恶性胸膜间皮瘤的CT诊断

CT Diagnosis of Malignant Pleural Mensothelioma

目的 分析恶性胸膜间皮瘤的CT征象 ,评价CT对本病的诊断价值。方法 回顾性分析 2 2例经组织学证实的恶性胸膜间皮瘤的CT征象 ,并讨论其鉴别诊断。结果 2 0例弥漫性恶性胸膜间皮瘤患者中 ,19例胸膜增厚大于 10mm ,占 95 % ,胸膜增厚呈结节状或肿块状 13例 ,占 6 8% ,环状胸膜增厚 15例 ,占 75 % ,纵隔胸膜受侵犯 18例 ,占 90 % ,2 0例有半侧胸体积缩小 ,7例CT判断为 1期的患者 ,手术证实 3例有胸壁破坏或横膈下蔓延 ,其中 2例同MRI所见。结论 恶性胸膜间皮瘤的诊断缺乏特异性CT征象 ,但CT在确定病变部位、范围及随访方面有帮助 ,MRI是CT的重要补充。

Objective ToanalaysetheCTfindingsofmalignantpleuralmensotheliomaanddeterminetheusefulnessof CTinthedifferentialdiagnosisofpleuraldiseases .Methods TheCTscansof2 2patientswithmalignantpleuralmensothe liomaprovedhistologicallywereretrospectivelyreviewed ,andthedifferentialdiagnosisofpleuraldiseaseswasalsodiscussed . Results Of 2 0 patientswithmalignantdiffusepleuralmesothelioma,pleuralthickeningmorethan 10mmin 19patients (95 % ) ,nodular/massivepleuralthickeningin 13(6 8% ) ,rind likepleuralthickeningin 15 (75 % ) ,mediastinalpleuralin volvementin 18(90 % ) ,contractionoftheinvolvedhemithoraxinall 2 0 patients.Of 7patientsclassifiedasstage 1onCT scans,chestwallinveasionorinfradiaphragmaticinvasionconfirmedbyoperationin 3patients,alsoshowedonMRIin 2 (2 / 3) .Conclusion Themostcommonfindingsofmalignantpleuralmensotheliomaarepleuralthickeninggreaterthan 10mm , nodular/massivepleuralthickening ,mediastinalpleuralinvolvementandrind likepleuralthickening .Frozen hemithoraxis quitecharacteristic ,butnotpathognomonic .CTishelpfulindetectingthelocation ,extentofpleurallesionsandfollow upof patients .However,MRIisimportantcomplementarytoCTinsomeaspects . [