在视网膜母细胞瘤的研究方案中，CT 仍然有用吗？
Is CT still useful in the study protocol of retinoblastoma?
机构信息
Unit of Diagnostic and Therapeutic Neuroradiology, Azienda Ospedaliera Universitaria Senese, Siena, Italy.
出版信息
AJNR Am J Neuroradiol. 2009 Oct;30(9):1760-5. doi: 10.3174/ajnr.A1716. Epub 2009 Jul 17.
BACKGROUND AND PURPOSE
Intralesional calcium deposition is considered a key element for differentiating retinoblastoma from simulating lesions. Our aim was to assess whether MR imaging associated with ophthalmologic investigations (ophthalmoscopy and ultrasonography) could replace CT in the detection of diagnostic intralesional calcifications in retinoblastoma.
MATERIALS AND METHODS
Ophthalmoscopic findings, MR images, CT scans, and histologic examination of 28 retinoblastomas from 23 consecutive children (11 males, 12 females; age range at admission, 1-35 months; mean age, 11 months; median age, 9 months) were retrospectively evaluated. Ultrasonography was performed in 18 patients with 21 retinoblastomas. MR imaging included T2-weighted spin-echo and gradient-echo images, fluid-attenuated inversion recovery images, and T1-weighted spin-echo images with and without contrast enhancement. Clinical data were integrated with MR imaging data to evaluate the utility of both approaches to discover calcifications; particularly, a correlation between intralesional signal-intensity void spots on MR imaging and hyperattenuating areas on CT scans was performed.
RESULTS
Ophthalmoscopy detected calcifications in 12 of 28 eyes (42.85%). Ultrasonography detected calcifications in 20 of 21 eyes (95.23%). CT showed hyperattenuating intralesional areas consistent with calcifications in 27 of 28 eyes (96.42%). MR imaging showed intralesional signal-intensity void spots in 25 of 28 eyes (89.28%). All spots detected with MR imaging matched the presence of calcifications on CT scans. Gradient-echo T2*-weighted and fast spin-echo T2-weighted images showed the highest degree of correlation with CT. When we put together ophthalmoscopy, ultrasonography, and MR imaging data, no calcifications detected on CT were missed, and the differential diagnosis was thorough.
CONCLUSIONS
A combination of clinical data and MR images may remove potentially harmful ionizing radiation from the study protocol of retinoblastoma.
背景与目的
瘤内钙沉积被认为是区分视网膜母细胞瘤与模拟病变的关键因素。我们的目的是评估磁共振成像（MRI）联合眼科检查（检眼镜和超声检查）是否可以替代 CT 检测视网膜母细胞瘤的诊断性瘤内钙化。
材料与方法
回顾性分析 23 例连续患儿（男 11 例，女 12 例；入院时年龄 1-35 个月，平均年龄 11 个月，中位数年龄 9 个月）的 28 例视网膜母细胞瘤的检眼镜检查结果、MR 图像、CT 扫描和组织学检查结果。18 例患儿的 21 例视网膜母细胞瘤进行了超声检查。MR 成像包括 T2 加权自旋回波和梯度回波图像、液体衰减反转恢复图像以及 T1 加权自旋回波图像，包括增强前后。将临床数据与 MR 成像数据相结合，以评估这两种方法发现钙化的效用；特别是，对 MR 成像上瘤内信号缺失点与 CT 扫描上高信号区之间的相关性进行了分析。
结果
28 只眼中，检眼镜检查发现钙化 12 只（42.85%）；超声检查发现钙化 20 只（95.23%）；CT 显示 28 只眼中 27 只（96.42%）存在与钙化一致的高信号瘤内区域；MR 成像显示 28 只眼中 25 只（89.28%）存在瘤内信号缺失点。MR 成像上所有发现的点均与 CT 扫描上的钙化相对应。梯度回波 T2*-加权和快速自旋回波 T2 加权图像与 CT 的相关性最高。当我们将检眼镜、超声和 MR 成像数据结合起来时，CT 未发现任何遗漏的钙化，并且进行了彻底的鉴别诊断。
结论
将临床数据与 MR 图像相结合，可能会使视网膜母细胞瘤的研究方案避免潜在的有害电离辐射。
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