CT在恶性胸膜间皮瘤诊断中的价值

The Value of CT in Diagnosis of Malignant Pleural Mesothelioma

目的探讨CT在恶性胸膜间皮瘤诊断中的价值。资料与方法回顾分析9年来我院经手术或/和病理证实的42例恶性胸膜间皮瘤患者的CT资料,并与12例手术所见作比较。结果结节状或肿块状胸膜增厚(97.6%)是胸膜间皮瘤最常见的CT表现,有诊断性的表现为胸膜增厚>1cm(59.5%),环状胸膜增厚(41.5%),病变累及纵隔胸膜(92.9%)或叶间裂(69.0%),病变侵犯周围胸壁或/和肋骨、纵隔、心包、膈肌等邻近组织或器官(65.9%),1例呈胸内巨大肿块,42.9%病例可见纵隔或/和肺门淋巴结肿大。在CT和手术所见的比较中,CT准确检出了13处(65%)对周围组织或器官的侵犯,漏诊7处(35%)。结论CT在恶性胸膜间皮瘤的诊断、分期上有重要价值,是治疗前的标准诊断方法。

Objective To discuss the CT value in diagnosis of malignant pleural mesothelioma. Materials and Methods The CT findings of 42 cases with malignant pleural mesothelioma confirmed pathologically over a nine years period were retrospectively reviewed, and compared the findings of 12 cases of them with the results of thoracotomy. Results The nodular and/or lumpy diffuse pleural thickening（97.6% ） was the commonest CT finding. The diagnostic CT appearances were pleural thickening larger than 1 cm （ 59.5% ）, rindlike pleural thickening （41.5%）, mediastinal （ 92.9% ） or fissural （69.0%） pleural involvement and extended through the pleural cavity invasive of the chest wall, lung, mediastinum and diaphragm（65.9% ）. 1 case presented with a large mass and 42.9% cases had mediastinal and/or hilum lymph node enlargement. On comparison of CT and operation findings, CT correctly picked out 13 lesions （65%） of invasive of the chest wall, mediastinum and diaphragm, and missed 7 lesions （35%）, which were diagnosed by operation. Conclusion CT has important value in the diagnosis, stage of malignant pleural mesothelioma, and should be considered the standard diagnostic method before therapy.