Department of Paediatric Radiology, The Royal London Hospital, London, UK.
Clin Radiol. 2013 Jan;68(1):16-20. doi: 10.1016/j.crad.2012.05.006. Epub 2012 Aug 11.
To assess the added information gained from computed tomography (CT) or magnetic resonance imaging (MRI) of the abdomen over abdominal ultrasound in children undergoing staging of Wilms' tumours.
Fifty-two consecutive patients with histologically proven Wilms' tumours were identified. Each had an initial staging abdominal ultrasound followed by either a CT or MRI examination of the abdomen. Details including tumour size, site, and characteristics, presence of lymph nodes, local invasion, evidence of nephroblastomatosis, and any other relevant finding were gathered from the report of each ultrasound and CT or MRI. Each CT/MRI was then re-reviewed by a consultant paediatric radiologist and a paediatric radiology fellow. The difference in findings between the ultrasound and cross-sectional imaging were noted.
Twelve patients were excluded from the study because the CT/MRI was performed before the ultrasound, or imaging was incomplete. Twenty-six patients were female, 14 male. The ages ranged from 9 months to 10.8 years (mean 3.75 years). Twenty-one patients out of the remaining 40 had additional findings detected on the CT or MRI examination that had not been reported on the ultrasound. The most important additional findings included three patients with nephroblastomatosis and two with contralateral tumours. Other findings included two patients with tumour haemorrhage, four with abdominal lymph node enlargement, three with inferior vena cava (IVC)/renal vein thrombus, four with adjacent organ invasion, one patient where the origin of the abdominal tumour was confirmed as renal, and one patient where possible liver invasion was excluded.
In over half the patients, CT or MRI added additional information in the local staging of Wilms' tumours. Sole reliance on ultrasound for Wilms' staging risks missing significant abnormalities.
评估腹部计算机断层扫描（CT）或磁共振成像（MRI）相对于腹部超声检查在儿童 Wilms 瘤分期中的附加信息。
确定了 52 例经组织学证实的 Wilms 瘤连续患者。每位患者均进行了初始分期腹部超声检查，随后进行 CT 或 MRI 腹部检查。从每次超声和 CT 或 MRI 的报告中收集了详细信息，包括肿瘤大小、部位和特征、淋巴结是否存在、局部侵犯、肾胚细胞瘤的证据以及任何其他相关发现。然后由一名顾问儿科放射科医师和一名儿科放射科医师对每例 CT/MRI 进行重新评估。记录了超声与横断面成像之间的发现差异。
由于 CT/MRI 在超声检查之前进行，或者成像不完整，12 例患者被排除在研究之外。26 例为女性，14 例为男性。年龄范围为 9 个月至 10.8 岁（平均 3.75 岁）。在其余 40 例患者中，有 21 例在 CT 或 MRI 检查中发现了超声未报告的其他发现。最重要的附加发现包括 3 例肾胚细胞瘤和 2 例对侧肿瘤。其他发现包括 2 例肿瘤出血、4 例腹部淋巴结肿大、3 例下腔静脉（IVC）/肾静脉血栓形成、4 例邻近器官侵犯、1 例患者腹部肿瘤起源被证实为肾脏，1 例患者排除了可能的肝侵犯。
在超过一半的患者中，CT 或 MRI 在 Wilms 瘤的局部分期中增加了额外的信息。仅依靠超声进行 Wilms 分期可能会遗漏重要的异常。
