儿童肾上腺神经母细胞瘤CT征象与Ki-67表达的相关性研究

Correlation between CT signs and Ki-67 expression in children with adrenal neuroblastoma

目的:探讨儿童肾上腺神经母细胞瘤(ANB)的CT表现与Ki-67表达的相关性。方法:回顾性搜集2019年10月至2021年10月经手术病理证实的36例ANB患儿,术前均行腹部CT平扫及增强扫描。根据Ki-67增殖指数将ANB分为高表达组(Ki-67指数≥25%,26例)和低表达组(Ki-67指数<25%,10例)。分析肿瘤最大径、形态、瘤内出血、坏死、钙化、血管包绕、周围淋巴结转移、肾脏侵犯及远处转移情况等肿瘤CT征象,并测量肿瘤实性部分的平扫及增强CT值。采用Fisher确切概率法比较高表达组与低表达组患儿性别、病灶形态特征的差异,采用两独立样本t检验或Mann-Whitney U检验比较两组间患儿年龄、肿瘤最大径、病灶平扫CT值、增强CT值的差异;采用ROC曲线分析相关参数诊断Ki-67高表达ANB的效能。结果:高表达组与低表达组的出血、形态、中线血管包绕、肿瘤最大径及增强CT值差异有统计学意义(P均<0.05)。ROC曲线分析结果显示,增强CT值诊断Ki-67高表达ANB的临界值为81.5 HU,肿瘤最大径的临界值为9.60 cm,中线血管包绕、增强CT值、出血、肿瘤最大径、形态及参数总联合诊断Ki-67高表达ANB的曲线下面积分别为0.796、 0.769、 0.715、0.752、0.758和0.915,参数总联合的诊断敏感度为96.2%,特异度为90.0%。结论:当肿块形态不规则、肿瘤最大径超过9.6 cm、增强CT值超过81.5 HU、肿块内出血且伴有中线血管包绕征象时,高度提示为Ki-67高表达ANB。

Objective:To investigate the correlation between the CT findings and Ki-67 expression in children with adrenal neuroblastoma(ANB).Methods:A total of 36 children with ANB confirmed by surgery and pathology from October 2019 to October 2021 were retrospectively collected.Plain and enhanced abdominal CT scans were performed before surgery.According to the Ki-67 proliferation index,the ANB was divided into a high-expression group(Ki-67 index≥25%,26 cases)and a low-expression group(Ki-67 index<25%,10 cases).CT signs of the tumor were analyzed,including maximum diameter,shape,intratumoral bleeding,necrosis,calcification,vascular abutment,peripheral lymph node metastasis,renal invasion,and distant metastasis.Fisher's exact probability method was used to compare the differences in gender,and lesion morphology between the high-and the low-expression groups.Two independent samples t-test or Mann-Whitney U test were used to compare the differences in age,maximum diameter,and CT values on non-enhanced and enhanced images between the two groups.The ROC curve was used to evaluate the efficacy of relevant parameters in diagnosing ANB with Ki-67 high-expression.Results:There were significant differences in bleeding,morphology,midline vascular abutment,maximum diameter,and enhanced CT value between the high-expression group and the low-expression group(all P<0.05).The results of the ROC curve analysis showed that the cutoff value of enhanced CT value and maximum diameter for diagnosing ANB with Ki-67 high-expression were 81.5HU and 9.60cm,respectively.The area under the curve for diagnosis of Ki-67 high-expression ANB by using midline vascular abutment,enhanced CT value,bleeding,maximum diameter,morphology,and combination of the above mentioned were 0.796,0.769,0.715,0.752,0.758,and 0.915,respectively.The sensitivity and specificity of the combined parameters were 96.2%and 90.0%,respectively.Conclusions:When the shape of the tumor is irregular,the maximum diameter of the tumor exceeds 9.6cm,the enhanced CT value exceeds 81.5HU,and there is bleeding within the tumor accompanied by midline vascular abutment,it is highly suggestive of ANB with Ki-67 high-expression.