儿童髓系肉瘤的CT和MRI影像学表现分析  

Analysis of CT and MRI imaging findings of myeloid sarcoma in children

作　　者：张宏[1] 于彤[1] 王岩[1] 尹光恒[1] 吕艳秋[1] 姚兴凤[2] 于皎乐[3] 彭芸[1] 段晓岷[1] ZHANG Hong;YU Tong;WANG Yan;YIN Guangheng;LV Yanqiu;YAO Xingfeng;YU Jiaole;PENG Yun;DUAN Xiaomin(Department of Radiology,Beijing Children′s Hospital,Capital Medical University,National Center for Children′s Health,Beijing100045,China;Department of Pathology,Beijing Children′s Hospital,Capital Medical University,National Center for Children′s Health,Beijing100045,China;Department of Hematology,Beijing Children′s Hospital,Capital Medical University,National Center for Children′s Health,Beijing100045,China)

机构地区：[1]首都医科大学附属北京儿童医院,国家儿童医学中心,影像中心,北京100045 [2]首都医科大学附属北京儿童医院,国家儿童医学中心,病理科,北京100045 [3]首都医科大学附属北京儿童医院,国家儿童医学中心,血液一科,北京100045

出　　处：《中国小儿血液与肿瘤杂志》2022年第6期383-389,共7页Journal of China Pediatric Blood and Cancer

基　　金：国家自然科学基金(12171330);科技创新2030-“脑科学与类脑研究”重大专项(2021ZD0200508);北京市医院管理中心“登峰”计划专项经费资助(DFL20221002);北京市医院管理局儿科学科协同发展中心“儿科专项”(XTCX201814)。

摘　　要：目的分析儿童髓系肉瘤(MS)的临床与影像学特征,提高对该病的早期识别及诊断能力。方法回顾性分析27例儿童MS患儿的临床及影像学资料,27例行CT检查,其中21例同时行MRI检查,分析其CT及MRI特征。结果27例患儿中,男性20例(74%),女性7例(26%),中位年龄3.5(0.6~10.8)岁。23例为MS合并AML,4例为孤立性MS。儿童MS病灶以多发为主,多见于眼眶,还可见于胸膜、前中颅窝底、颅板下、皮下结节和脊柱旁等部位,肿块为实性,呈梭形或不规则形,瘤体大小不等。在CT上,病灶与肌肉组织相比呈等密度,与邻近的脑组织相比,呈稍高密度,无钙化;在MRI上,肿块在T1W1呈等信号,在T2WI以高或等信号为主,伴弥散受限。病灶可以对邻近的肌肉和骨骼组织侵犯和破坏,还可以侵犯椎间孔及椎管,压迫脊髓,同时还常伴有淋巴结肿大、脾大及肝大。结论在影像学提示儿童存在实性强化肿块且边界不清、具有一定的侵袭性时应该考虑MS的可能,儿童MS的临床和影像学表现具有一定的特征性,根据这些临床和影像学特征应建议临床围绕MS展开检查,便于早期诊断。Objective To demonstrate the clinical and imaging features of myeloid sarcoma(MS)in children and to improve the ability of early identification and diagnosis of the disease.Methods Clinical and imaging data of 27children with MS were retrospectively analyzed.The CT and MRI examinations were performed in 27 and 21 cases,respectively.The features of CT and MRI of MS in children were analyzed.Results Among the 27 children,there were 20 males(74%)and 7 females(26%).The age varied from 0.6 to 10.8years old with a median age of 3.5 years old.23 cases were MS complicated with AML,4 cases were isolated MS.The lesions of MS in children were mainly multiple,mostly located in the orbit,and could also be seen in the pleura,the base of the anterior and middle cranial fossa,subcranial,subcutaneous nodule and paraspinal.The lesions were solid,fusiform or irregular,and the size of the lesions varies.On CT,the lesions showed equal density compared with muscle tissue and slightly higher density compared with adjacent brain tissue,and no calcification.On MRI,the lesions showed iso-signal on T1W1,and high or equal signal on T2WI,with limited diffusion.The lesions could invade and destroy the adjacent muscle and bone tissue,or invade the intervertebral foramen and spinal canal,and oppress the spinal cord.At the same time,it is often accompanied by lymph node enlargement,splenomegaly and hepatomegaly.Conclusions Any solid enhanced mass in children with hematological diseases should consider MS.The clinical and imaging manifestations of MS in children have certain characteristics.According to these clinical and imaging features,MS should be highly suspected even if there is no hematological disease.It is suggested that clinical examination should be carried out around MS to facilitate early diagnosis.

关 键 词：髓系肉瘤 儿童 计算机体层成像 磁共振成像 

分 类 号：R733.71[医药卫生—肿瘤]