原发性非黏液瘤性良性心脏心包肿瘤的影像学评价

Imaging Diagnosis of Primary Benign Nonmyxomatous Neoplasms of the Heart and Pericardium

目的 分析原发性非黏液瘤性良性心脏心包肿瘤的影像学特征 ,评估几种常用的影像学诊断方法的主要优势及局限性。资料与方法 搜集 1979年 1月～ 2 0 0 4年 3月间经手术及病理证实的原发性非黏液瘤性良性心脏心包肿瘤 4 4例 ,其中接受电子束CT(EBCT)检查者 2 0例 ,MRI检查者 16例。结果 X线平片示异常 31例 ;超声心动图 (UCG)定位诊断正确 31例 ;EBCT和MRI定位诊断全部正确 ,其中EBCT定性准确 9例 (脂肪瘤 4例 ,淋巴管瘤和心包囊肿各 2例 ,血管瘤 1例 ) ,MRI定性准确 9例 (脂肪瘤 5例 ,纤维瘤和囊肿各 2例 )。结论 X线胸片适合作为常规检查 ,UCG可作为首选初查且对心腔或心包腔内的肿瘤诊断准确率高 ,结合MRI高度的软组织分辨率和EBCT优良的空间、时间分辨率 ,可对大部分良性肿瘤进行组织学推断。

Objective To evaluate the value of several nonimvasive imaging techniques in the diagnosis of benign primary nonmyxomatous cardiac neoplasms and analyze the image feature of primary benign nonmyxomatous neoplasms of the heart and pericardium.Materials and Methods Between Jan 1979 and Mar 2004, a total of 44 cases with primary benign nonmyxomatous neoplasms of the heart and pericardium proved by surgical and pathology were analyzed in the present study. EBCT and MRI were performed in 20 and 16 patients respectively.Results Chest films in 31 of 44 patients were found abnormal. 31 tumors were detected by echocardiography. Neoplasms were all detected in patients with EBCT or/and MRI. EBCT findings are consistent with pathology in 9 cases, including 4 cases with lipoma and 2 with pericardial cyst, 2 with lymphangioma and 1 with haemangioma. MRI are consistent with pathology in other 9 cases including 5 cases with lipoma, 2 with fibroma and 2 with cardiac cyst.Conclusion Chest film could be used as a routine examination. Echocardiography is the preferred initial imaging modality, especially in evaluating intracardiac and pericardial neoplasms. With advantages of excellent high soft tissue resolution from MRI and outstanding temporal, spatial and density resolution from EBCT, most benign neoplasms can be diagnosed.