基于儿童肝母细胞瘤PRETEXT分期的不同扫描期相的CT征象比较  

Comparison study of CT findings at different phases among pediatric hepatoblastoma patients based on PRETEXT system

作　　者：白凤森[1] 闫淯淳 袁新宇[1] 郭宏伟[1] 

机构地区：[1]首都儿科研究所附属儿童医院放射科,北京100020

出　　处：《中华放射学杂志》2017年第5期386-390,共5页Chinese Journal of Radiology

摘　　要：目的 基于儿童肝母细胞瘤PRETEXT分期系统比较不同期相肿瘤重要的CT征象,探讨优化儿童肝母细胞瘤CT扫描方案的可能性.方法 2014年6月至2015年12月回顾性总结我院58例经手术及病理确诊肝母细胞瘤患儿的手术前CT图像,观察肿瘤累及范围、肿瘤肝外腹部侵袭、腹腔内出血、肝内转移或多发、淋巴结转移、远处转移（腹腔内除淋巴结）、门静脉脉主干受累、3支肝静脉和（或）下腔静脉受累,肿瘤旁肝动脉主干、分支及穿行动脉等CT征象.以手术所见及病理为标准,比较CT平扫期、动脉期和静脉期各征象与术中及病理的符合度.不同期相间影像征象差异比较采用Fisher精确检验及R×C表χ2检验.结果 与手术及病理对照,肿瘤累及范围符合率分别为平扫期40例（68.9%）,动脉期43例（74.1%）,静脉期52例（91.2%）,静脉期扫描更适合观察肿瘤累及范围（χ2=8.16,P=0.018）;门静脉主干、三支肝静脉或下腔静脉受累,在平扫及动脉期均未见显示,静脉期见12例（20.7%,P〈0.001）;肿瘤旁肝动脉主干、分支及肿瘤穿行动脉,平扫期未见显示,动脉期显示46例（79.3%）,静脉期17例（29.3%）,动脉期更适合观察（P〈0.001）;3期扫描在肝内转移或多发、淋巴结转移、远处转移的差异无统计学意义.结论 拟诊肝母细胞瘤患儿,术前CT扫描动脉和静脉两期可以满足临床需求,无需平扫.术后复查静脉一期扫描即可,静脉期有助于评价肿瘤累及范围与高危影像预后因素.Objective To compare the CT findings of different phases in pediatric hepatoblastoma （HB） based on PRETEXT system in order to optimize pediatric HB CT scan protocol. Methods A total of 58 HB patients who were surgical and pathological diagnosed from January 2015 to December 2016 were analyzed. Pre-operation CT exams were analyzed respectively. Observing items included tumor size, intra-abdominal invasion, bleeding, intrahepatic metastasis, lymphatic metastasis, metastasis （except lymphatic in abdomen） main portal vein, three main hepatic vein, inferior vena cava （IVC） invasion, paratumor hepatic arteries, and its branches. All image findings were compared to pathological and surgical findings to calculate the agreement rate. Exact Fisher test and R×C χ2 test were used. Results According to the surgery and pathological results, the agreement rate of tumor size was n=40 （68.9%） at non-contrast phase, n=43 （74.1%） at artery phase and n=52 （91.2%） at venous phase. Venous phase was adaptive for observing tumor size （χ2=8.16,P=0.018）. For main portal vein, three main hepatic vein, and IVC invasion, none was found at both non-contrast and artery phase. N=12 （20.7%, P〈0.001） was found at venous phase. For para-tumor hepatic arteries, and its branches, none was found at non-contrast phase. N=46 （79.3%） was found at artery phase. N=17 （29.3%） was found at venous phase. Artery phase was adaptive for observing （P〈0.001）. There was no statistical significant difference in intrahepatic metastasis, lymphatic metastasis and metastasis. Conclusions Suspected pediatric HB, artery and venous phase CT scan would meet the clinical requirement, there was no need for non-contrast pahse. Follow up cases, a single venous phase was enough. Venous phase contributed much more information on tumor size and high risk prognosis evaluation.

关 键 词：儿童 肝肿瘤 体层摄影术 X线计算机 辐射剂量 

分 类 号：R730.44[医药卫生—肿瘤] R735.7[医药卫生—临床医学]