摘要
目的探讨原发纵隔神经母细胞瘤（PMNB）CT、MRI表现。方法回顾分析12例经病理证实的PMNB临床、病理和CT（n=12）、MRI（n=5）资料，将CT、MRI表现与病理对照。结果12例均单发，其中后纵隔10例，年龄1个月-2岁，前纵隔2例，年龄65岁、19岁；CT／MRI平扫肿块以实性为主，间杂小片状囊变／坏死，增强后中度-明显强化，其中5例以实性为主夹杂“类蜂窝”状改变，蜂窝内见低密度／稍长T1、稍长T2信号，组织学检查，镜下为小片状囊变、坏死；间隔呈T1WI、T2WI低信号，实质部分呈等密度／等T1等T2信号，镜下见肿瘤由巢状排列的小圆细胞构成，并被增生的纤维血管基质分隔成小叶状；9例病灶内见钙化；5例后纵隔病灶内见“血管漂浮征”，并侵犯邻近椎管；3例并双腋下、1例并纵隔、1例并左锁骨上淋巴结转移，未见肺内／远处转移，邻近肋骨无破坏；NSE均明显升高（均值88ng／ml）。结论儿童（特别≤2岁）、后上纵隔肿块，平扫以实性为主，间杂小片状囊变、坏死，增强后呈中度-明显强化，钙化多见，出现“血管漂浮征”、易侵犯邻近椎管，结合NSE明显升高，应考虑PMNB的诊断；“类蜂窝”状改变更能反映PMNB多种成分构成的病理基础，对其诊断可能具有特征性。
Objective To discuss CT and MRI features of primary mediastinal neuroblatomas （PMNB） and to compare imaging findings with pathologic results in order to improve the imaging diagnostic accuracy. Methods CT and MRI findings of 12 patients with pathologically-confirmed PMNB were retrospectively analyzed. CT scanning was performed in 12 patients, while additional MRI scanning was adopted in 5 patients. The correlations between imaging findings and pathological results were analyzed. Results The neuroblatoma lesion was solitary in all the 12 patients. The lesion was located in the posterior mediastinum in 10 cases, and the patient＇ s age ranged from 1 month to 2 years. In the other two cases the lesion was situated in the anterior mediastinum, and the two patients were 65 and 19 years old respectively. Plain CT and MRI scanning showed that the lesions presented mainly as a solid mass mixed with some small patchy necrotic and cystic degeneration areas. Contrast-enhanced CT/MRI scanning revealed that the lesions showed moderate to strong enhancement. In 5 cases, ＂honeycomb-like＂ shadow was seen, within which low-density with slight longer T1 and T2 signals could be seen. Pathologically, small patchy necrotic and cystic degeneration areas were demonstrated. The interval part exhibited low-signal on both T1WI and T2WI, and the substantial part displayed iso-density or iso-T1 and iso-T2 signals. The histologic examination showed that the tumor cells were composed of small round cells that arranged in a nest pattern, and the cells were separated into small lobules by the proliferated fibrovascular stroma. Calcification was seen in 9 lesions, and the ＂floating- vessel＂ sing was observed in 5 cases with the lesion being located in the posterior mediastinum associated with the involvement of the adjacent vertebral canal. Lymph node metastasis regions included bilateral axillary （ n = 3 ） and left supraclavicular （ n = 1 ）. No intrapulmonary or distant metastasis was observed, and also no involvement of the adjacent ribs was seen. NSE was significantly increased （a mean of 88 ng/ml） in all cases. Conclusion Primary mediastinal neuroblatoma should be strongly considered in a patient, especially in a ≤2years child, who shows a solid mass in the posterior upper mediastinum with cystic degeneration, calcifications, ＂floating-vessel＂ sing and who has an increased NSE level. The ＂honeycomb-like＂ shadow can reflect the pathologic basis of the components of the lesion, which may be characteristic for the diagnosis.
出处
《临床放射学杂志》
CSCD
北大核心
2014年第7期988-992,共5页
Journal of Clinical Radiology
关键词
神经母细胞瘤
纵隔
体层摄影术
X线计算机
磁共振成像
病理
Neuroblatoma Neuroblastoma Tomography, X-ray computed Mangetic resonance imaging Pathology.
