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目的回顾性地判定CT在确定术前是否存在肾母细胞瘤破裂的诊断效能。材料与方法该队列研究源自儿童肿瘤学组AREN03B2研究。本研究通过机构伦理委员会批准并符合HIPAA标准。在入围研究前签署知情同意书。肾母细胞瘤破裂由外科手术中的关键手术记录和(或)病理学检查确诊。70例肾母细胞瘤破裂病人与70例肾母细胞瘤没有破裂的对照组病人按照年龄和肿瘤质量(差别分别在6个月和50g内)进行配对。CT扫描结果由两名放射学专家分别回顾,并对以下CT所见进行评估:肿块界限不清,肾周脂肪条索,瘤周脂肪层模糊,腹膜后积液(被膜下,被膜外),腹水远达道格拉斯腔,腹膜种植转移,同侧胸腔积液和肿瘤内出血。所有液性成分以30HU为界分为血性和非血性。CT所见与肿瘤破裂间的相关性用逻辑回归模型进行评估。结果 1号读片者对肾母细胞瘤破裂检出的敏感度和特异度分别为54%(36/67例)和88%(61/69例),2号读片者的分别为70%(47/67例)和88%(61/69例)。观察者间的一致性可靠(κ=0.76)。所有被检测的成像征象,除了腹膜种植转移、瘤内出血和被膜下积液外,均与肿瘤破裂显著相关(P≤0.02)。腹水的CT值与肿瘤破裂并无显著相关性(P=0.9990)。对于两位读片者来说,提示破裂的单个最佳指征均为远达道格拉斯腔的腹水,而肾周脂肪条索和腹膜后积液(P<0.01)被认为是其次的征象。结论 CT对于术前检查肾母细胞瘤破裂有适度的特异性但敏感性较低。如不考虑衰减,远达道格拉斯腔的腹水是肿瘤破裂最具预兆性的指征。
Objective To retrospectively determine the diagnostic efficacy of CT in determining the presence or absence of rupture of nephroblastoma before surgery. Materials and Methods This cohort study was derived from the Children’s Oncology Group AREN03B2 study. This study was approved by the Institutional Ethics Committee and complied with HIPAA standards. Sign informed consent before finalizing study. Nephroblastic rupture is diagnosed by key surgical recording and / or pathology in surgery. Seventy patients with ruptured nephroblastoma and 70 patients with ruptured nephroblastoma were matched according to age and tumor mass (within 6 months and 50 g, respectively). The results of the CT scan were reviewed by two radiologists individually and evaluated on the following CT findings: unclear tumor mass, perirenal fat cords, peritumoral fat layer obscure, retroperitoneal effusion (sub-membranous, extra-membranous) Ascites as far as Douglas cavity, peritoneal metastasis, ipsilateral pleural effusion and intra-tumor hemorrhage. All liquid components to 30 HU for the boundaries of bloody and non-bloody. The correlation between CT findings and tumor rupture was evaluated using a logistic regression model. Results The sensitivity and specificity of No. 1 readers in detection of nephroblastoma were 54% (36/67) and 88% (61/69), respectively, while that of No. 2 readers was 70% (47/67 cases) and 88% (61/69 cases). Consistency between observers was reliable (κ = 0.76). All detected signs of imaging were significantly associated with tumor rupture except for peritoneal metastasis, intratumoral hemorrhage and subcapsular effusion (P <0.02). There was no significant correlation between ascites CT value and tumor rupture (P = 0.9990). For both readers, the single best indication of a rupture was ascites as far as the Douglas cavity, while perirenal fat cords and retroperitoneal effusion (P <0.01) were considered as secondary signs. Conclusion CT has a modest specificity but a low sensitivity for preoperative examination of nephroblastoma. If you do not consider attenuation, ascites of Douglas cavity is the most indicative indication of tumor rupture.