多层螺旋CT对儿童前纵隔原发性肿瘤的诊断价值

Diagnostic value of multislice spiral CT in primary tumor of anterior mediastinum in children

目的探讨多层螺旋CT(MSCT)对儿童前纵隔原发性肿瘤的诊断价值。方法选取我院42例前纵隔原发性肿瘤患儿,均行MSCT平扫及增强扫描,分析影像学表现及诊断准确率。结果经穿刺活检或手术病理证实,本组42例包括淋巴瘤30例,畸胎瘤6例,卵黄囊瘤3例,混合性生殖细胞瘤1例,侵袭性胸腺瘤1例,胸腺脂肪瘤1例。淋巴瘤呈多结节融合状,沿血管间隙向周围浸润性生长,增强后强化均匀或不均匀,其中10例瘤体内部伴囊变坏死。畸胎瘤内部可见骨骼、软组织及脂肪成分。卵黄囊瘤密度不均匀,压迫周围血管,增强后内部可见增粗迂曲血管影。混合性生殖细胞瘤形态不规则,伴液化坏死,增强后强化不均匀。侵袭性胸腺瘤密度不均匀,偏向纵隔一侧压迫血管生长,同侧胸膜增厚并胸腔积液。胸腺脂肪瘤内部可见大量脂肪密度及条片状软组织密度影,沿血管间隙生长,边界清晰。术前MSCT诊断准确率92.86%(39/42)。结论儿童前纵隔原发性肿瘤的影像表现具有一定特点,MSCT可做出准确诊断,为临床诊疗提供可靠依据。

Objective To analyze the diagnostic value of multislice spiral CT(MSCT)in primary tumors of the anterior mediastinum in children.Methods A total of 42 children with primary tumor of the anterior mediastinum in our hospital were selected as the research subjects.All the children received MSCT plain and contrast-enhanced scanning,and the imaging findings and diagnostic accuracy were analyzed.Results The 42 cases were confirmed by puncture biopsy or surgical pathology,including 30 cases of lymphoma,6 cases of teratoma,3 cases of yolk sac tumor,1 case of mixed germ cell tumor,1 case of invasive thymoma,and 1 case of thymoma.The lymphoma presented a multi-nodular fusion with perivascular infiltrative growth and uniform or uneven enhancement after enhancement.In 10 cases,the tumor was accompanied by cystic necrosis.There were bone,soft tissue and fat components in the teratoma.Yolk sac tumor density was not uniform,compression of peripheral blood vessels.After enhancement,the internal thickened tortuous shadow can be seen.Mixed germ cell tumor had irregular shape,with liquefaction necrosis,and uneven enhancement after enhancement.This invasive thymoma had uneven density,mediastinal compression of vascular growth,ipsilateral pleural thickening and pleural effusion.There were a large amount of fat density and lamellar soft tissue density shadow in the thymic lipoma,which grew along the vascular space and had clear boundaries.The preoperative diagnostic accuracy of MSCT was 92.86%(39/42).Conclusion The imaging manifestations of primary tumor of the anterior mediastinum in children have certain characteristics.MSCT can make accurate diagnosis and provide reliable basis for clinical diagnosis and treatment.