儿童胰腺实性假乳头状瘤CT和MRI征象

目的探讨儿童胰腺实性假乳头状瘤(SPTP)的CT和MRI影像学征象。方法回顾分析经手术、病理证实的SPTP患儿的临床及影像资料。结果共纳入21例SPTP患儿,男2例、女19例;平均年龄(11.00±2.66)岁。19例行术前CT检查,7例行术前MRI检查。21例患儿均为单发病灶,肿瘤最大径中位数5.80(5.00～7.31)cm,多位于体尾部。病灶均为囊实性,其中实性为主9例,囊性为主2例,囊实性成分相当10例。计算机X线体层摄影术(CT)平扫常表现为界限清楚、等密度或稍低密度囊实性肿块。磁共振成像(MRI)平扫实性部分表现为T1WI低信号、T2WI高信号,可伴有T1WI高信号出血灶;动态增强扫描示实性部分动脉期轻度强化,门脉期渐进性强化,增强各期强化程度均低于正常胰腺实质。5例患儿为恶性SPTP,最大径均5.00 cm,包膜均不完整,其中3例呈分叶状,2例伴钙化。结论 SPTP的CT和MRI影像学表现具有一定特征,对术前正确诊断及评估肿瘤恶性风险具有重要价值。     

5例儿童纵隔恶性横纹肌样瘤临床及影像学特征

目的探讨儿童纵隔恶性横纹肌样瘤(MRT)的临床与影像学特征,提高对该病的认知。方法收集2013年1月-2016年1月就诊于首都医科大学附属北京儿童医院的5例纵隔MRT患儿病历资料,术前均行CT平扫,其中3例行增强扫描,1例行MRI平扫检查,总结分析其临床及影像学特点。结果 5例患儿中,男1例、女4例;中位发病年龄5岁4个月(5个月～8岁4个月);肿瘤位于上纵隔3例、前纵隔1例、后纵隔1例;呈类圆形或不规则形;肿物边界均欠清晰,与周围软组织分界不清;瘤体多较大,最大径范围(3.1～8.9)cm;CT扫描2例可见囊变,囊性部分与实性部分边界模糊,呈渐进性变化;2例有钙化;3例伴有大量胸腔积液;CT增强扫描可见,肿瘤实性部分不均匀持续性强化。1例MRI平扫,肿瘤表现为混杂信号肿块,以T1WI稍低信号,T2WI稍高信号为主。5例中4例为局限性肿瘤,另外1例伴有远处转移。本组5例纵隔MRT患儿,4例死亡,仅1例经过手术、化疗及放疗的综合性治疗已存活37个月。结论纵隔MRT是一种高度侵袭性恶性肿瘤,极易复发及进展,影像学主要表现为纵隔内较大不均质肿块,可伴有囊变、钙化及胸腔积液。     

儿童神经母细胞瘤的影像学表现

目的探讨儿童神经母细胞瘤的CT、MRI及超声表现特征。方法收集经病理证实的儿童神经母细胞瘤38例,均行超声检查,CT检查24例,MRI检查8例,回顾性分析其影像学特点。结果神经母细胞瘤主要影像学特征为圆形、类圆形或不规则形实性肿块,内可见钙化、坏死囊变,增强扫描肿块见非均匀明显强化。肿块多跨越中线,侵犯邻近器官,包绕或推移相邻的血管。本组38例中肿块位于腹部34例,其中位于肾上腺31例;2例位于纵隔;2例位于盆腔骶前区。肿块侵犯肾脏12例,侵犯肝脏6例,向远处转移4例。结论超声、CT及MRI检查可清晰显示神经母细胞瘤的大小、形态及侵犯范围,多数能定性诊断,为临床治疗提供指导。     

儿童毛细胞黏液样星形细胞瘤的影像与病理特征研究

目的　探讨儿童毛细胞黏液样星形细胞瘤（PMA）的影像特征及其与病理学改变的关系。方法　回顾性分析2010年10月至2018年6月首都医科大学附属北京天坛医院收治的20例儿童颅内PMA患者的临床资料、CT和磁共振成像（MRI）影像表现以及病理和免疫组织化学结果。结果　20例儿童PMA患者中,男15例,女5例;肿瘤位于幕下小脑半球10例,幕上大脑半球5例,视交叉-下丘脑4例,三脑室内1例。在CT图像上,PMA表现为低密度10例;在MRI图像上,肿瘤呈混杂信号11例,T1WI低信号7例,T2WI高信号7例,DWI未见弥散受限12例,MRI增强扫描表现为不均匀强化17例;肿瘤边界清楚18例,发生囊变16例,瘤周水肿11例。组织病理学检查可见双极性梭形细胞,以血管为中心生长,间质内含有大量黏液,缺乏Rosenthal纤维。结论　儿童PMA具有较为特征性的影像表现和低度恶性的肿瘤特征,肿瘤不均质性、边界清楚、边缘囊变和不均匀强化是PMA的特征性表现,CT和MRI可为儿童PMA的术前诊断、临床治疗和预后评估提供参考。     

儿童鞍区肿瘤32例磁共振成像分析

目的 分析常见儿童鞍区肿瘤磁共振成像（MRI）特点，以提高术前诊断水平。方法 搜集32例经手术病理证实的儿童鞍区肿瘤，回顾性分析其MRI表现。结果 32例中颅咽管瘤14例，占43.8%；生殖细胞瘤7例，占21.9%，星形细胞瘤5例，占15.6%，Rathke囊肿2例，占6.2%，垂体瘤、脊索瘤、表皮样囊肿、蛛网膜囊肿各1例，各占3.1%。14例颅咽管瘤均呈囊性，其中10例瘤体底部可见壁结节；6例呈长T1长T2信号，4例呈等T1长T2信号，4例多囊性肿瘤呈长、等、短T1长T2信号；增强扫描壁结节及囊壁明显强化。7例生殖细胞瘤均实性，呈等T1稍长T2信号；2例并囊变，2例同时可见松果体区病灶，2例累及及基底节区，鞍区肿块均呈上下方向生长，增强扫描肿瘤实性部分明显强化。5例星形细胞瘤中实性4例，囊性1例，均呈长T1长T2信号，其中4例肿块呈前后方向生长，增强扫描肿瘤实性部分明显变化。结论 儿童鞍区肿瘤以颅咽管瘤、生殖细胞瘤及星形细胞瘤最常见，MRI表现较具特征性，仔细分析可做到术前诊断。     

儿童幕上原始神经外胚叶肿瘤的临床病理诊断与显微外科手术治疗

目的分析儿童颅内幕上原始神经外胚层肿瘤的临床、影像学、病理及手术治疗。方法回顾性分析了8例经手术和病理证实的儿童颅内幕上原始神经外胚层肿瘤。结果本组病例肿瘤均位于颅内幕上，影像学上表现有肿瘤呈圆形或类圆形，边界清楚，病灶周围无水肿或水肿较轻；MRIT1WI显示肿瘤实质为等低信号，T2WI为等信号，增强时肿瘤实质明显强化；肿瘤可呈囊性变，部分肿瘤内可见出血。在病理上原始神经外胚层肿瘤由小圆细胞构成，可观察到菊花团形成，免疫组化染色显示肿瘤有多向分化的倾向。本组病例全部进行了显微外科手术治疗，其中4例进行了术后的放射治疗。随访的病例生存期2～16个月，平均8个月。结论需结合临床、影像学和病理特点对原始神经外胚层肿瘤进行诊断，手术后需进行放射治疗。     

儿童毛细胞黏液样星形细胞瘤的影像与病理特征研究

目的　探讨儿童毛细胞黏液样星形细胞瘤（PMA）的影像特征及其与病理学改变的关系。方法　回顾性分析2010年10月至2018年6月首都医科大学附属北京天坛医院收治的20例儿童颅内PMA患者的临床资料、CT和磁共振成像（MRI）影像表现以及病理和免疫组织化学结果。结果　20例儿童PMA患者中，男15例，女5例；肿瘤位于幕下小脑半球10例，幕上大脑半球5例，视交叉-下丘脑4例，三脑室内1例。在CT图像上，PMA表现为低密度10例；在MRI图像上，肿瘤呈混杂信号11例，T1WI低信号7例，T2WI高信号7例，DWI未见弥散受限12例，MRI增强扫描表现为不均匀强化17例；肿瘤边界清楚18例，发生囊变16例，瘤周水肿11例。组织病理学检查可见双极性梭形细胞，以血管为中心生长，间质内含有大量黏液，缺乏Rosenthal纤维。结论　儿童PMA具有较为特征性的影像表现和低度恶性的肿瘤特征，肿瘤不均质性、边界清楚、边缘囊变和不均匀强化是PMA的特征性表现，CT和MRI可为儿童PMA的术前诊断、临床治疗和预后评估提供参考。     

小儿腹腔非霍奇金淋巴瘤的CT影像分析

目的探讨儿童腹腔非霍奇金淋巴瘤的CT表现特征。方法回顾性分析10例经病理检查证实为腹腔非霍奇金淋巴瘤患儿的临床资料及CT表现。结果CT表现：肠壁增厚及肠腔内肿块改变6例,肠管扩张4例,伴有不完全性肠梗阻I例,肠系膜肿块4例;浸润邻近器官1例;肿瘤平扫密度较均匀,增强扫描肿瘤实质轻中度强化10例,合并腹水6例。结论CT检查对儿童腹腔淋巴瘤的诊断及明确病灶范围具有重要价值。     

CT,magnetic resonance imaging and clinicopathological characteristics of perivascular epithelioid cell tumor in children北大核心CSCD

目的评价儿童血管周上皮样细胞瘤(PEComa)的CT、磁共振成像(MRI)和临床病理特征,以提高对该肿瘤的诊断水平。方法回顾性分析2019年3月至2022年4月首都医科大学附属北京儿童医院经病理确诊的6例儿童PEComa的CT、MRI和临床病理特征。结果患儿年龄1.7~11.9岁(平均7.6岁)。男女比例为1∶2。6例单发肿瘤发病部位分别见于肾脏(2例)、腹腔(2例)、盆腔(1例)和腹股沟(1例)。肿瘤边界清晰,呈类椭圆形(5例)或多结节样(1例),边缘见花边样或结节样改变(3例)。肿瘤长径4.8~15.9 cm(平均9.3 cm)。5例肿瘤表现出周围侵犯,2例存在淋巴结转移。2例患儿合并结节性硬化症。1例肿瘤为术后复发。CT平扫(6例)示肿瘤呈等/低密度,增强后呈不均匀渐进性强化。多数(5例)肿瘤见瘤内迂曲增粗血管影,少数(2例)见沙砾样钙化。肿瘤中心在MRI(3例)T1WI及T2WI上呈斑片样或结节样高信号,周边呈等肌肉信号,弥散加权成像(DWI)(b=800 s/mm2)上病灶周边部分弥散受限且增强后强化明显,中心部分呈等信号,增强后不强化或仅轻微强化。1例组织学分类为良性PEComa,5例为恶性PEComa。Melan-A和SMA的表达率分别为100.0%、83.3%。结论儿童PEComa的CT、MRI和病理表现存在一些特异性,常表现为腹盆腔内边界清楚的类椭圆形肿块,伴结节样边缘,可见瘤内迂曲增粗血管,增强后以周边强化为主,可有局部侵犯和远处转移,病理上以恶性病变居多,免疫组织化学上呈黑色素-肌肉双源性表达。     

儿童髓系肉瘤的CT和MRI影像学表现分析

目的 分析儿童髓系肉瘤(MS)的临床与影像学特征,提高对该病的早期识别及诊断能力。方法 回顾性分析27例儿童MS患儿的临床及影像学资料,27例行CT检查,其中21例同时行MRI检查,分析其CT及MRI特征。结果 27例患儿中,男性20例(74%),女性7例(26%),中位年龄3.5(0.6～10.8)岁。23例为MS合并AML,4例为孤立性MS。儿童MS病灶以多发为主,多见于眼眶,还可见于胸膜、前中颅窝底、颅板下、皮下结节和脊柱旁等部位,肿块为实性,呈梭形或不规则形,瘤体大小不等。在CT上,病灶与肌肉组织相比呈等密度,与邻近的脑组织相比,呈稍高密度,无钙化;在MRI上,肿块在T1W1呈等信号,在T2WI以高或等信号为主,伴弥散受限。病灶可以对邻近的肌肉和骨骼组织侵犯和破坏,还可以侵犯椎间孔及椎管,压迫脊髓,同时还常伴有淋巴结肿大、脾大及肝大。结论 在影像学提示儿童存在实性强化肿块且边界不清、具有一定的侵袭性时应该考虑MS的可能,儿童MS的临床和影像学表现具有一定的特征性,根据这些临床和影像学特征应建议临床围绕MS展开检查,便于早期诊断。     

Splenic trauma in the pediatric patient: the integrated roles of ultrasound and computed tomography

Seven children who sustained splenic trauma were scanned by ultrasound and computed tomography (CT) or ultrasound and nuclear liver/spleen scan. All patients were managed conservatively and did not need abdominal surgery. On the initial sonogram, the majority of children had multiple areas of both increased and decreased echogenicity. Hematomas were followed to resolution in five of seven children and were usually multiple and hypoechoic prior to complete disappearance. On contrast-enhanced CT scans, areas of splenic hemorrhage appeared as low attenuation. Our small patient population demonstrates that, following an initial CT scan, sonography is helpful for sequential splenic imaging to show when the appearance of the spleen returns to normal. When correlated with the clinical information, such data are helpful to the clinician in determining when a child who has sustained splenic trauma may resume normal activity.     

Cystic mesenchymal hamartoma of the liver

Two cases of multicystic mesenchymal hamartoma of the liver in children are described. In both cases noninvasive imaging techniques (ultrasound, CT or MR, radionuclide scan) showed a bulky cystic mass suggesting a correct preoperative diagnosis, while selective arteriography defined the operability of the tumor.     

Diagnosis of liver-spleen abscesses in children — with emphasis on ultrasound for the initial and follow-up examinations

Seven children with hepatic and one with splenic abscess were evaluated using at least two of the following imaging modalities: ultrasound, radionuclide liver-spleen scan, computed tomography (CT) and angiography. Seven children had pyogenic, and one mixed pyogenic-amebic abscess. In all cases ultrasound demonstrated the lesions, which in 6/7 of hepatic abscesses were located only to the right liver lobe.^99mTc-sulphur colloid liver-spleen scans were positive in 4/4 cases while⁶⁷Ga failed to demonstrate 2/2 lesions. CT gave additional information in regard to etiology of lesions observed at ultrasound examination. Angiography performed in four cases showed vessel displacement by poorly vascularized mass lesions and arterioportal shunting in one but, overall, did not contribute to patient management. In clinically suggested hepatic-splenic abscesses, ultrasound together with CT will provide the diagnostic information needed for treatment. Follow-up studies should be performed by ultrasound.     

Value of lymphography, computer tomography and ultrasound in the diagnosis of infradiaphragmatic malignant lymphomas in children

25 children with Hodgkin's disease and 6 children with Non-Hodgkin-lymphoma were reviewed in order to compare the diagnostic value of lymphography, CT and sonography. As compared with staging-laparotomy, sensitivity for the detection of lymph node involvement was 78% for lymphography, 33% for CT and 57% for the ultrasound examination. Specifity was 55%, 88%, and 83% respectively. Undetected involvement of splenic and liver hilar lymph nodes, unspecific lymphadenitis and fluid-filled bowl loops caused most of the false negative and false positive findings. In 10 children histological examination showed splenic involvement. No splenic lesion was seen by CT in 7 of these children. Splenic disease could be clearly identified by ultrasound in only one child. Although children with lymph node involvement had always splenic manifestations of malignant lymphomatous disease it is concluded that staging laparotomy is an indispensable tool in diagnosing malignant lymphoma. Lymphography should not be abandoned with children. It should be used in combination with either CT or ultrasound examination.     

Imaging of cervico-thoracic lymphangiomas in children

This study was undertaken to define the role of ultrasound (US) and magnetic resonance (MR) imaging in the diagnosis and preoperative staging of cervicothoracic lymphangiomas in children. In a retrospective study, 11 patients with surgically and pathologically proved lymphangiomas had MR imaging and 6 of them underwent simultaneous US. US showed superficial hypoechogenic multilocular cystic masses with septa of variable thickness, but failed to demonstrate retropharyngeal, axillary or mediastinal extensions in all patients. All lesions were identified on both MR T1-weighted images (T1WI) and T2-weighted images (T2WI). T2WI provided the best tissue contrast between the lymphangiomas and surrounding tissues. T1WI after i.v. injection of gadolinium DOTA (Gd DOTA) in two patients provided additional information regarding the extent of the lesion. The authors concluded that although lymphangiomas have a distinctive sonographic appearance, MR imaging allowed a better tissue characterisation and tumour exten. T2WI and T1WI after i.v. injection of Gd DOTA are especially helpful for the diagnosis and preoperative staging of cervico-thoracic lymphangiomas in children.     

Osteoid osteoma mimicking Brodie's abscess in a 13‐year‐old girl

Osteoid osteoma is a solitary, benign lesion of bone causing significant nocturnal pain. Magnetic resonance imaging (MRI), computed tomography (CT), and bone scan are commonly used in this diagnosis. A case of osteoid osteoma of the distal femur mimicking chronic osteomyelitis with Brodie's abscess is reported and discussed. Initial radiographs and MRI showed a lesion of the distal femur consistent with subacute osteomyelitis with a Brodie's abscess. Because primary malignant tumor could not be eliminated, surgical biopsy was carried out. Histological examination showed a typical nidus consistent with the diagnosis of osteoid osteoma. Subacute osteomyelitis (Brodie's abscess) may be difficult to distinguish from other malignant or benign bone lesions as osteoid osteoma. CT usually is recommended as the best imaging procedure to identify the nidus and confirm the diagnosis. MRI also can be used for this purpose. Surgical biopsy remains mandatory for unclear lesions before deciding on appropriate treatment.     

Spontaneous involution of pulmonary sequestration in children: a report of two cases and review of the literature

Background. Two cases of pulmonary sequestration which regressed spontaneously are presented. Objective. To demonstrate the value of imaging studies in the diagnosis and follow-up of some forms of congenital masses of the lung in asymptomatic patients. Material and methods. We reviewed the clinical records and imaging studies of two asymptomatic children, one newborn and the other 3 months old, with thoracic masses which demonstrated variable degrees of spontaneous involution. Results. Abdominal ultrasound performed on the newborn with a palpable mass showed a triangular echogenic mass with a large central feeding vessel arising from the aorta. The mass had disappeared on follow-up US exam performed 6 years later. CT was performed in the 3-month-old patient with a persistent retrocardiac mass. A soft-tissue density mass in the left pulmonary base with a large feeding vessel arising from the aorta was visualised on contrast-enhanced CT. Five years later, a new CT scan showed significant shrinkage of the mass and no vessel. Conclusion. Radiological techniques such as real-time US with Doppler imaging and contrast-enhanced CT may establish the diagnosis of pulmonary sequestration by demonstrating the mass and its systemic vessel, thereby eliminating the need for more aggressive imaging procedures. Partial or total disappearance of these masses represents a further example of involutive pathology and suggests that not all cases of pulmonary sequestration should be surgically treated. Received: 12 September 1997 Accepted: 18 September 1997     

Adrenal carcinoma and adenoma in children: A review of 17 patients

Seventeen children with adrenocortical neoplasms (13 carcinomas: four adenomas) are reviewed and attention is focused on the value of the newer imaging modalities in the management of these children. All the lesions were functioning tumors. CT is the single most important modality in assessing primary and metastatic disease at diagnosis and during follow-up. In children suspected of having an adrenal lesion, high resolution CT will promptly localize the lesion to an adrenal. Since the only curative treatment is complete surgical removal CT plays an important role in defining the extent of the primary lesion pre-operatively. Large carcinomas have an inhomogeneous density on CT and a complex echo pattern on ultrasound reflecting the areas of hemorrhage and necrosis seen macroscopically in these lesions. Smaller lesions have a more homogeneous density on CT but benign and malignant disease could not be differentiated by this modality. Ultrasound is useful in screening the adrenal area in those patients in whom there is a low clinical index of suspicion for an adrenal tumor and also in the post-operative period.     

Papillary renal cell carcinoma in a child.

AIM: To report a case of papillary renal cell carcinoma in a pediatric patient. METHOD: A seven-year-old boy complained of hematuria for one year. CT scan showed a mass in the middle zone of the right kidney. Radical nephrectomy was performed without incident. RESULT: Histology of the specimen showed papillary renal cell carcinoma. As the tumor was stage one, no chemotherapy was offered. At follow-up after 6 months the child was without recurrence or metastases. CONCLUSIONS: Papillary renal cell carcinoma is an uncommon kidney tumor in children and in its early stages it can be cured by nephrectomy alone.