超声及CT在婴幼儿内寄生胎诊断中的应用

Application of Ultrasound and CT in the Diagnosis of Fetus in Fetu in Infants

目的探讨婴幼儿内寄生胎的超声及CT特点。资料与方法回顾性分析2015年1月—2021年9月在广州市妇女儿童医疗中心经病理证实的8例婴幼儿内寄生胎,患儿均行超声、CT平扫+增强扫描,分析其临床、超声和CT特征。结果7例位于腹腔内(2例位于右侧肾上腺区、1例位于左侧肾上腺区、1例邻近肝门部、1例位于右下腹精索走行区、1例与左侧输卵管相连、1例与肠系膜根部相连),1例位于阴囊内,肿块最小径1.7 cm×2.1 cm×4.2 cm,最大径13.1 cm×11.2 cm×13.2 cm。超声表现:8例肿块均与周围组织分界清,6例为囊实性,2例为实性;3例探及长骨回声,1例探及类圆形骨回声,7例探及脂肪回声,3例探及肢体样组织回声,2例探及脐带样血管蒂回声。CT表现:8例肿块均有包膜,并含有混杂密度成分。7例含长骨状骨骼密度,2例含类圆形骨骼密度,4例含椎骨状骨骼密度,8例均含软组织密度,7例含脂肪密度,6例含液体密度。5例肿块可见供血的血管。病理检查:8例均可见骨组织,7例有椎骨组织,6例有长骨组织,7例有皮肤组织,4例有肠道上皮,2例有呼吸道上皮,6例有肌肉组织,5例有神经胶质组织,2例有脐带样血管蒂。5例术前超声诊断为内寄生胎,7例术前CT诊断为内寄生胎,与术后病理诊断符合率分别为62.5%和87.5%。结论婴幼儿内寄生胎大多数位于腹膜后,肿块内常含有骨骼和软组织成分,CT能更好地检出肿块的骨骼成分和供血的血管来源,超声能显示其肢体样软组织,具有一定特异性,两者结合对婴幼儿内寄生胎的诊断和临床治疗具有指导意义。

Purpose To explore the characteristics of ultrasound and CT images of fetus in fetu(FIF)in infants.Materials and Methods A total of eight FIF cases confirmed by pathology in Guangzhou Women and Children's Medical Center from January 2015 to September 2021 were retrospectively enrolled.All 8 cases underwent ultrasound,CT plain and enhanced scan.The data of ultrasound and CT images were analyzed and reviewed via relevant literature.Results A total of 7 cases were located in the abdominal cavity,including 2 cases located in the right adrenal area,1 case located in the left adrenal area,and 1 case closed to the hilar,1 case located in the spermatic cord area of the right lower abdomen,1 case connected to the left fallopian tube,1 case connected to the root of the mesentery.One case was located in the scrotum,with diameter ranged from the minimum of 1.7 cm×2.1 cm×4.2 cm to maximum of 13.1 cm×11.2 cm×13.2 cm.There were 8 cases with clear boundary,6 cases with heterogeneous lesion,2 cases with solid lesion,3 cases with long bone echo,1 case with round-shaped bone echo,7 cases with fat echo,3 cases with limb echo,and 2 cases with umbilical-like vessels on ultrasound images.There were 8 cases with mixed density and encapsulated clear boundary,7 cases with long bone density,2 cases with round-shaped bone density,4 cases with vertebra density,8 cases with soft issue density,7 cases with fat density,6 cases with liquid density,and 5 cases with feeding artery on CT images.Pathological specimen showed that all cases had bone tissue,7 had spinal vertebrae,6 had long bones,7 had skin tissue,4 had intestinal epithelium,2 had respiratory epithelium,6 had muscle tissue,5 had neuroglial tissue,and 2 had vascular pedicle tissue.Of 8 children,there were 5 cases diagnosed as FIF via ultrasound sonography,and 7 cases diagnosed as FIF via CT.The coincidence rates with postoperative pathological results were 62.5%and 87.5%,respectively.Conclusion Most of the FIF in infants and young children are located behind the peritoneum,and the tumor often contains bone and soft tissue components.CT can better detect the bone components and blood supply sources of the tumor,and ultrasound can display its specific limb like soft tissue.Combining ultrasound and CT imaging are of great value in the diagnosis and clinical treatment of FIF in infants and young children.