螺旋CT诊断胸膜斑的临床价值

Clinic Application of SCT Diagnosis for Pleural Plaque

目的:研究胸膜斑的螺旋CT表现,提高诊断和鉴别诊断水平。材料和方法:回顾性分析与石棉粉尘密切接触的42例胸膜斑的螺旋CT表现。结果:42例中,螺旋CT发现胸膜斑407个,其中透明型/非钙化型胸膜斑250个、钙化型胸膜斑36个和混合型胸膜斑121个;单侧10例、双侧32例;单发胸膜斑5例,多发胸膜斑37例;最大胸膜斑长4.2cm,厚1.2cm;胸膜斑的形状多种多样;钙化型和混合型胸膜斑内可见不同形态的钙化;胸膜斑多位于中、下胸部前或后外侧胸壁,肋骨下方28例(66.7%),侵犯双侧膈顶10例,心包4例,合并肺纤维化4例,6例增强扫描胸膜斑未见增强;肺尖和肋膈角不受累。正确诊断42例,正确诊断率100%。结论:螺旋CT能清晰地显示胸膜斑的部位、分布、范围、形态、大小、密度及其毗邻关系,结合石棉粉尘接触史,能与其他胸膜增厚病变鉴别,明确诊断。对胸膜斑/石棉肺,螺旋CT是最佳的影像学检查方法。

Purpose To study the spiral CT（SCT）appearances of pleural plaques,to improve the accuracy of diagnosis and differential diagnosis,and to evaluate clinic application.Materials and Methods The SCT appearances in 42 cases with pleural plaques were analysed retrospectively,which closed met with asbestos dust.Results SCT showed 407 pleural plaques in 42 cases,of which there were hyline /uncalcified pleural plaques（n=250）,calcified pleural plaques（n= 36）,mixed pleural plaques（n=121）;unilateral pleural plaques（n=10）,bilateral pleural plaques（n=32）;single pleural plaque in 5 cases,multiple pleural plaques in 37 cases.The largest pleural plaque was 4.2cm×1.2cm.There were a lot of shapes of the pleural plaques.Various shapes of calcifications could be showed in the calcified or mixed type pleural plaques.The pleural plaques distributed in the middle-inferior part,anterior /posterior-lateral chest wall,underlying the ribs in 28 cases（66.6 %）,both bilateral domes of diaphragm in 10 cases and mediastinal pericardium in 4 cases.The pleural plaques associated with pulmonary intertitial fibrosis in 4 cases.No cases in the apices /costophrenic angles.No enhancement of pleural plaques in 6 cases which were administrated contrast scan.Conclusion SCT can clearly show the distribution,extention,shape,size,density and relation to adjacent tissues of the pleural plaques,and with asbestos exposure history,can make a diagnosis and differential diagnosis from other pleural thickened lesions.SCT is the best choice of imaging methods for asbestosis and pleural plaque.