增强CT鉴别腹膜后副节瘤和神经鞘瘤  

CT differentiation of retroperitoneal paragangliomas and schwannomas

作　　者：曹云太 鲍海华[1] CAO Yun-tai;BAO Hai-hua(Department of Medical Imaging,Qinghai University Affiliated Hospital,Qinghai 810001,China)

机构地区：[1]青海大学附属医院医学影像中心,青海西宁810001

出　　处：《影像诊断与介入放射学》2022年第3期182-187,共6页Diagnostic Imaging & Interventional Radiology

基　　金：青海大学附属医院中青年科研基金一般项目(ASRF-2017-YB-13);青海省“昆仑英才·高端创新创业人才”培养拔尖人才项目。

摘　　要：目的探讨多期增强CT影像学对腹膜后副节瘤和神经鞘瘤的鉴别价值。方法回顾性分析2013年~2019年病理确诊的32例腹膜后副节瘤和24例神经鞘瘤的临床和影像学资料。用独立样本t检验或秩和检验比较腹膜后副节瘤和神经鞘瘤之间的计量资料(年龄、肿瘤最大直径、肿瘤CT值);用χ^(2)检验或F检验比较两种肿瘤间的计数资料(性别、临床症状、肿瘤位置、形状、边界、出血、钙化、瘤周血管、分隔、囊变或坏死、增强形式)。结果腹膜后副节瘤和神经鞘瘤的临床特征无显著差异,而两种肿瘤的影像特征存在一些差异:(1)腹膜后副节瘤好发于椎前区域(26例,81.2%),神经鞘瘤则好发于椎旁区域(13例,54.2%);(2)腹膜后嗜铬细胞“瘤周迂曲血管征”较神经鞘瘤常见(71.9%比4.2%,P<0.001);(3)腹膜后副节瘤“瘤内分隔征”的发生率少于神经鞘瘤(15.6%比50.0%,P=0.01);(4)增强后副节瘤在动态增强上呈现快进快出的影像表现(20例,62.5%),而大部分神经鞘瘤表现为渐进性强化模式(18例,75.0%);(5)副节瘤动脉期及静脉期的强化幅度明显高于神经鞘瘤(动脉期58.0±15.9比14.7±6.8,P<0.001;静脉期38.6±12.0比24.4±9.4,P<0.001)。结论术前CT三期动态增强扫描可为鉴别副节瘤和神经鞘瘤提供重要的信息。Objective To investigate the value of multi-phase enhanced CT for differentiating retroperitoneal paragangliomas and schwannomas.Methods The clinical records and CT of 56 patients with pathologically confirmed retroperitoneal paragangliomas(32)and schwannomas(24)in our institution between 2013 and 2019 were retrospectively analyzed.The student’s t-test or Mann-Whitney U test was used to compare the patient age,maximum tumor diameters,and tumor CT values of paragangliomas and schwannomas.Chi-square test and Fisher’s exact test were used to compare patient gender,symptoms,tumor location,shape,boundary,peritumor tortuous vessels,tumor hemorrhage,calcification,septum,cyst/necrosis,and contrast enhancement.Results There were no significant differences in clinical features between paragangliomas and schwannomas(all P>0.05).Some CT features could aid differential diagnosis.Retroperitoneal paragangliomas were more common in the prevertebral region and schwannomas in the paravertebral region.Peritumor tortuous vessels were significantly more common(P<0.001)in paragangliomas(71.9%)than schwannomas(4.2%).Septum was significantly more common(P=0.01)in schwannomas(50.0%)than paragangliomas(15.6%).Paragangliomas(62.5%)had more marked rapid enhancement and washout than schwannomas(75%)with lesser and progressive enhancement.The enhancement amplitude of paragangliomas in arterial and venous phases was significantly higher than that of schwannomas(P<0.001).Conclusion Multiphase dynamic contrast-enhanced CT examination can provide some valuable information for the differentiation of paragangliomas and schwannomas.

关 键 词：腹膜后 嗜铬细胞瘤 神经鞘瘤 体层摄影术 X线计算机 

分 类 号：R735.4[医药卫生—肿瘤] R814.42[医药卫生—临床医学]