CT在儿童纵隔神经母细胞源性肿瘤诊断、分期及治疗方案选择中的应用
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摘要
目的探讨CT在儿童纵隔神经母细胞源性肿瘤诊断、分期及治疗方案选择中的应用价值。方法回顾性分析经病理证实的29例儿童纵隔神经母细胞源性肿瘤的临床资料、CT表现及分期,并与病理结果进行对照分析。其中神经母细胞瘤(NB)20例,节细胞神经母细胞瘤(GNB)4例,节细胞神经瘤(GN)5例。平均发病年龄NB为(34.35±24.12)个月,GNB为(91.75±53.65)个月,GN为(67.40±68.00)个月。所有病例均行CT平扫及增强扫描。结果 CT平扫上,80.0%(16/20)NB、25.0%(1/4)GNB表现为密度不均匀,100.0%(5/5)GN密度均匀;80.0%(16/20)NB有不规则斑片状、点条状钙化,75.0%(3/4)GNB和80.0%(4/5)GN呈点状钙化。增强后75.0%(15/20)NB、50.0%(2/4)GNB呈不均匀强化,85.0%(17/20)NB和75.0%(3/4)GNB呈中度及明显强化,而100%(5/5)GN为均匀轻度强化。70.0%(14/20)NB、50.0%(2/4)GNB和40%(2/5)GN可见局部侵犯或远处转移。肿瘤分期中L_1期3例,L_2期15例,M期11例。随访中3例M期NB发生复发转移。肿瘤生物因子检测显示7例NB香草扁桃酸(VMA)升高,8例NB、1例GNB及1例GN的神经元特异性烯醇化酶(NSE)升高,6例NB的N-myc基因阳性。结论 CT在纵隔神经母细胞源性肿瘤的诊断、分期及治疗方案的选择中具有重要价值。
Objective To explore the application of CT in diagnosis, staging, and treatment planning of peripheral neuroblastic tumors in children. Methods The imaging findings, staging, and clinical data of 29 cases with peripheral neuroblastic tumors, confirmed by pathology, were retrospectively analyzed and correlated with pathology features. In 29 cases, there were 20 cases of neuroblastoma(NB), 4 cases of ganglioneuroblastoma(GNB), 5 cases of ganglioneuroma(GN).The mean age of NB group was 34.35±24.12 months, while GNB group was 91.75±53.65 months, and GN group was 67.40±68.00 months. CT scanning were performed in all cases. Results On plain CT scan, 80.0%(16/20) NB and 25.0%(1/4)GNB had inhomogeneous density. 100.0%(5/5) GN had homogeneous density, 80.0%(16/20) NB had irregular patchy calcifications, while 75.0%(3/4) GNB and 80.0%(4/5) GN had punctuate calcifications. Contrast-enhanced CT showed heterogeneous enhancement in 75.0%(15/20) NB and 50.0%(2/4) GNB, moderate and strong enhancement in 85%(17/20)NB and 75%(3/4) GNB, while mild heterogeneous enhancement in 100%(5/5) GN. 70.0%(14/20) NB and 50.0%(2/4) GNB and 40%(2/5) GN had local invasion or distant metastasis. In the INRGSS staging, L_1 in 3 cases, L_2 in 15 cases, M in 11 cases. Recurrence and metastases were found during clinical followup in 3 M cases of NB. Urine vanil mandelic acid(VMA)was elevated in 7 cases of NB. Neuron-specific enolase(NSE) level raised in 8 cases of NB, 1 case of GNB, and 1 case of GN.N-myc gene positive in 6 cases of NB. Conclusion CT imaging have great value for diagnosis, staging, and treatment planning of peripheral neuroblastic tumors in children.
Objective To explore the application of CT in diagnosis, staging, and treatment planning of peripheral neuroblastic tumors in children. Methods The imaging findings, staging, and clinical data of 29 cases with peripheral neuroblastic tumors, confirmed by pathology, were retrospectively analyzed and correlated with pathology features. In 29 cases, there were 20 cases of neuroblastoma(NB), 4 cases of ganglioneuroblastoma(GNB), 5 cases of ganglioneuroma(GN).The mean age of NB group was 34.35±24.12 months, while GNB group was 91.75±53.65 months, and GN group was 67.40±68.00 months. CT scanning were performed in all cases. Results On plain CT scan, 80.0%(16/20) NB and 25.0%(1/4)GNB had inhomogeneous density. 100.0%(5/5) GN had homogeneous density, 80.0%(16/20) NB had irregular patchy calcifications, while 75.0%(3/4) GNB and 80.0%(4/5) GN had punctuate calcifications. Contrast-enhanced CT showed heterogeneous enhancement in 75.0%(15/20) NB and 50.0%(2/4) GNB, moderate and strong enhancement in 85%(17/20)NB and 75%(3/4) GNB, while mild heterogeneous enhancement in 100%(5/5) GN. 70.0%(14/20) NB and 50.0%(2/4) GNB and 40%(2/5) GN had local invasion or distant metastasis. In the INRGSS staging, L_1 in 3 cases, L_2 in 15 cases, M in 11 cases. Recurrence and metastases were found during clinical followup in 3 M cases of NB. Urine vanil mandelic acid(VMA)was elevated in 7 cases of NB. Neuron-specific enolase(NSE) level raised in 8 cases of NB, 1 case of GNB, and 1 case of GN.N-myc gene positive in 6 cases of NB. Conclusion CT imaging have great value for diagnosis, staging, and treatment planning of peripheral neuroblastic tumors in children.
引文
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[3]Monclair T,Brodeur GM,Ambros PF,et al.The International Neuroblastoma Risk Group(INRG)staging system:an INRG Task Force report[J].J Clin Oncol,2009,27:298-303.
[4]张大伟,金眉,曾骐,等.后纵隔神经母细胞瘤35例[J].实用儿科临床杂志,2012,27:835-836.
[5]Pavlus JD,Carter BW,Tolley MD,et al.Imaging of thoracic neurogenic tumors[J].AJR,2016,207:1-10.
[6]刘菁华,朱珍,张骥,等.儿童腹膜后神经母细胞瘤CT特征分析[J].国际医学放射学杂志,2014,37:106-109.
[7]Zhang Y,Huang D,Zhang W,et al.Clinical characteristics of infant neuroblastoma and asum-mary of treatment outcome[J].Oncol Lett,2016,12:5356-5362.
[8]吴瑜,唐艳华,王海屹,等.儿童腹膜后节细胞神经瘤的CT表现[J].中国医学影像学杂志,2016,24:303-306.
[9]王兰菁,许乙凯.后纵隔神经节细胞瘤影像表现与病理对照[J].分子影像学杂志,2017,40:9-11.
[10]Shawa H,Elsayes KM,Javadi S,et al.Adrenal ganglioneuroma:features and outcomes of 27 cases at a referral cancer centre[J].Clin Endocrinol,2014,80:342-347.
[11]Granchi D,Corrias MV,Garaventa A,et al.Neuroblastoma and bone metastases:clinical significance and prognostic value of Dickkopf1plasma levels[J].Bone,2011,48:152-159.
[12]Solovyov AE,Morgun VV,Paholchuk AP.Neuroblastoma in pediatric patients[J].Klin Khir,2015:59-61.
[13]Decarolis B,Simon T,Krug B,et al.Treatment and outcome of ganglioneuroma and ganglioneuroblastoma intermixed[J].BMC Cancer,2016,16:542.
[14]Bagatell R,McHugh K,Naranjo A,et al.Assessment of primary site response in children with high-risk neuroblastoma:an international multicenter study[J].Clin Oncol,2016,34:740-746.
[15]Whittle SB,Smith V,Doherty E,et al.Overview and recent advances in the treatment of neuroblastoma[J].Expert Rev Anticancer Ther,2017,17:369-386.
[16]苏雁,岳志霞,金眉,等.单中心116例婴幼儿神经母细胞瘤临床特征及预后分析[J].中国小儿血液与肿瘤杂志,2019,24:19-26.
[17]Thompson D,Vo KT,London WB,et al.Identification of patient subgroups with markedly disparate rates of MYCN amplification in neuroblastoma:a report form the International Neuroblastoma Risk Group project[J].Cancer,2016,122:935-945.
[18]黄程,马晓莉.神经母细胞瘤生物学特征及其预后因素的研究进展[J].中华实用儿科临床杂志,2016,31:235-237.
[19]Park JR,Bagatell R,Cohn SL,et al.Revisions to the international neuroblastoma response criteria:a consensus statement from the national cancer institute clinical trials planning meeting[J].Clin Oncol,2017,35:2580-2587.