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目的基于肝母细胞瘤PRETEXT分期系统及其相关影像学高危预后因素,总结肝母细胞瘤影像学表现。方法选择2013年1月至2015年6月在首都儿科研究所附属儿童医院经手术和病理确诊的肝母细胞瘤CT影像学资料82例,其中男性42例,女性40例;年龄1个月~11岁,平均年龄1.65岁。观察肿瘤位置、大小、数量、边界、肿瘤内坏死及钙化等征象;此外,基于PRETEXT分期,探讨与预后相关的高危影像学征象(肿瘤侵袭邻近器官、腹水、肿瘤破裂出血、远处器官转移、淋巴结转移、肝静脉受累、门静脉/下腔静脉受累等)关系。结果 PRETEXT分期Ⅰ期5例,Ⅱ期38例,Ⅲ期33例,Ⅳ期6例。肿瘤的CT表现,39例(47.6%)在右叶,22例(26.8%)在左右叶,18例(22.0%)在左叶,3例(3.6%)在尾叶。肿瘤体积约为2.5 cm×2.5 cm×3.0 cm~9.2 cm×18.6 cm×20.0 cm。71例(86.6%)肿瘤单发,11例(13.4%)肿瘤多发。64例(78.0%)肿瘤与肝脏实质多数分界清楚,18例(22.0%)边界模糊。肿瘤内坏死:72例(87.8%)有大小不等、分布无规律、数量不定的裂隙状或片状低密度区(CT值约15~38 Hu)。49例(59.8%)有点片状、团块状和多种形态混合状的钙化。高危预后因素最常见为远处转移33例(40.2%),以肺转移多见;其次是门静脉主干、三支肝静脉或下腔静脉受累13(15.9%)、PRETEXTⅣ期6例(7.3%)、淋巴结转移5例(6.1%),肿瘤肝外腹部侵袭(0例)及肿瘤破裂出血(0例)相对少见。结论肝母细胞瘤的术前增强CT检查可着重观察与临床分期及高危预后相关征象,有助于临床分期、治疗和预后的判断。
Objective To summarize the imaging features of hepatoblastoma based on the PRETEXT staging system of hepatoblastoma and related high-risk and prognostic factors of radiology. Methods From January 2013 to June 2015, 82 cases of hepatoblastoma confirmed by operation and pathology from Children’s Hospital Affiliated to Capital Institute of Pediatrics from January 2013 to June 2015 were selected, including 42 males and 40 females, aged 1 month ~ 11 years old, average age 1.65 years old. In addition, based on the PRETEXT staging, to explore the prognosis-related high-risk imaging signs (tumor invasion adjacent organs, ascites, tumor rupture, distant organ metastasis, Lymph node metastasis, hepatic vein involvement, portal vein / inferior vena cava involvement, etc.). Results PRETEXT stage Ⅰ 5 cases, Ⅱ 38 cases, Ⅲ 33 cases, Ⅳ 6 cases. Tumors showed CT findings in 39 cases (47.6%) in the right lobe, 22 (26.8%) in the left and right lobes, 18 (22.0%) in the left lobe, and 3 (3.6%) in the caudate lobe. The tumor volume is about 2.5 cm × 2.5 cm × 3.0 cm ~ 9.2 cm × 18.6 cm × 20.0 cm. 71 (86.6%) tumors were single and 11 (13.4%) tumors were multiple. In 64 cases (78.0%), the demarcation between tumor and liver parenchyma was clear, and the borderline in 18 cases (22.0%) was blurred. Tumor necrosis: There are 72 cases (87.8%) with irregular or irregularly distributed fractures or lamellar low density areas (CT value of about 15 ~ 38 Hu). Forty-nine cases (59.8%) were somewhat flaky, lumpy and mixed with various forms of calcification. High-risk prognostic factors were the most common distant metastasis in 33 cases (40.2%), with lung metastasis more common; followed by the main portal vein, three hepatic veins or inferior vena cava involvement 13 (15.9%), PRETEXTⅣperiod of 6 cases , Lymph node metastasis in 5 cases (6.1%), extrahepatic abdominal invasion (0 cases) and tumor rupture (0 cases) were relatively rare. Conclusion Preoperative enhanced CT examination of hepatoblastoma can focus on clinical staging and high risk prognosis-related signs, contribute to clinical staging, treatment and prognosis.