胸膜间皮瘤的CT诊断

CT Diagnosis of Pleural Mensothelioma

目的:回顾性分析胸膜间皮瘤的CT表现,评估CT诊断胸膜间皮瘤的价值。材料和方法:20例胸膜间皮瘤均经病理证实,其中开胸术14例,全麻下胸膜活检3例,CT导引下经皮穿刺活检1例,胸腔镜下活检2例,均作了CT检查。结果:20例胸膜间皮瘤中,良性6例,恶性14例。局限性结节样或团块状胸膜增厚9例,良性6例,恶性3例;结节或肿块<5cm6例,其中良性5例;肿块与胸壁夹角为锐角者4例均为良性;平扫及增强密度较均匀者5例,均为良性。11例弥漫性胸膜增厚均为恶性,其中胸膜增厚>1cm以上9例,环状增厚呈盔甲状5例,纵隔胸膜受侵10例,9例伴有胸水,7例手术证实有胸壁或横膈侵犯。14例恶性胸膜间皮瘤中,ButchardⅠ期5例,Ⅱ期5例,Ⅲ期3例Ⅳ期1例。结论:CT能很好地显示病变的部位、形态、大小、密度、范围,与周边组织的关系,有否远处转移,可鉴别病变的良、恶性并对恶性病例进行分期,对临床的治疗有非常重要的指导作用。

Purpose： To study the CT features of pleural mensothelioma, and to evaluate the CT diagnostic value. Materials and Methods： 20 patients with pleural mensothelioma proved histologically were performed CT scan, among 20 cases, 14 cases with thoracotomy, 3 cases with biopsy of pleura under general anesthesia, one case with biopsy of pleura through percutaneous puncture guided by CT, two cases with biopsy of pleura by thoracoscope. Results： Of 20 patients with pleural mesothelioma, 6 cases were benign and 14 cases were malignant. Local nodular or massive pleural thickening in 9 cases, 6/9 were benign, 3/9 were malignant; among 6 nodule or mass less than 5 cm, 5 were benign; all 4 cases with acute included angle between mass and chest wall were benign; all 5 cases with even density before and after enhancement were benign. Diffuse pleural thickening in 14 cases were malignant, 9 cases with pleural thickening over 1 cm, 5 cases with circularity pleural thickening like armature, mediastinal pleural involvement in 10 cases, pleural effusion were observed on CT scan in 9 patients, chest wall invasion or infradiaphragmatic invasion confirmed by operation in 7 patients. Of 14 malignant cases, 5 cases were classified as stage Ⅰ according to Butchard classification, 5 as stage Ⅱ, 2 as stage Ⅲ, 1 as stage Ⅳ . Conclusion： CT is helpful in detecting the location , extent of pleural lesions , differentiating the pleural mensothelioma and classifted the stage of malignant cases,and play a very important guidance role for clinical therapy.