clinical and pathology in 17 cases were retrospectively analyzed. The tumor growth pattern, size, density, degree of enhancement, invasion to the surrounding tissues and metastatic characteristics were observed, and the results were compared with pathological analysis. Results Among the 17 cases, 2 were at the right posterior upper mediastinum, 3 at posterior right middle and upper mediastinum,3 at the posterior right middle and lower mediastinum, 1 at the posterior right lower mediastinum,3 at the posterior left middle mediastinum,3 at the posterior left middle and lower mediastinum, 1 at the posterior left lower mediastinum, and 1 at bilateral posterior middle and lower mediastinum. The average tumor size was 6. 3 × 4. 3 cm, ranging from 2. 3 ×2. 0 cm - 12. 6 ×4. 0 cm. CT plain scan showed 8 cases with clear boundary and 9 case without clear boundary. 13 cases were with inhomogeneous density and 4 cases with homogeneous density. 8 calcification of grainy or strip was found in the tumor. 10 cases were with pleural thickening and 5 ca- ses with pleural effusion. 6 cases were with tracheal or main bronchial compression, 4 with cardiac compression, 7 with pulmonary artery compression, and 1 with descending aorta compression were found. 6 cases were with tumors crossing the midline, 5 with intervertebral foramen growth, 3 wrapped around the aorta, 3 with rib attack damage,2 with rib compression deformation,2 with thoracic invasion, and 1 into the upper abdomen. 10 cases were with mediastinal lymph nodes enlargement, 10 with bone metastasis, 4 with cervical lymph nodes enlargement, 1 with liver metastasis, and 1 with cerebral metastasis. Enhanced CT scan was performed in 14 cases： 11with inhomogeneous enhancement, and 3 with homogeneous enhancement. The average CT value of the 3 mild enhancement was 36 HU, ranging from 20 to 56 HU. The average CT value of the 8 moderate enhancement was 53 HU, ranging from 36 to74 HU. The average CT val-ue of the 3 marked enhancement 72 HU, ranging from 56 to 88 HU. 7 punctate vessels and 6 polycystic changes were found in the tumors. Conclusions Mediastinal neuroblastoma in children are with certain characteristics. CT findings with clinical manifestations can make a definite diagnosis.