摘要
目的探讨肝母细胞瘤(HB)的CT表现预判病理分型的可行性及价值。方法回顾性分析经病理证实为HB的44例患儿的临床及影像资料,术前行腹部CT平扫及三期增强扫描。观察肿瘤最大径,瘤内有无出血、坏死或囊变、钙化及多发纤维分隔,肿瘤假包膜是否光滑连续,有无肝包膜回缩征及包膜下积液,有无与预后相关的高危影像学征象。测量并计算病灶平扫CT值、相对密度指数,动脉期、静脉期及延迟期CT值、CT差值、强化百分比、强化指数。依据肿瘤组织内上皮或上皮-间质成分将病灶分为完全上皮型和上皮与间叶混合型,完全上皮型和混合型可进一步分为各亚型。采用Pearson卡方检验或连续性校正的卡方检验比较完全上皮型和混合型患儿间性别、年龄、甲胎蛋白(AFP)、病灶形态特征及相关高危影像学征象的差异,采用两独立样本t检验或Mann-Whitney检验(非正态分布数据)比较组间病灶最大径、组间CT平扫及增强扫描参数的差异,将有统计学意义的指标纳入二元Logistic回归分析。结果完全上皮型和混合型HB各22例,其中6例为分化良好的胎儿型,表现为肿瘤假包膜完整、边缘较光滑,无瘤内出血及多发纤维分隔,无肝包膜回缩征及包膜下积液。完全上皮型和混合型HB患儿的性别、年龄、AFP差异均无统计学意义(P均>0.05)。完全上皮型和混合型HB病灶的最大径、瘤内出血、坏死或囊变、肿瘤假包膜光滑连续、肝周积液及高危影像征象的差异在两组间均无统计学意义(P均>0.05)。完全上皮型和混合型HB的平扫CT值及相对密度指数、CT增强动脉期、静脉期及延迟期的CT值、CT差值、强化百分比及强化指数的差异无统计学意义(P均>0.05)。完全上皮型和混合型HB病灶内钙化、多发纤维分隔及肝包膜回缩的出现率差异有统计学意义(P均<0.05)。二元Logistic回归分析提示肝包膜回缩征为混合型HB的独立预测因素(OR=9.643,95%CI:2.362~39.365)。结论完全上皮型和混合型HB具有一定的CT影像学特征,CT增强扫描延迟期肝包膜回缩征可初步提示混合型HB。
Objective To investigate the feasibility and value of CT findings in hepatoblastoma(HB)for predicting pathological typing.Methods The clinical and imaging data of 44 patients with HB confirmed by pathology were retrospectively analyzed.Abdominal plain CT and three-phased contrast-enhanced CT were performed before operation.Size of lesion,cystic change or necrosis,bleeding,calcification,multiple separation,pseudo-capsule,liver capsule retraction,subcapsular effusionandhigh-risk imaging signswere evaluated.Plain CT values,relative density index,CT value,CT value difference,enhanced percentage and enhancement index on arterial、venous and delayed phase of each tumor were measured and calculated.The lesions were divided into epithelial or mixed epithelial and mesenchymal types according to epithelial or epithelial-mesenchymal components in the tumor tissue,which can be further divided into subtypes.Pearson Chi-Square or Continuity Correction test were used to compare differences of gender,age,AFP,lesion morphology and high-risk imaging findings between the two pathological types.Two independent sample t-tests or Mann-Whitney test(non-normal distribution data)were performed to compare differences of the maximum diameter of the lesions,plain CT parameters and the contrast-enhanced CT parameters between the two groups.Statistically significant features between two groups were included in binary Logistic regression analysis.Results Twenty-two of our cases were classified as epithelial,and the others were mixed epithelial and mesenchymal type.Six of which were well-differentiated fetal types,showing complete tumor pseudocapsules,smooth edges,no intratumoral bleeding,liver capsule retraction signs,subcapsular effusions,and no multiple fibrous separation.The difference of gender,age and AFP between the two pathological types demonstrated no statistical significance(P>0.05).The difference of maximum size of lesion,intratumoral hemorrhage,necrosis or cystic degeneration and high-risk imaging signs between epithelial and mixed epithelial and mesenchymal type tumors showed no statistical significance(P>0.05).Both types of HB displayed similar density and relative density index on plain CT,and the difference showed no significance(P>0.05).In addition,the difference of CT value,enhanced percentage and enhancement index on arterial,portal and delayed phase showed no statistical significance(P>0.05).The difference of calcification,multiple fibrous separation and capsule retraction demonstrated statistical significance(P<0.05).Binary logistic regression analysis indicated the capsule retraction was the independent predictive factor(OR=9.643,95%CI:2.362-39.365).Conclusion Epithelial and mixed epithelial and mesenchymal types of HB have certain CT imagingfeatures.Capsule retraction on contrast-enhanced CT indicates mixed epithelial and mesenchymal type.
作者
张龚巍
李钱程
张欢
徐坚德
李志勇
林飞飞
干芸根
ZHANG Gongwei;LI Qiancheng;ZHANG Huan(Departmentof Radiology,Shenzhen Children’s Hospital,Shenzhen,Guangdong Province 518038,P.R.China)
出处
《临床放射学杂志》
CSCD
北大核心
2020年第12期2507-2512,共6页
Journal of Clinical Radiology
基金
深圳市医疗卫生三名工程项目(编号:SZSM202011005)
