儿童鼻腔鼻窦恶性肿瘤及肿瘤样病变的影像表现

目的 分析儿童鼻腔鼻窦恶性肿瘤及肿瘤样病变的CT和MRI特征,提高诊断准确性。资料与方法 回顾性分析2014年8月—2021年1月深圳市儿童医院经病理诊断为鼻腔鼻窦恶性肿瘤及肿瘤样病变的29例患儿的临床及影像资料,观察病变的CT密度、MRI信号、强化情况以及邻近骨质改变等影像学表现。结果 29例患者中,淋巴瘤7例、神经母细胞瘤骨转移6例、横纹肌肉瘤4例、白血病3例、朗格汉斯细胞组织细胞增生症（LCH）9例。4例神经母细胞瘤骨转移可见长条垂直骨针;2例白血病可见短粗骨针;3例横纹肌肉瘤可见粗大血管影,呈渐进性葡萄状强化;5例LCH骨质破坏呈纽扣征或火山口征。结论淋巴瘤、神经母细胞瘤骨转移、横纹肌肉瘤及白血病均为儿童鼻腔鼻窦常见恶性肿瘤,均有相对特异的影像学表现,软组织强化模式、骨质破坏形式及骨膜反应特点均为影像鉴别诊断关键点,同时需要与LCH进行鉴别。     

骨显像在儿童常见恶性实体瘤骨转移中的应用

目的 探讨骨显像在诊断儿童常见恶性实体瘤骨转移中的价值。方法 202例恶性实体瘤（淋巴瘤91例、神经母细胞瘤81例、横纹肌肉瘤20例、肾母细胞瘤10例）患儿行^99Tc^m-MDP全身骨显像，观察各自骨转移发生率、表现特征及好发部位。结果 202例患儿骨显像阳性者92例，占45．5％，其中单发病灶20例，多发病灶72例。好发部位为下肢骨骼和椎体。91例淋巴瘤骨显像阳性者38例，占41．8％，单发与多发性转移灶分别占28．9％与71．1％。肾脏受累15例，占16．5％；81例神经母细胞瘤阳性46例，占56．8％，单发与多发性转移灶分别占21，7％与78．3％。原发灶显影30例，占37．0％；20例横纹肌肉瘤阳性8例，占40，0％；10例肾母细胞瘤均未见骨骼转移。结论 骨显像对诊断儿童恶性实体瘤的骨转移有一定的价值，神经母细胞瘤的骨转移最常见，肾母细胞瘤极少发生骨骼浸润。^99Tc^m-MDP骨显像可显示恶性淋巴瘤的肾脏受累情况。     

椎管内髓系肉瘤的MRI表现及鉴别诊断

目的 评价椎管内髓系肉瘤的MRI表现及其鉴别诊断。方法 回顾性分析经病理证实的椎管内髓系肉瘤6例，以及椎管内其他恶性肿瘤7例(淋巴瘤4例，原始神经外胚层肿瘤3例),良性肿瘤18例(神经鞘瘤13例，血管瘤5例),评价肿瘤发病部位、MRI信号特征、血管穿行征、包绕征以及周围骨骼、肌肉受累征。结果 椎管内髓系肉瘤与其他肿瘤均好发于胸椎，MRI信号无特征性表现。椎管内恶性肿瘤其血管穿行征、包绕征及周围肌肉受累征象均明显高于良性肿瘤，且差异有统计学意义(P=0.000,P=0.001,P=0.008),而周围骨骼破坏差异无统计学意义(P=1);椎管内髓系肉瘤及淋巴瘤、原始神经外胚层肿瘤均出现血管穿行征及包绕征，6例髓系肉瘤均未出现周围肌肉及骨骼破坏，而淋巴瘤与原始神经外胚层肿瘤易累及周围肌肉及骨骼。结论 椎管内髓系肉瘤进展迅速、治疗棘手且临床表现缺乏特异性。因此，对于一些可疑的影像学征象应提高警惕。     

小儿眼部恶性肿瘤的CT诊断

目的：总结分析小儿眼部恶性肿瘤的CT表现,提高影像诊断水平。方法：回顾性分析经过手术病理、临床证实的儿童眼部恶性肿瘤患者54例,分析其CT影像学改变。其中视网膜母细胞瘤41例,其它肿瘤13例,包括：白血病眼部浸润4例,横纹肌肉瘤3例,淋巴瘤2例,脉络膜黑色素瘤、恶性婴儿色素性神经外胚层瘤、转移性神经母细胞瘤、肌源性转移瘤各1例。结果：视网膜母细胞瘤以眼球内含有钙化的不规则肿块为明确的CT征象;其它肿瘤（如白血病的绿色瘤）多有不规则的生长方式以及周围骨质结构破坏而可以得出恶性肿瘤的诊断,结合临床资料可以得出相对准确的病理诊断;但是横纹肌肉瘤可因病变范围局限且境界清楚而恶性征象不明显。结论：在CT图像上,累及小儿眼部的大部分恶性肿瘤通常都有影像学的恶性征象,对定性诊断有重要的临床应用价值。     

前列腺横纹肌肉瘤的MRI表现(附2例分析)

横纹肌肉瘤是儿童前列腺、膀胱、阴道最常见的恶性肿瘤,占15岁以下儿童恶性肿瘤的4%～8%,其中前列腺横纹肌肉瘤最为多见.前列腺横纹肌肉瘤的MRI表现少见有文献报道.本研究收集2例前列腺横纹肌肉瘤患者的临床及MRI资料,结合文献资料探讨其MRI表现.     

骨外尤文肉瘤/外周原始神经外胚层肿瘤的CT及MRI表现

【摘要】目的：探讨骨外尤文肉瘤/外周原始神经外胚层肿瘤的CT及MRI表现及临床特点,旨在提高对该病的认识。方法：回顾性分析12例经病理证实的骨外尤文肉瘤/外周原始神经外胚层肿瘤的CT及MRI资料并复习相关文献,总结其影像学特征。结果：病灶位于鼻口咽3例,舌1例,颌下1例,鼻腔鼻窦3例,颈根部1例,胸腔2例,空肠1例。4例同时行CT及MRI平扫+增强检查,5例行CT平扫+增强检查,3例行MRI平扫+增强检查。病变为浸润性生长的软组织肿块,体积较大,密度或信号不均,增强后强化程度不一,3例DWI高b值扩散受限呈混杂高/稍高信号,对应ADC图为低信号。12例均伴坏死,2例伴钙化,12例均伴邻近结构受压移位,9例伴周围组织受侵,5例伴骨质破坏,5例病灶内部或边缘见血管影,2例MRI检查见流空血管影,3例伴淋巴结转移。结论：骨外尤文肉瘤/外周原始神经外胚层肿瘤的CT及MRI表现具有一定的特征：病灶多表现为体积较大的软组织肿块,占位效应明显,囊变坏死多见,钙化少见,易侵犯周围组织,病灶周围或内部常可见流空血管影。     

胸壁的原始神经外胚层肿瘤(Askin肿瘤):CT和MR所见

1979年Askin等描述一罕见的恶性小细胞肿瘤(Askin肿瘤),可发生在胸壁软组织,偶尔发生于骨,罕见于肺外周。现在认为是原始神经外胚层肿瘤(PNET)的一种类型。Askin肿瘤在儿童和青年人多见,可能是从神经脊的胚胎迁移细胞发展而来,是一未分化的小圆细胞肉瘤,需与其他含小圆细胞的肿瘤鉴别,例如未分化成神经细胞瘤、胚胎性的横纹肌肉瘤、Ewing′s肉瘤和淋巴瘤。作     

原发性颞下窝肿瘤的CT与MRI特点分析

目的 探讨原发性颞下窝肿瘤的CT、MRI表现特点.方法 回顾性分析经手术或穿刺病理证实的21例原发性颞下窝肿瘤的CT及MRI资料,分析其影像学表现.结果 21例中良性肿瘤10例(47.6％),包括血管瘤4例,神经鞘瘤2例,神经纤维瘤3例,脂肪瘤1例;恶性肿瘤11例(52.4％),包括横纹肌肉瘤3例,滑膜肉瘤2例,腺样囊性癌2例,腺泡状软组织肉瘤2例,纤维肉瘤和淋巴瘤各1例.血管瘤呈渐进性显著强化,常伴钙化,MRI T2WI病灶内见流空信号.神经鞘瘤表现为不均匀强化的软组织肿块,伴有出血、坏死、囊变.神经纤维瘤密度/信号较均匀,内含有散在钙化灶.脂肪瘤CT及MRI均表现为脂肪密度/信号肿块,边界清晰.横纹肌肉瘤、纤维肉瘤及淋巴瘤浸润性生长并向邻近间隙蔓延,增强扫描均匀或不均匀强化.滑膜肉瘤边界较清楚,强化明显,可伴不规则钙化.腺样囊性癌表现为浸润性生长的软组织肿块,内可见“筛状”改变.腺泡状软组织肉瘤为不均匀软组织肿块,病灶中央及周边有流空血管为其特征性影像学表现.结论 颞下窝原发性肿瘤少见,熟悉其影像学特点有利于提高诊断及鉴别诊断水平.     

神经母细胞瘤股骨远端干骺端骨转移全身骨显像分析

目的 评价全身骨显像半定量分析在神经母细胞瘤股骨远端干骺端骨转移中的应用价值.方法 45例经病理证实的神经母细胞瘤患儿,按骨髓涂片、X线片、CT、MRl或临床随访结果等将其分为股骨远端干骺端转移组和无转移组,术前或术后行99Tcm-MDPSPECT全身骨显像,以两种方法对其进行分析:①半定量分析法:对每个患儿双侧股骨远端干骺端及股骨骨下中段勾画ROI,并测定其平均计数,计算每个患儿干骺端/骨干的放射性比值;②视觉分析法:根据骨显像视觉分析诊断患儿是否存在股骨远端干骺端转移.比较这两种方法的诊断结果有无差异.结果 半定量分析法:转移组及无转移组干骺端/骨干的放射性比值差异有统计学意义(t=8.334,P＜0.01).半定量分析法诊断股骨远端干骺端转移的灵敏度、特异度、准确率、阳性预测值及阴性预测值分别为90.5％、95.7％、94.4％、86.4％及97.1％;视觉分析法分别为81％、100％、95.6％、100％及94.5％.两种方法诊断结果的差异无统计学意义(x2=0.68,P＞o.05).结论 放射性核素全身骨显像对神经母细胞瘤骨转移的诊断具有重要的价值,结合视觉分析法及半定量分析法可提高诊断的准确率.     

骨原始神经外胚层肿瘤的临床及影像学分析 (附3例报告及文献复习)

目的为了提高对骨原始神经外胚层肿瘤的临床及影像学认识.方法收集1978～2002年25年内国内文献报道的12例及本院工作中遇到的3例共15例进行综合分析. 结果①发病部位肱骨6例,股骨1例,髋骨4例,椎体2例,肩胛骨1例,下颌骨1例.②以青壮年多见,平均年龄为26岁左右.女多于男,女12例,男3例.③临床发病缓慢,病程多为几个月,以局部疼痛为主要病症.④影像学表现以溶骨性骨质破坏及巨大软组织肿物为特征,其次针状骨膜增生或肿瘤骨也较常见.⑤病理以镜下见Homer-Wright菊形团为特点.结论骨原始神经外胚层肿瘤好发于青壮年,女性多见,主要以溶骨性破坏为主,并有巨大软组织肿块,病理上有大量Homer-Wright菊形团.免疫组化NSF阳性,糖原染色阴性为主要特点.     

18 F-FDG PET显像与99Tcm-MDP全身骨显像诊断肿瘤远处转移的比较

目的　评价18F 脱氧葡萄糖 (FDG)PET肿瘤显像与99Tcm 亚甲基二膦酸盐 (MDP)全身骨显像对检出骨和远处转移的价值。方法　对 16例恶性肿瘤放化疗后的患者进行18F FDGPET显像和99Tcm MDP全身骨显像 ,并对两种结果进行了比较。结果　 16例肿瘤患者中18F FDGPET显像皆阳性 ,其中 14例患者有远处转移 ,转移病灶共 62处 ,其中骨转移病灶 2 0处 ;在全身骨显像中 ,11例有局限性异常放射性浓聚 ,其中 2例为单一病灶 ,9例为多发病灶 ,共检出病灶 5 7处 ,另 5例骨显像正常。结论　18F FDGPET对恶性肿瘤的诊断具有较高的准确性和特异性 ,但对骨转移灶的诊断价值相对较差 ;99Tcm MDP显像阴性或单一病灶的可疑转移瘤患者有必要进行18F FDGPET检查 ,以明确诊断其他远处转移灶     

How does iliac crest bone marrow biopsy compare with imaging in the detection of bone metastases in small cell lung cancer?

Iliac crest bone marrow biopsy (BMB) has often been used as the gold standard for the detection of bone marrow metastases in small cell lung cancer (SCLC). However, it is likely to lead to numerous false-negative results. For this reason, we compared the results of bone scintigraphy (BS), magnetic resonance imaging (MRI), and BMB in 48 sequential patients affected with pathologically confirmed SCLC (47 were evaluable; mean age, 58.4 years). The three procedures were carried out within 1 week, no treatment being performed during this period. Whole-body scans and spot views were obtained in the anterior and posterior projections. For MRI, only the thoracolumbar spine, the sternum and the pelvis were scanned, using spin-echo T1-weighted sequences, resulting in an acquisition time of less than 45 min. Only five BMBs were rated as positive. In these cases, both BS and MRI were also positive. The other 42 biopsies were negative. Among them, in ten cases both BS and MRI were positive. In 21 cases, both BS and MRI were negative. In five cases MRI was positive while BS was negative. Finally, in six cases MRI was negative whilst BS was positive. In most cases in which either BS or MRI was positive, follow-up scans confirmed the initial findings. This study suggests that BMB is more invasive and less sensitive than BS or MRI in detecting bone metastases. MRI seems to be more sensitive than BS in detecting small spinal or pelvic metastases. Whole-body bone scintigraphy is more sensitive in detecting skull, costal or peripheral metastases. BS and MRI should be used in combination and may replace BMB in the detection of bone metastases in SCLC. Correspondence to: I. Perrin-Resche     

Fast spin echo MRI and bone scintigraphy in the detection of skeletal metastases

Standard Spin Echo (SE) magnetic resonance imaging (MRI) is known to be a very sensitive method for the detection of bone metastases and in comparison to skeletal scintigraphy, MRI detects more lesions when field of view includes the area of suspicion. However, only with the introduction of new fast SE sequences, have MRI protocols, for the detection of metastases, become rapid enough to make it a potential screening procedure for metastatic disease. Twenty-one patients with a suspicion of carcinomatous bone metastases were evaluated with both conventional T1 weighted (T1w), T2 weighted (T2w) and fast T2w SE (FSE) sequences (thoraco-lumbar spine and pelvis) and whole body bone scintigraphy. Conventional and fast T2w SE sequences detected the same number of lesions while bone scintigraphy detected only 70% of the lesions seen on MRI. However, more importantly, in 11 of the 21 patients bone scintigraphy detected lesions outside the MR field of view, lying in the ribs, skull, scapulae and extremities and in 4 of them, MRI was negative. Our results suggest first that fast SE MRI can replace conventional SE MRI when looking for carcinomatous bone metastases in the axial skeleton, with the advantage of a four to six times reduced acquisition time for fast T2w sequences. However, the limited field of view still limits the usefulness of MRI and whole body bone scintigraphy remains the screening modality for bone metastases. Fast MRI plays an important complementary role. Correspondence to: G. K. von Schulthess     

The value of bone scintigraphy,bone marrow scintigraphy and fast spin-echo magnetic resonance imaging in staging of patients with malignant solid tumours: a prospective study

The purpose of this prospective study was to define the value of bone scintigraphy (BS), bone marrow scintigraphy (BMS) and the new fast spin-echo (FSE) magnetic resonance imaging (MRI) sequences in screening for bone metastases in patients with solid malignant tumours. It was our particular interest to classify patients into a group with and a group without bone metastases, and not only to compare the absolute number of metastases detected by each method. Thirty-two patients were examined using technetium-99m dicarboxy propane diphosphonate bone scintigraphy, ^99mTc-labelled monoclonal anti-granulocyte antibodies for bone marrow scintigraphy and 1.5 T MRI using T1-weighted and FSE T2-weighted sequences. Against a reference standard obtained by re-evaluation of all clinical and imaging data 1 year after prospective BS, BMS and MRI had been performed, the three imaging modalities were falsely positive in two, eight and two cases and falsely negative in zero and four cases, respectively. BMS was falsely positive in eight patients because of vertebral marrow degeneration which caused photopenic defects which could not be differentiated from metastases. MRI showed these lesions to unequivocally contain fat. BMS and MRI were falsely negative in four cases because of the limited field of examination. In our study the key factor in classifying a patient as bone MI or MO was the possibility of surveying the entire skeleton, as is the case in BS, and not that MRI had a higher sensitivity compared to BS when analysis was on a lesion-by-lesion basis. BMS had the same limitations as MRI because the usual bone marrow distribution resulted in a physiologically limited field of view. We conclude that BS remains the method of choice in staging patients with solid tumours despite the fact that MRI is no longer a time-consuming method using FSE sequences. MRI has a complemantary role if special questions remain. BMS appears to have little value in the detection of bone metastases because of its poor specificity, its limited spatial resolution and its restriction to those areas of the skeleton containing haematopoietic marrow. Correspondence to: G.K. v. Schulthess     

Whole-body bone marrow MRI in patients with metastatic disease to the skeletal system

PURPOSE: The purpose of this study was to evaluate the diagnostic potential of a whole-body bone marrow MR protocol in the detection of bone metastases. METHOD: Whole-body bone marrow MRI was performed in 18 patients with known malignant tumors and suspected bone metastases. The imaging protocol consisted of fast T1-weighted and STIR sequences applied in different anatomical positions covering the whole skeleton. MRI findings indicating bone metastases were compared with findings from bone scintigraphy. Metastatic lesions were confirmed by follow-up MR examinations, bone scintigraphy, radiography, or CT. RESULTS: A total number of 216 lesions were detected with MRI in comparison with 159 lesions detected with bone scintigraphy. Follow-up examinations confirmed 105 lesions. MRI detected 96 (91.4%) of the confirmed lesions, whereas bone scintigraphy detected 89 (84.8%). The entire examination, including patient positioning and changing of imaging coils, required 45 min of room time. CONCLUSION: Whole-body bone marrow MRI as used in this study is an effective method for evaluating the entire skeletal system in patients with suspected metastatic disease.     

髓母细胞瘤骨转移的MRI诊断及临床治疗

目的：探讨髓母细胞瘤骨转移的MRI诊断及临床治疗。方法：回顾性分析髓母细胞瘤术后骨转移病例4例,分别行脊柱、髋关节或股骨MRI扫描,根据MRI检查结果运用常规分割法放射治疗。结果：4例中脊柱转移2例,髂骨及股骨颈转移1例,股骨下段转移1例,均表现为骨质内块状T1WI低信号、T2WI高信号影;经局部放射治疗疼痛症状均得到明显缓解。结论：髓母细胞瘤可以发生骨转移,MRI检查能够明确转移的范围和数目,其主要治疗手段是局部放射治疗。     

Detection of bone metastases in patients with endocrine gastroenteropancreatic tumors: bone scintigraphy compared with somatostatin receptor scintigraphy.

Scintigraphy with somatostatin analogs is a sensitive method for the staging and therapeutic management of patients with endocrine gastroenteropancreatic (GEP) tumors. The aim of this study was to compare prospectively somatostatin receptor scintigraphy (SRS) using 111n-pentetreotide with bone scintigraphy using 99mTc-hydroxymethylene diphosphonate for the detection of bone metastases. METHODS: One-hundred-forty-five patients with proven endocrine GEP tumors were investigated. Patients were classified according to the presence of bone metastases as indicated by CT, MRI or histologic data. Group I included 19 patients with confirmed bone metastases, and group II included 126 patients without bone metastases. RESULTS: In group I, SRS was positive in all 19 patients with bone metastases, and bone scintigraphy was positive in 17 patients. Bone metastases were found to occur predominantly in patients with liver metastases. In group 11, 5 patients had recent bone surgery for fracture or arthritis. SRS showed bone uptake in 4 of these patients, and bone scanning showed abnormal uptake in 5. In 7 of the remaining 121 group II patients, SRS was negative and bone scanning showed abnormal bone uptake suggesting bone metastases. The detection of bone metastases was of major prognostic value, because 42% of group 1 patients died during a 2-y follow-up. CONCLUSION: In patients with GEP tumors, the accuracy of SRS appears to be similar to that of bone scintigraphy for the detection of bone metastases.     

舌骨上颈部跨间隙及多间隙病变的MRI表现

目的探讨舌骨上颈部常见疾病的生长特点及MRI诊断价值。资料与方法良性肿瘤8例，包括神经鞘瘤3例，囊状淋巴管瘤2例，脊索瘤2例，脂肪瘤1例；恶性肿瘤40例，包括鳞状细胞癌20例，转移瘤12例，淋巴瘤6例，未分化癌2例。48例中手术病理证实20例，穿刺活检证实27例，典型MRI特征结合病史确诊1例。结果8例良性肿瘤均表现为跨间隙病变；恶性肿瘤中7例鳞状细胞癌、2例未分化癌和1例转移瘤表现为跨间隙病变；10例转移瘤、5例鳞状细胞癌和2例淋巴瘤表现为多间隙病变；8例鳞状细胞癌、4例淋巴瘤和1例转移瘤既呈跨间隙又表现为多间隙病变。结论良性肿瘤生长较大时可呈跨间隙生长，以神经鞘瘤、囊状淋巴管瘤、脂肪瘤和脊索瘤多见；恶性肿瘤易于跨间隙或多间隙生长，既呈跨间隙又出现多间隙生长时，以鳞状细胞癌和非霍奇金淋巴瘤常见。     

Integrated imaging using MRI and 123I metaiodobenzylguanidine scintigraphy to improve sensitivity and specificity in the diagnosis of pediatric neuroblastoma

OBJECTIVE: The objectives of this study were to compare MRI and iodine-123 ((123)I) metaiodobenzylguanidine (MIBG) scintigraphy in the detection of neuroblastoma lesions in pediatric patients and to assess the additional value of combined imaging. MATERIALS AND METHODS: Fifty MRI and 50 (123)I MIBG examinations (mean interval, 6.4 days) were analyzed retrospectively with regard to suspected or proven neuroblastoma lesions (n = 193) in 28 patients. MRI and MIBG scans were reviewed by two independent observers each. Separate and combined analyses of MRI and MIBG scintigraphy were compared with clinical and histologic findings. RESULTS: With regard to the diagnosis of neuroblastoma lesion, MIBG scintigraphy, MRI, and combined analysis showed a sensitivity of 69%, 86%, and 99% and a specificity of 85%, 77%, and 95%, respectively. On MRI, 15 false-positive findings were recorded: posttherapeutic reactive changes (n = 10), benign adrenal tumors (n = 3), and enlarged lymph nodes (n = 2). On MIBG scintigraphy, 10 false-positive findings occurred: ganglioneuromas (n = 2), benign liver tumors (n = 2), and physiologic uptake (n = 6). Thirteen neuroblastoma metastases and two residual masses under treatment with chemotherapy were judged to be false-negative findings on MRI. Two primary or residual neuroblastomas and one orbital metastasis were misinterpreted as Wilms' tumor, reactive changes after surgery, and rhabdomyosarcoma on MRI. Thirty-two bone metastases, six other neuroblastoma metastases, and one adrenal neuroblastoma showed no MIBG uptake. On combined imaging, one false-negative (bone metastasis) and three false-positive (two ganglioneuromas and one pheochromocytoma) findings remained. CONCLUSION: In the assessment of neuroblastoma lesions in pediatric patients, MRI showed a higher sensitivity and MIBG scintigraphy a higher specificity. However, integrated imaging showed an increase in both sensitivity and specificity.     

骨原始神经外胚叶肿瘤影像学表现

目的研究骨原始神经外胚叶肿瘤的影像学特点。资料与方法搜集5例骨原始神经外胚叶肿瘤的影像及临床、手术病理资料,分析其影像学表现。结果5例中．胸椎2例,胸壁、股骨、胫骨各1例。1例胸壁病变表现为巨大软组织肿块,并推移周围组织。2例脊椎病变破坏椎管内外骨质及软组织。2例四肢长骨病变呈溶骨性骨质破坏,1例有软组织肿块。5例均未见病变内钙化及局部淋巴结肿大。MRI对显示病变组织成分及侵袭范围较X线和CT好。结论溶骨性骨破坏和巨大软组织肿块是骨原始神经外胚叶肿瘤的常见影像学表现,病灶内钙化和局部淋巴结肿大少见。MR／对显示病变组织成分及侵袭范围较好。本病最终诊断依靠病理和免疫组织化学检查。