Objective To evaluate the value of PRETEXT staging system and CT imaging features in evaluating treatment response of pediatric hepatoblastoma (HB). Methods The multi-detector CT imaging features in 47 children with pathologically confirmed HB were retrospectively reviewed between January 2013 and August 2016. The consistency between PRETEXT stage and post-surgical pathological grade was assessed. The CT imaging findings, including tumor margin,morphology,intra-tumor hemorrhage,calcification and intra-tumor cystic necrosis, and pathological grades was evaluated. Results Out of 47 children with HB,30 (63.8%) were pathological-proven epithelial,and 17 (36.2%) with epithelial-mesenchymal type;eight children with HB,including 6 with PRETEXT stage II and 2 with PRETEXT stage III, received surgery without chemotherapy,and their PRETEXT stages was completely consistent with pathological-proven grade, and the accuracy rate between POSTTEXT stages and pathological grades reached 79.5% (31/39) in 39 children receiving surgery after chemotherapy;the overall accuracy of PRETEXT stage was 83.0% as compared with post-surgical pathological grade;out of ten children with tumor calcification,eight was with epithelial-mesenchymal type tumor, much higher than in with epithelial type (x2=8.313, P=0.004). Conclusion The PRETEXT stage is well consistent with post-surgical grade, and it might predict the pathological grade in consideration of specific image findings,which is helpful in determining management strategy of children with HB.%目的 探讨儿童肝母细胞瘤(HB)PRETEXT分期系统和CT征象在疗效评估中的应用价值.方法 2013年1月～2016年8月经组织病理学检查确诊的47例HB患儿,回顾性分析其CT检查资料,以术后组织病理学检查结果为参照,分析术前PRETEXT分期系统的正确性,并分析不同病理学分型患儿肿瘤边界、形态、出血、钙化和囊变坏死程度等CT征象的异同.结果 本组单纯上皮型30例(63.8%),上皮与间叶混合型17例(36.2%);8例直接手术患儿术前PRETEXT分期6例为II期,2例为III期,均与术后病理学诊断分期相符,39例化疗后手术患儿术前和术后PRETEXT分期准确率为79.5%(31/39);在47例患儿中,术前PRETEXTCT分期与术后病理学判定比,其准确率达83.0%(39/47);钙化多见于上皮与间叶混合型,本组病例中MDCT显示10例出现钙化,其中上皮与间叶混合型者8例,显著多于单纯上皮型(x2=8.313,P=0.004).结论 PRETEXT术前和术后分期诊断HB患儿的准确率较高,结合特征性CT征象可提示组织病理学分型,为HB临床决策提供较为可靠的依据.
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