节细胞神经瘤与节细胞神经母细胞瘤的CT诊断

CT diagnosis of ganglioneuroma and ganglioneuroblastoma

目的:探讨节细胞神经瘤与节细胞神经母细胞瘤的CT表现特点及其鉴别诊断。方法:回顾性分析本院经手术病理证实的28例节细胞神经瘤及2例节细胞神经母细胞瘤患者的病例资料,所有患者均行CT平扫及增强检查。结果:28例节细胞神经瘤中,位于肾上腺区15例、胸段脊柱旁6例、腰段脊柱旁2例、颈鞘区4例、骶前区1例;肿瘤表现为圆形、类圆形、水滴状软组织肿块,边界清晰、边缘光滑;14例可见点状钙化;16例有伪足征;24例密度均匀,4例密度不均匀,1例含有脂肪成分。增强扫描轻度强化,11例呈片絮状延迟强化。2例节细胞神经母细胞瘤均位于肾上腺区,CT表现为不规则软组织肿块,密度不均匀,其内见明显坏死、囊变、粗大钙化,增强扫描明显不均匀强化,1例伴淋巴结转移。结论:节细胞神经瘤与节细胞神经母细胞瘤CT表现具有一定特征,CT对其定性诊断具有重要价值,出现肿块内粗大钙化、边界模糊、周围组织侵犯及淋巴结转移时,应考虑节细胞神经母细胞瘤的可能。

Objective：To study the CT manifestations and the value of differential diagnosis in ganglioneuroma and ganlioneuroblastoma. Methods：The clinical materials of twenty-eight cases with ganglioneuroma and two cases with gangli- oneuroblastoma confirmed by pathology were enrolled. All had plain and enhanced CT scanning. The clinical and imaging materials were analyzed retrospectively. Results： Of the 28 patients with ganglioneuroma, the location included adrenal gland （15 patients）,para-thoracie spine （6 patients）,para-lunbral spine （2 patients）,carotid sheath （4 patients） and anterior to sacrum （1 patient）. The lesions usually showed soft tissue density, round or water-drop in shape, well-defined, with punctate calcification （14 cases）. Pseudopodia sign could be assessed in 16 patients. The density of 24 cases were homogeneous and the other 4 cases were uneven,intra-tumoral fat tissue could be seen in one lesion. All lesions showed slight enhancement af- ter contrast administration, 11 cases showed progressive and patchy enhancement in venous phase. All of the 2 patients with ganglioneuroblastoma were located in adrenal gland,irregular in shape, with heterogeneous density and marked intra tumoral necrosis, cystic change and coarse calcification. Obvious heterogeneous enhancement after contrast administration could be assessed. One case had lymph node metastases. Conclusion： Certain characteristic findings could be revealed in ganglioneuro- ma and ganglioneuroblastoma, and CT was valuable in the diagnosis and differential diagnosis. Display of intra-tumoral coarse calcification, ill-defined boundary, invasion of adjacent tissue and lymph node metastases provides the hints of the di- agnosis of ganlioneuroblastoma.