儿童腹膜后肿瘤的CT诊断及鉴别诊断.docVIP

儿童常见腹膜后肿瘤的CT诊断及鉴别诊断 郑鹤琳(，蔡金华（重庆医科大学附属儿童医院放射科，重庆 400014）　 摘要：目的 探讨儿童腹膜后肿瘤的CT诊断及鉴别诊断。方法 回顾性分析189例儿童腹膜后肿瘤的CT表现。所有病例均经手术病理证实，其中肾母细胞瘤71例，神经源性肿瘤89例（成神经细胞瘤70例，神经节成神经细胞瘤2例，神经节细胞瘤17例），畸胎瘤18例，淋巴瘤11例。结果 肾母细胞瘤CT表现为圆形或类圆形的有包膜肿块，常引起肾脏破坏，残肾呈新月形包绕肿块，易形成肾静脉、下腔静脉瘤栓及肺内转移；成神经细胞瘤与神经节成神经细胞瘤表现类似，多有钙化及血管包埋等征象，可侵犯肾脏，以淋巴结、颅脑、骨骼及肝脏转移常见；淋巴瘤发生于中线附近，呈分叶状多中心融合病灶，血管包埋较松散，侵犯肾脏多为双侧；畸胎瘤发生于一侧腹膜后，钙化或骨化以及脂肪密度是其特征。结论 CT对儿童腹膜后肿瘤具有较高的诊断和鉴别诊断价值。 关键词：体层摄影术，X线计算机；腹膜后肿瘤；儿童 中图法分类号：R735.4; R814.42 文献标识码：A CT diagnosis and differential diagnosis of retroperitoneal tumors in children ZHENG He-lin, CAI Jin-hua (Department of Radiology, Children’s Hospital, Chongqing Medical University, Chongqing 400014, China) Abstract： Objective To investigate CT diagnosis and differential diagnosis of retroperitoneal tumors in children. Methods CT findings of 189 cases of pathologically confirmed retroperitoneal tumors including 71 nephroblastomas, 89 neurogenic tumors (70 neuroblastomas, 2 ganglioneuroblastomas and 17 ganglioneuromas), 18 teratomas and 11 lymphomas, were retrospectively analyzed. Results Nephroblastomas showed on CT round or oval encapsuled mass with a crescent-shaped residual kidney resulted from renal destruction. Tumor thrombus in renal vein or inferior vena cava and lung metastasis were frequently observed in nephroblastomas. Neuroblastomas, in which calcification and vessel embedding were frequently found, were more invasive and often metastasized to lymph node or cranium. Lymphomas located around the median line and presented as an irregular mass fused by multiple lymph nodes embedding the vessels loosly. Teratomas, usually detected on one side of retroperitonium, were characterized by calcification/ossification and fat tissue. Conclusion CT examination is of higher value for the diagnosis and differential diagnosis of retroperitoneal tumors in children, and can be used for the first choice of imaging modalities. Key words: tomography; x-ray computed; retroperitoneal tumor; children 儿童腹膜后肿瘤不同于成人，其发病