儿童胰母细胞瘤的B超与CT表现分析

Ultrasound and CT findings in children pancreatoblastoma

目的分析儿童胰母细胞瘤（PB）的超声、CT影像特点，提高对PB的影像诊断水平。方法回顾性搜集2000年1月至2016年12月经手术及病理证实的9例儿童PB，女5例、男4例；年龄2个月~13岁，中位年龄4.1岁。分析所有患儿的超声及CT影像表现，对病灶部位、大小、质地、包膜、钙化、与周围组织关系、淋巴结与术中及术后病理进行符合性比较，对肿瘤大小的比较采用组内相关系数（ICC）进行一致性评价。结果肿瘤直径30~95 mm，中位直径40 mm。6例位于胰腺头部，3例位于胰腺体尾部；1例囊性，2例囊实性，6例实性；5例钙化；5例有包膜。3例肿瘤有周围血管、胆道及肠管浸润。2例有肿大淋巴结，其中1例转移。超声及CT在显示肿瘤位置、质地及钙化方面没有差异；超声、CT测量肿瘤的最大径与肿瘤实际直径的ICC=0.90，三者之间有较好的一致性。肿瘤包膜超声显示5例，CT仅显示3例。CT显示5例钙化的形态，2例肿瘤周围肿大淋巴结，2例腹腔积液，1例门脉侧支循坏开放；超声没有提示。超声及CT均未能明确显示周围组织结构的直接浸润征象，但是均显示3例胆道系统扩张。结论PB典型表现为有包膜的胰腺实性肿块，伴有坏死囊变及钙化。超声在显示肿瘤的包膜结构时略优于CT，CT则显示肿瘤钙化、周围组织关系及淋巴结更清晰直观，且无操作者依赖性。

ObjectiveTo improve the imaging diagnostic performance by analyzing US and CT findings of pancreatoblastoma in children.MethodsFrom January 2000 to December 2016, 9 patients with pancreatoblastoma proven pathologically were enrolled in the study. The clinical and imaging features in 9 cases were analyzed retrospectively, the tumor parameters compared with intraoperative and postoperative pathology were location, size, texture, capsule, calcification, adjacent organs invasion and lymph node metastasis. The parameter of tumor size was evaluated by intraclass correlation coefficient.ResultsThe tumor diameter ranged from 30-95 mm （median diameter 40 mm）. Six tumors located in the head of the pancreas, 3 tumors located in the body and tail of the pancreas. One tumor was pure cystic, 2 tumors were solid and cystic mixed, 5 tumors were solid. Calcification was seen in 5 cases. Capsule was seen in 5 cases. Blood vessels, biliary tract and bowel around tumors were infiltrated by tumors in 3 cases proven by the pathology. Lymphadenectasis was seen in 2 cases, in which 1 case was metastasis. There were no significant differences in location, nature, calcification on US and CT. The largest diameter measured by CT and US was consistent with the tumor＇s actual size, ICC=0.90. Capsule was shown by US in 5 cases and CT in 3 cases. CT showed the morphology of calcification in 5 cases, lymphadenectasis in 2 cases, abdominal effusion in 2 cases, cavernous transformation of the portal vein with the extensive collaterals in 1 case, which were not shown by US. Both US and CT dit not show the surrounding tissue infiltrated by tumors in 3 cases, but showed biliary system expansion.ConclusionsThe typical pancreatoblastoma manifested as encapsulated solid tumor originated in the pancreas with necrosis and calcification. US examination took a slight advantage on displaying capsule of tumor than CT. CT was more clear and intuitive in showing calcification and relationship between tumor with surrounding tissues and lymph node, and no operator dependent.