胸膜CT改变对良恶性胸腔积液的鉴别价值

The value of pleural membrance CT features for benign and malignant pleural effusion differentiation

目的分析良、恶性胸腔积液的胸部CT片,总结对鉴别良、恶性胸腔积液有价值的胸膜改变的CT征象。方法最终确诊的20例恶性胸腔积液及30例良性胸腔积液病人的胸膜改变方面的CT征象回顾分析。结果良性胸腔积液胸膜增厚主要呈弥漫均匀增厚,以中下部胸膜为主;胸膜外脂肪层明确显示;胸腔体积无明显改变,纵隔胸膜增厚;包裹性胸腔积液;胸膜钙化、脏层胸膜增厚和粘连、肺基底部胸膜增厚光滑且小于10mm,这些征象特异性分别为81.0%、62.0%、83.5%、78.0%和85.0%。恶性胸腔积液胸膜病变的CT征象主要是环状胸膜增厚,结节状胸膜增厚;壁层胸膜厚度大于10mm;一侧胸膜受累且中上部胸膜病变较显著,以上改变的特异性分别为100.0%、86.9%、72.0%和91.0%。结论应用CT观察胸膜改变对胸腔积液的良、恶性鉴别诊断有价值,与临床结合能提高诊断的准确率。

Objective To summarize the valuable pleural change of chest CT for benign and malignant pleural effusion differentiation. Methods The pleural change of CT of 20 malignant and 30 benign pleural effusion cases were analyzed retrospectively. Results In benign pleural effusion cases, pleural thicken with almost widespread and regular, primarily occurred in the middle and lower part of pleural; extrapleural fact （EPF） were demonstrated; thoracic cavity volume didn＇t decrease, mediastinal pleural thicken, encapsulated pleural effusion; pleural calcify, visceral pleura thicken and conglutination can be seen and base pleura thicken were all smooth, the thickness were 〈 10mm. The specificity of the above features were 81.0% , 62.0% , 83.5% , 78.0% and 85.0% respectively. In malignant pleural effusion cases, pleural thicken were annular and nodulated; parietal pleura thicken, the thickness were 〉 10mm; occurred in unilateral upper part of pleura. The specificity of the a- bove features were 100%, 86.9%, 72. 0% and 91.0% respectively. Conclusion Pleural CT features were valuable in benign and malignant pleural effusion differentiation, combining the clinical symotom can help to confirmed diagnosis.