儿童颈部原发性神经母细胞瘤的CT、MRI影像学特征分析  

Analysis of CT and MRI imaging features of primary cervical neuroblastoma in children

作　　者：戴望春 尹训涛 吴璠 李建明 梁田 张欣 陈秋怡 刘鸿圣 Dai Wangchun;Yin Xuntao;Wu Fan;Li Jianming;Liang Tian;Zhang Xin;Chen Qiuyi;Liu Hongsheng(Department of Radiology,Guangzhou Women and Children's Medical Center,Guangzhou Medical University,Guangzhou510623,China)

机构地区：[1]广州医科大学附属妇女儿童医疗中心放射科,广州510623

出　　处：《中华解剖与临床杂志》2025年第1期17-22,共6页Chinese Journal of Anatomy and Clinics

基　　金：广州市科技计划(202201020630, 202201020627)。

摘　　要：目的探讨颈部原发性神经母细胞瘤(NB)的CT、MRI影像学特征及其诊断价值。方法横断面研究。纳入2013年6月—2023年8月广州医科大学附属妇女儿童医疗中心经病理证实的17例NB患儿的临床和影像资料,其中男8例、女9例,年龄1个月~7岁[1(0.3,3.0)岁]。15例行颈部CT平扫及增强检查,6例行颈部MR平扫及增强检查。观察患儿颈部NB的影像解剖学特征(包括肿瘤的大小、部位、外形)及影像学表现。结果17例颈部NB的肿瘤最大径为3.71~10.62(5.10±1.84)cm。16/17的肿瘤整体或主体位于椎前筋膜,1/17位于咽后间隙。10/17的肿瘤呈不规则形,5/17呈椭圆形,2/17呈类圆形;11/17肿瘤无包膜,6/17包膜不完整、大多边界不清晰;肿瘤合并坏死14例;17例肿瘤同侧颈动脉均受推压移位改变,其中肿瘤包绕同侧颈动脉、锁骨下动脉和/或椎动脉8例;15例患儿气道不同程度受压移位、变窄。CT表现:15例平扫示肿瘤密度低于颈部肌肉密度,8例伴散在多发斑点状边缘模糊钙化;CT增强后均呈轻度至明显强化。MRI表现:3例肿瘤在T1WI上表现为中央及外周低信号、中间带为高信号。结论颈部原发性NB主要位于椎前筋膜,CT、MRI影像表现为肿瘤推压和/或包绕颈部血管,容易钙化、坏死、出血,MR T1WI序列出现"三环征"具有一定特征性。结合颈部精确解剖划分有助于提高颈部NB的诊断。Objective:This study aimed to evaluate the imaging anatomical features and diagnostic value of primary cervical neuroblastoma(NB).Methods:This was a cross-sectional study.The clinical imaging findings and pathologic features of 17 patients with primary cervical NB admitted in Guangzhou Women and Children's Medical Center,Guangzhou Medical University from June 2013 to August 2023 were retrospectively analyzed.The patients consisted of 8 males and 9 females with an age range of 1 month to 7 years(1[0.3,3.0]year).CT enhancement studies were obtained in 15 cases.Six cases had MR enhancement examination.All imaging anatomical features,including tumor size,location,and shape,were analyzed.Results:The maximum diameter of the primary NB was 3.71-10.62(5.10±1.84)cm.The lesion was in the prevertebral fascia in 16 cases and in the retropharyngeal space in 1 case.The tumors were irregular in 10 cases,oval in 5 cases,and round in 2 cases.Eleven cases had no envelope,6 cases had incomplete envelope,and most of them had unclear boundaries.Fourteen cases were combined with necrosis.In all cases,the ipsilateral carotid artery was displaced by compression.In 8 cases,the neuroblasts were surrounded by the ipsilateral carotid artery,subclavian artery,and/or vertebral artery.Fifteen cases showed different narrowing degrees of airway compression displacement.Plain CT scan showed low density in 15 cases and scattered multiple spotty margin fuzzy calcification in 8 cases.After CT enhancement,all cases showed mild to evident enhancement.Three cases showed low signal on MR T 1WI sequence in the central and peripheral and high signal in the middle space.Conclusion:Primary cervical NB is mainly located in the prevertebral fascia.There are some relatively specific imaging findings of primary NB.The"tricyclic sign"on MR T 1WI sequence combined with precise anatomical division maybe helpful to improve the diagnosis of cervical NB.

关 键 词：神经母细胞瘤 头颈部肿瘤 影像解剖学 磁共振成像 体层摄影术 螺旋计算机 儿童 

分 类 号：R73[医药卫生—肿瘤]