儿童原发性肾上腺皮质癌的影像分析和鉴别诊断  

Imaging analysis and differential diagnosis of primary adrenocortical carcinoma in children

作　　者：郑兰 刘鸿圣 李建明 吴倩倩 ZHENG Lan;LIU Hong-sheng;Li Jian-ming(Department of Radiology,the Guangzhou Women and Children's Medical Center,Guangzhou 510120,China)

机构地区：[1]广州市妇女儿童医疗中心放射科,广州510120

出　　处：《放射学实践》2021年第12期1571-1576,共6页Radiologic Practice

摘　　要：目的:探讨儿童原发性肾上腺皮质癌的影像表现,提高影像诊断水平。方法:回顾性分析在本院经手术病理证实的15例儿童肾上腺皮质癌的影像资料。行CT检查13例,行MRI检查5例,同时行两种影像检查者3例。结果:患儿平均年龄(2.8±2.9)岁。肿瘤均为单发,位于左侧9例、右侧6例。瘤体最大径线1.6~11.0 cm,平均(5.4±2.4)cm。病灶呈类圆形12例,不规则形3例;边界清楚11例,边界模糊4例,其中肿瘤突破包膜向周围浸润生长者1例。所有肿瘤内均可见不同程度坏死,未见出血灶,瘤内出现钙化4例。增强扫描动脉期示瘤体内可见多条强化的肿瘤血管影迂曲穿行,使整个瘤体呈现网络状强化的特征;整个动态增强扫描过程中,肿瘤呈渐进性不均匀强化。3例出现转移灶,2例为肺转移,1例为右肾及肝脏多发转移。3例患者术后肿瘤复发,2例于术后1年复发,其中1例在第二次手术切除后2个月再次复发;1例于术后3年复发。结论:儿童原发性肾上腺皮质癌的影像表现具有一定的特征性,结合患儿年龄和临床表现有助于该病的诊断。Objectives:To explore the imaging manifestations of primary adreno-cortical carcinoma in children and to improve the understanding of this disease.Methods:The imaging data of 15 children with adreno-cortical carcinoma confirmed by operation and pathology in our hospital were retrospectively analyzed.CT examination was performed in 13 cases,MRI examination was performed in 5 cases,and both CT and MRI scan were performed in 3 cases.Results:The average age of the 15 children was(2.8±2.9)years old.All the tumors were single,with 9 cases on the left side and 6 cases on the right side.The maximum diameter of the tumor in this group was 1.6~11.0cm,with an average of(5.4±2.4)cm.The lesions were nearly round in 12 cases,irregular in 3 cases.The boundary was clear in 11 cases and fuzzy in 4 cases.The tumor capsule was penetrated in one case.Necrosis of different degrees was observed in all the masses,and no hemorrhage were observed.Calcification was found in 4 cases.On arterial phase of enhanced images,multiple tortuous enhanced tumor vessels could be seen running through which showed as network-line enhanced characteristics.During the whole process of dynamic contrast-enhanced scanning,the tumor presented progressive heterogeneous enhancement.Metastases were found in three cases,with lung metastasis in two cases and multiple metastasis in right kidney and liver in one case.In this group,The tumor recurred after surgery in 3 cases,of which 2 cases recurred one year and 3 years after surgery,respectively;the other case recurred one year after surgery,and recurred again 2 months after the second surgical resection.Conclusion:The imaging fin-dings of primary adreno-cortical carcinoma in children show certain characteristics,and the combination of age and clinical features is helpful for the diagnosis of this disease.

关 键 词：肾上腺皮质癌 儿童 体层摄影术 X线计算机 磁共振成像 

分 类 号：R814.42[医药卫生—影像医学与核医学] R445.2[医药卫生—放射医学]