不同病理分型肝母细胞瘤的多层螺旋CT征象与鉴别  

Multi-slice spiral computed tomography features and differential diagnosis of different pathological subtypes of hepatoblastoma

作　　者：刘雨晴 向永华[2] 李理 马秋红[2] 金科[2] Liu Yuqing;Xiang Yonghua;Li Li;Ma Qiuhong;Jin Ke(College of Pediatrics,Nanhua University,Changsha,Hunan 410007,China;Department of Radiology,Hunan Children's Hospital,Changsha 410007,China)

机构地区：[1]南华大学儿科学院,长沙410007 [2]湖南省儿童医院放射科,长沙410007

出　　处：《临床小儿外科杂志》2022年第5期452-457,共6页Journal of Clinical Pediatric Surgery

基　　金：湖南省科技厅临床医疗技术创新引导计划项目(S2020SFYLJS0680)。

摘　　要：目的探讨不同病理分型肝母细胞瘤(hepatoblastoma,HB)的多层螺旋CT(multi-slice spiral computed tomography,MSCT)表现。方法回顾性分析湖南省儿童医院2015年10月至2021年5月经手术或穿刺病理活检证实的71例HB患儿影像学及临床资料,根据病理结果分为胎儿型HB(胎儿型组,共16例)、胚胎型HB(胚胎型组,共34例)、混合性上皮间叶型HB(混合性上皮间叶型组,共21例)。从肿瘤边缘是否规则,是否外生,PRETEXT分期,多发结节融合,有无瘤内出血、坏死或囊变、钙化,肿瘤假包膜是否光滑连续,有无包膜回缩征、包膜下积液、多发纤维分隔、高危影像特征等方面观察CT图像,并测量肿瘤大小、各期实性成分CT值。采用χ^(2)检验或Fisher精确概率法分析三组患儿性别、年龄、甲胎蛋白及病灶形态特征的差异,采用单因素方差分析对比三组肿瘤直径及各期扫描CT值的差异。结果不同病理类型HB在肿瘤最大径,病灶边缘规则,瘤内多发结节融合、出血、坏死或囊变、钙化,包膜回缩征,多发纤维分隔上的阳性率差异均有统计学意义(P<0.05)。胎儿型主要表现为肿瘤直径较小,边缘较规则,瘤内密度更均匀;胚胎型多呈多灶型结节改变,坏死及囊变较多见;混合性上皮间叶型主要表现为瘤内出血及钙化率高,延迟期多发纤维分隔、包膜回缩征阳性率高。胚胎型的病灶门脉期绝对强化程度小于胎儿型、混合性上皮间叶型(P<0.05)。结论不同病理分型HB患儿的CT征象存在一定差异,且各有特点,CT表现可在一定程度上鉴别HB的病理亚型。Objective To explore the multi-slice spiral computed tomography(MSCT) features and differential diagnosis of different pathological subtypes of hepatoblastoma(HB). Methods Imaging and clinical data were retrospectively reviewed for 71 HB children confirmed by surgery or puncture biopsy.According to the pathological results, they were divided into fetal, embryonal and mixed epithelial & mesenchymal types.CT images were observed from whether tumor margin was regular, exogenous, PRETEXT staging, multiple nodule fusion, intratumoral hemorrhage, necrosis or cyst, calcification, neoplastic envelope was smooth and continuous, whether capsule retraction, subcapsule effusion, multiple fiber separation and high-risk image characteristics.Tumor size and CT value of solid components of each phase were measured.Chi-square or Fisher’s exact test was utilized for comparing differences in gender, age, alpha-fetoprotein(AFP) and focal morphological characteristics.Independent sample analysis of variance was employed for comparing differences in tumor size and CT values among three groups. Results Statistically significant differences existed in tumor maximum diameter, regular margins, multiple nodules, hemorrhage, necrosis or cystic degeneration, calcification, multiple fibrous separation and capsule retraction among different pathological subtypes(P<0.05).Fetal type had the CT features of small tumor diameter, regular margin and more uniform intratumoral density;embryonal type features more multifocal nodules, necrosis or cystic degeneration;mixed epithelial and mesenchymal type was associated with a high rate of intratumoral hemorrhage and calcification and a high incidence of delayed multiple fibrous separation and capsule retraction.During portal phase, absolute embryonal enhancement was less than that of fetal or mixed epithelial & mesenchymal type(P<0.05). Conclusion Different pathological subtypes of HB have different CT signs with their own characteristics.And CT imaging can distinguish the pathological subtypes of HB t

关 键 词：肝母细胞瘤/诊断 肝母细胞瘤/分类 体层摄影技术 X线计算机 

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