胸部神经鞘瘤CT与病理对照研究(附35例分析)

Correlative pathologic and CT studies of thoracic neurilemoma (analysis of 35 cases)

目的 进一步认识胸部神经鞘瘤的CT表现 ,提高诊断准确率。方法 对 3 5例 ( 3 7个肿瘤 )首先行CT平扫 ,再行增强扫描。每例留取大体和组织学标本 ,将CT所见与病理组织进行比较。结果 3 7个肿瘤按CT增强所见分为 2组 :不均匀强化组和无明显强化组。不均匀强化组分为 4种类型 :( 1)弥漫性形态不规则的非均匀性强化 :共 2 0个 ( 5 4 .1% )。 ( 2 )多发性低密度区或囊变区伴轻度放射状强化 :6个 ( 16.2 % )。 ( 3 )边缘强化伴中间低密度区 :5个 ( 13 .5 % )。 ( 4 )中央强化而周围呈低密度 :1个 ( 2 .7% )。无明显强化组 :5个 ( 13 .5 % ) ,表现为强化不明显 ,呈均匀性低密度。在病理上将 3 7个肿瘤根据其病理学特点分为 2种组织类型 :AntoniA型 (束状型 ) ;AntoniB型 (网状型 )。将肿瘤的CT表现尤其是增强表现与各病理类型进行比较 ,发现病灶呈非均匀性强化的 ,其病理组织绝大多数为AntoniA型 ,而强化不明显者主要为AntoniB型。结论 两种病理组织类型是CT表现复杂化及误诊的主要原因。恶性神经鞘瘤的CT特征性表现与肿瘤大小、密度及强化形式无关 ,而边缘不光整及对周围结构的侵犯破坏则高度提示恶性的可能性。

Objective TheCTandpathologicfindingsofneurilemonasin 3 7patientsprovedbyoperation andpathologywereretrospectivelyanalyzedinordertoimprovediagnositicaccuracy.Methods Bothplainand enhancedCTstudiesweredone ,theresultswerecomparedwithpathologicfindings.Results Accordingtothe patternofCTenhancement.Thetumorwasclassifiedintotwogroups:thosewithinhomogeneousenhancementand withoutenhancement.Theinhomogeneousenhancedgroupwasfurherdividedintofourtypes :( 1)Diffuse , amorphous,inhomogeneousenhancement,2 0 ( 5 4 .1% ) ;( 2 )Multiplelowdensityorcysticareaswithradial enhancement,6( 16.2 % ) ;( 3 )Peripheralenhancementwithalargecentralhypodensearea ,5 ( 13 .4 % ) ;( 4 ) Centralenhancementwithperipheralhypodensity 1( 2 .7% ) .Thenonenhancementgroupmainlydemonstrated homogeneoushypodensity,5 ( 13 .5 % ) .Pathologically ,the 3 7tumorsweredivisibleintotwodifferenttypes : AntoniApattern (Bunchypattern) ,withdense,spindlecellsinpalisadeandmorevascular;andAntoniB pattern (Reticularpattern) ,withsparsecelllessvascular,andmoredegenerativechanges.Thetumorwith inhomogeneousenhancementonCTmainlyconsistedofthetissuesofAntoniAtypeandtumorswithnonenhanced hypodensitybelongedtoAntoniBtype .Conclusions Thedifferentpathologictypeswithdifferentenhancement behavioraccountforthecomplexmanifestationsofthoracicneurilemomandfrequentmisdiagnosis .TheCTfindings ofmalignantneurilemomaarenotrelatedtosize ,densityandenhancedpatternsofthetumorwhileirregularmargin andsurroundinginvasionarehighlysuggestiveofmalignancy .