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论著-头颈部

儿童及青少年松果体区生殖细胞肿瘤的CT、MRI表现

作者:武乐乐

所属单位:河南科技大学第二附属医院影像科(河南 洛阳 471000)

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摘要

目的分析儿童及青少年松果体 区生殖细胞肿瘤(GCTs)的CT、MRI表现。 方法 收集24例GCTs患者的临床资料,结 合病理分析其CT及MRI特点。结果 生殖细 胞瘤13例,CT平扫呈稍低或等密度,MRI 呈T1WI等低、T2WI等高信号,多伴钙化 及小囊变,增强扫描明显强化。畸胎瘤5 例,平扫密度/信号混杂,瘤体内含不同 比例脂肪及钙化,增强后强化不均。内胚 窦瘤3例,CT平扫呈等低密度,MRI平扫呈 较均匀T1WI低、T2WI高信号,部分病灶内 含黏液囊腔,增强扫描均匀或不均匀强 化。胚胎性癌2例,CT/MRI平扫密度/信号 混杂,可伴明显液化坏死,增强扫描不均 匀强化,瘤周水肿显著。混合性生殖细胞 瘤1例,平扫密度/信号混杂,增强扫描 强化不均。结论 儿童及青少年松果体区 GCTs影像表现多样,部分肿瘤具有一定特 征性,结合肿瘤标志物及发病年龄等临床 特点有助于提高诊断准确性。

Objective To analyze the CT and MRI manifestations of germ cell tumor in children and adolescents. Methods Clinical data of 24 patients with GCTs were collected, and CT and MRI characteristics were analyzed and compared with pathological analysis. Results There were 13 cases of germinal cell tumor, and the CT scan was slightly lower or equal density, and the MRI showed a low T1WI and a high signal of T2WI, accompanied by calcification and microcystic changes, and was significantly enhanced. In 5 cases of teratoma, the density/signal was mixed, and the tumor contained different proportions of fat and calcification, which enhanced the unevenness. In 3 cases of endodermal sinus tumor, CT scan showed low density, and MRI scan showed a relatively uniform T1WI low and T2WI high signal. Some lesions had mucous cystic lumen, and enhanced scanning was uniform or non-uniform. In 2 cases of embryonic carcinoma, CT/MRI scanning density/signal was mixed, with obvious liquefaction necrosis, inhomogeneity enhancement, and significant edema around the tumor. In the case of mixed germ cell tumor, the density/signal was mixed, and enhanced obviously. Conclusion There is a variety of images of GCTs in children and adolescents, and some tumors have certain characteristics, which can help to improve the accuracy of diagnosis in combination with clinical features such as tumor markers and age of onset.

【关键词】儿童;青少年;松果体;生殖细胞肿瘤;计算机体层摄影; 磁共振成像

【中图分类号】R739.41;R814.42;R445.2

【文献标识码】A

【DOI】10.3969/j.issn.1672-5131.2018.12.001

前言

颅内生殖细胞肿瘤(germ cell tumors,GCTs)是一种少见的胚 胎源性肿瘤,好发于儿童和青少年[1-2]。2016年世界卫生组织(WHO)将 GCTs分为生殖细胞瘤和非生殖细胞瘤性生殖细胞肿瘤,后者又可分为 畸胎瘤、内胚窦瘤、胚胎癌、绒癌和混合性生殖细胞肿瘤[3]。颅内GCTs 多发生于中线部位,其临床表现缺乏特异性,影像表现多样化、但亦 具有一定特征性。本文回顾性分析24例松果体区GCTs患者的临床资 料,分析其CT及MRI表现,并结合术后病理讨论其影像学特点。