原发性骶尾部脊索瘤的CT分型及征象  

The Classification and Features of Primary Sacrococcygeal Chordoma Based on CT Imaging

作　　者：陈芳妮 王玮[1] 刘士远[1] 王晨光[1] 范丽[1] 萧毅[1] 赵洪波 CHEN Fangni;WANG Wei;LIU Shiyuan(Department of Radiology and Nuclear Medicine,Changzheng Hospital,Second Military Medical University,Shanghai 200003,P.R.China)

机构地区：[1]第二军医大学长征医院影像医学与核医学科,上海200003

出　　处：《临床放射学杂志》2020年第1期132-137,共6页Journal of Clinical Radiology

摘　　要：目的对治疗前原发性骶尾部脊索瘤(PSC)CT图像分型,并分析其CT征象,为诊断和个性化治疗提供依据。方法回顾性分析101例PSC患者治疗前的CT图像,包括肿瘤的部位、范围、大小、密度、肿瘤与邻近结构的关系。按照肿瘤的部位由上及下分为Ⅰ~Ⅳ型,并根据肿瘤侵犯的范围从小到大分为a^d亚型。采用Kruskal-Wallis H检验比较PSC各亚型的占比,并对各亚型之间进行两两比较。采用R×C列联表精确概率检验比较分型和亚型肿瘤钙化的发生率。采用单因素方差分析及LSD-t检验对各分型和亚型肿瘤的大小和密度进行分析、比较。结果101例PSC中,Ⅰ~Ⅳ型的发生率分别为17.8%、30.7%、36.6%、14.9%,a^d亚型的占比分别为9.9%、25.7%、58.4%、5.9%。各亚型的占比差异具有统计学意义(P=0.012)。c亚型明显高于a亚型(P=0.039),d亚型明显低于a亚型(P=0.036),其余各型之间无明显差异。各分型肿瘤内钙化的差异无统计学意义(P=0.233);各亚型肿瘤内钙化的差异有统计学意义(P=0.003),a^d亚型肿瘤钙化的比率逐渐增加。Ⅰ型肿瘤的左右径及上下径明显大于Ⅱ~Ⅳ型(P<0.05)。a亚型与b亚型肿瘤之间前后径的差异无统计学意义(P=0.102),b^d亚型之间前后径的差异均有统计学意义(P<0.05);不同亚型肿瘤之间的左右径、上下径之间的差异均有统计学意义(P<0.05),a亚型径线最小,d亚型径线最大。结论101例PSC中,Ⅱ、Ⅲ型最多见,肿瘤较少累及第一骶骨;各亚型中,a型较少见,c亚型最多见,d亚型最少见。肿瘤的密度与分型无关,肿瘤内钙化与亚型有关。Ⅰ型肿瘤侵犯的范围较Ⅱ~Ⅳ型广泛,a^d亚型肿瘤的径线逐渐增大,CT分型有利于判断肿瘤的范围。PSC诊断延迟现象比较明显,但很少发生远处侵犯和转移。CT图像可对治疗前PSC分型,为诊断和个性化治疗提供依据。Objective To develop a CT imaging classification system and analyze CT imaging features for pretreatment primary sacrococcygeal chordoma(PSC),provide evidences for its diagnosis and individualized treatment.Methods Pretreatment CT imaging of 101 patients with a histopathological diagnosis of PSC were analyzed retrospectively,including tumor location,extent,size,intensity,involvement of adjacent structure.According to the location of the tumor,it is divided into typeⅠ~Ⅳfrom top to bottom,and according to the range of tumor invasion,it is divided into subtypes a^d.The Kruskal-Wallis H test was used to compare the proportion of PSC subtypes,and the pairwise comparisons were performed among the subtypes.The R×C contingency table exact probability test was used to compare the incidence of calcification in the subtype and subtype tumors.One-way analysis of variance and LSD-t test were used to analyze and compare the size and density of tumors of different types and subtypes.Results In 101 cases,the ratios of typeⅠ-Ⅳwere 17.8%,30.7%,36.6%and 14.9%respectively;the ratios of subtype a-d were 9.9%,25.7%,58.4%and 5.9%respectively.Differences of ratio among subtypes had statistical significance(P=0.012).The proportion of subtype c was higher than subtype a(P=0.039),while the proportion of subtype d was lower than subtype a(P=0.036).There were no significant differences among the other subtypes.For the occurrence rates of tumor calcification,there were no significant differences among different types(P=0.233),but not among subtypes(P=0.003).The occurrence rates of tumor calcification were increasing from subtype a to d.The transverse dimensions and vertical dimensions of typeⅠwere larger than typeⅡtoⅣ(P<0.05).For the anteroposterior dimensions,there were significant differences from subtype b to d(P<0.05),but not between subtype a and b(P=0.102).The transverse and vertical dimensions had significant different among different subtypes(P<0.05);the dimensions were increasing from subtype a to subtype d.Conclusion

关 键 词：原发性 骶尾部 脊索瘤 体层摄影术 X线计算机 分型 亚型 

分 类 号：R730.44[医药卫生—肿瘤] R739.93[医药卫生—临床医学]