胸膜间皮瘤影像学诊断的优选

Optimalselectionofimagingmodalitiesindiagnosisofpleuralmesothelioma

目的：评价各种影像检查在胸膜间皮瘤诊断中的作用。材料与方法：回顾性分析４７例经临床、手术及病理证实的胸膜间皮瘤的影像学资料，所有病人均经胸部Ｘ线平片检查；２７例经超声检查，其中１１例在超声引导下进行了经皮胸膜活检；１０例经ＣＴ检查；１７例经ＭＲＩ检查。结果：胸部Ｘ线平片表现为单发肺野内肿块４例，波浪状胸膜增厚、多发性胸膜结节或肿块３３例，纵隔影增宽３例，心包积液样改变３例，仅表现为胸腔积液４例。超声检查均把胸膜结节或肿块同胸水加以鉴别，并在１１例中成功地引导了胸膜活检。ＣＴ显示叶间胸膜肿块１例，广泛性胸膜增厚、结节或肿块９例，均合并不同程度胸水。ＭＲＩ均显示胸膜增厚、结节或肿块，包绕患侧肺组织，肿瘤在Ｔ１加权图像上呈中等信号，在Ｔ２加权图像上呈高信号。病变侵犯纵隔１１例，膈肌３例，延伸入肺叶间裂２例，纵隔淋巴结转移３例，肿瘤直接侵犯腹膜１例。结论：胸部Ｘ线平片、超声、ＣＴ和ＭＲＩ在胸膜间皮瘤的诊断中具有相互补充作用。胸部Ｘ线平片仍然是首选的方法，是各种影像检查的基础。超声可以弥补Ｘ线平片的某些不足。ＣＴ在评价肿瘤的侵犯范围方面优于Ｘ线平片，ＣＴ和ＭＲＩ在确定肿瘤的侵犯范围和程度方面具有相同作用，但由于ＭＲ具?

Purpose:Toevaluatetheusefulnesofvariousimagingmodalitiesindiagnosisofpleuralmesothelioma.Materialsandmethods:Imagingdatain47patientswithclinicalyandpatho-logicalyprovedpleuralmesotheliomawerestudiedretrospectively.Plainchestfilmsweredoneinalpatients;sonographyin27,sonographyguidedpercutaneouspleuralneedlebiopsyin11of27patients;CTin10andMRIin17.Results:Plainfilmsshowedsolitarymassin4cases,wavypleuralthickeningandpleuralnodulesormassesin33,wideningofmediastinalshadowin3,efusion-likechangeofpericardiumin3andonlypleuralefusionin4.Sonographyhadbenefittodelineatepleuralnodulesormasesfrompleuralfluidinalpatientsandtoguidesuccessfulypercutaneousneedlebiopsyofthepleurain11cases.CTscansidentifiedamasofinterlobarfissurein1case,anddifusepleuralthickeningandpleuralnodulesormassesfromvariableamountsofpleuralfluidin9cases.OnMRimagingalpatientshadpleuralthickening,nodulesormassessuroundingthelungontheafectedside.ThesetumorshadasignalofintermediateintensityonT1-weightedimages,whileonT2-weightedimagesaslightincreaseinsignalintensityofthemaseswasseen.Thelesionextendedintomediastinumin11cases,diaphragmin3,andspreadedintotheinterlobarfissuresin2cases.Lymph-adenopathywasdemonstratedwithMRIin3patients.DirectretroperitonealextensionwasseenonMRimagingin1case.Conclusion:Therolesofplainfilms,sonography,CTandMRIintheevaluationofpleuralmesotheliomaarecomplementary.Plainfilmsremaintheinitialchoice.Sonographycouldsupplementtheplainfilmsinsomedegree.CThasbenshowntobesuperioroverplainfilmsinevaluationofthisneoplasm.CTandMRIcouldprovidesimilarinformationsfordeter-minationofextentofthetumor,MRscansareslightlysuperioroverCTforappreciationofinvolve-mentoftheminorfissure,diaphragmandperitonium,becauseofitsmultiplanarcapability.Ontheotherhand,CTismoresensitiveindemonstrationofcalcificationwithinthetumorandribdestruc-tion.Sonography-guidedbiopsyissafe,simpleandaccurate.Rationaluseofvariousimagingmodali-tieswouldimprovethediagnosticaccuracyofmesothelioma.Finaly,theauthorsproposedanopti-malimagingapproachindiagnosisofpleuralmesothelioma.