儿童幕下原发脑肿瘤实性部分平扫CT值对肿瘤分级的价值  

Value of non-contrast computed tomography attenuation of the solid tumor region in differentiating WHO grades of primary infratentorial tumors in children

作　　者：段宏璐 孙梦雅 王欣怡 陈苑 周旭辉[1] DUAN Honglu;SUN Mengya;WANG Xinyi;CHEN Yuan;ZHOU Xuhui(Department of Radiology,The Eighth Affiliated Hospital,Sun Yat-Sen University,Guangdong 518033,China)

机构地区：[1]中山大学附属第八医院放射科,广东深圳518033 [2]中山大学第六附属医院放射科,广东广州510655 [3]中山大学第一附属医院放射科,广东广州510080

出　　处：《影像诊断与介入放射学》2024年第5期342-347,共6页Diagnostic Imaging & Interventional Radiology

摘　　要：目的探讨肿瘤实性成分的平扫CT值对儿童高、低级别幕下肿瘤的鉴别价值。方法回顾性纳入87例儿童原发幕下脑肿瘤,包括34例低级别脑肿瘤和53例高级别脑肿瘤。在CT平扫图像上测量肿瘤实性成分、尾状核和半卵圆中心的CT值。计算标准化CT值1(肿瘤实性成分/尾状核,CT-1)和标准化CT值2(肿瘤实性成分/半卵圆中心,CT-2)。采用受试者工作特征曲线下面积(AUC)确定各参数的诊断效能。对其中30例完成CT平扫和MRI检查(含扩散加权成像序列)的患儿(低级别8例,高级别22例),比较肿瘤实性成分表观扩散系数(ADC)值和CT参数的鉴别诊断效能。结果高级别儿童幕下脑肿瘤其肿瘤实性成分CT值[(42.94±5.75)HU比(30.88±7.53)HU]、CT-1(1.19±0.15比0.84±0.18)、CT-2(1.77±0.31比1.25±0.37)均高于低级别组,两组间具有统计学差异(P<0.001)。其中CT-1具有较高的诊断效能,当CT-1等于0.99时,鉴别高、低级别儿童幕下脑肿瘤的敏感度和特异度分别为92.5%和85.3%,AUC为0.922。在30例完成CT平扫和MRI检查的患儿中,CT参数与ADC值均可鉴别高、低级别儿童幕下脑肿瘤;且ADC值和CT参数的诊断效能无显著差异(CT-1的敏感度和特异度分别为95.5%和100%,ADC的敏感度和特异度分别为86.4%和100%,P>0.05)。结论CT参数可简便地对儿童幕下脑肿瘤进行术前分级,为诊疗提供有效诊断信息和更广泛的应用场景。Objective To assess the value of non-contrast CT attenuation of the solid tumor region in differentiating high-grade and low-grade infratentorial tumors in children.Methods 87 children with primary infratentorial brain tumors including 34 low-grade tumors and 53 high-grade tumors were included in this retrospective study.CT attenuations of the solid regions of the tumors,caudate nuclei,and centrum semiovale were measured on non-contrast CT images.Standardized CT attenuation 1(CT attenuation ratio of the solid tumor to caudate nucleus,CT-1)and standardized CT attenuation 2(CT attenuation ratio of the solid tumor to centrum semiovale,CT-2)were calculated.The area under the receiver operating characteristic curve(AUC)was used to determine the diagnostic efficacy of each parameter.The diagnostic efficacy of ADC value and CT parameters was compared in 30 children with 8 low-grade and 22 high-grade tumors,who completed non-contrast CT and MRI.Results The CT attenuation[(42.94±5.75)HU],CT-1(1.19±0.15),and CT-2(1.77±0.31)of the solid portions in high-grade tumors were significantly(P<0.001)higher than those of the low-grade tumors[(30.88±7.53)HU,0.84±0.18,1.25±0.37].CT-1 cutoff value of 0.99 had higher diagnostic efficacy with 0.922 AUC,92.5%sensitivity,and 85.3%specificity for distinguishing high-grade and low-grade tumors.In 30 children with non-contrast CT and MRI,the sensitivity and specificity of CT-1(95.5%,86.4%)and ADC(100%,100%)values for distinguishing high-grade and low-grade tumors were similar(P>0.05).Conclusion Non-contrast CT attenuation of the solid tumor region is valuable in differentiating high-grade and low-grade infratentorial tumors in children.

关 键 词：儿童 幕下脑肿瘤 CT平扫 CT值 表观扩散系数 

分 类 号：R739.41[医药卫生—肿瘤] R814.42[医药卫生—临床医学]