CT在儿童肾母细胞瘤临床分期的价值

The Value of CT in Clinical Staging of Children's Nephroblastoma

目的 探讨CT在儿童肾母细胞瘤临床分期的意义。方法 回顾性审阅39例经手术病理证实的肾母细胞瘤的CT影像资料,记录肿瘤最大径,辨别包膜完整性、坏死囊变、出血、钙化、中等度强化、残肾征及蟹足征等CT征象,比较临床分期中早期组与中晚期组肾母细胞瘤的CT表现,评价CT分期与临床分期的一致性。结果 1.39例患儿肾区可见较大、不均质软组织肿块,肿瘤边界清楚,肿块可见包膜,增强扫描肿瘤表现为中等度强化(28/39),残余肾明显强化,形成“残肾”征和“抱球”征(38/39),内部囊变坏死区不强化(35/39)。2.在早期组与中晚期组中仅肿瘤包膜的完整性具有统计学差异(P=0.023),对于CT分期有一定意义。3.CT分期与临床分期具有较高的一致性(Kappa值=0.676)。结论 肾母细胞瘤具有较为特征性的CT表现,CT分期与肾母细胞瘤的临床分期具有较高的一致性,我们应注重观察假包膜的完整性,邻近脏器有无侵犯,腹膜后淋巴结、肝肺等远处转移,以便肾母细胞瘤的准确评估。

Objective To investigate the significance of CT in clinical staging of children’s nephroblastoma.Methods The CT findings of 39 patients with surgically and pathologically confirmed nephroblastoma were retrospectively reviewed.The largest diameter of the tumors was recorded and the CT signs of capsule integrity,necrotic cyst,hemorrhage,calcification,moderate enhancement,residual kidney sign and crab foot sign were distinguished.The CT findings of nephroblastoma in the early and middle-late stages of clinical staging were compared,and the consistency between CT staging and clinical staging were evaluated.Results 1.Large and heterogeneous soft tissue masses with clear boundary and capsule could be seen in the kidney of 39children.On enhanced scan,all tumors showed moderate enhancement(28/39),residual kidney showed obvious enhancement,forming"residual kidney sign"and"holding ball sign"(38/39),and internal cystic necrosis area showed no enhancement(35/39).2.There was a statistical difference in the integrity of tumor capsule between the early group and the middle-late group(P=0.023),which was significant for CT staging.3.The consistency between CT staging and clinical staging was high(Kappa value=0.676).Conclusion The CT staging of the nephroblastoma`s tumor is consistent with the clinical staging of the nephroblastoma`s tumor.We should pay more attention to observe the integrity of the false capsule and the presence of adjacent organs,retroperitoneal lymph nodes,liver and lungs,and so on,for accurate assessment of nephroblastoma`s tumor.