胸腺瘤的CT影像学特征与临床病理相关性分析

Relation study of CT and pathology in thymoma

目的:分析胸腺瘤的CT影像学特征,探讨其在胸腺瘤的临床病理学的价值。方法:回顾性分析58例胸腺瘤的临床资料与CT影像学表现,并进行临床分期、病理学对照分析。结果:胸腺瘤的CT影像学主要表现为不规则形,密度不均匀,胸膜、心包、肺受侵犯。A型和AB型胸腺瘤的CT影像学在肿块形态、边缘、密度、增强、局部侵犯和转移方面与B型胸腺瘤和胸腺癌差异有统计学意义(P<0.05)。与标本的手术病理比较,CT对肿块胸膜侵犯、心包侵犯和大血管侵犯的阳性预测率均为100.0%,对包膜不整和肺侵犯的阳性预测率分别为97.4%和90.9%;而在包膜不整、肺侵犯、心包侵犯和大血管侵犯的阴性预测率分别为90.0%、93.8%、92.5%和92.6%,在胸膜侵犯方面的阴性预测率为28.9%。CT影像表现的临床分期与术后病理分期相似,χ2=0.23,P=0.97。结论:A型和AB型胸腺瘤与B型胸腺瘤和胸腺癌之间的CT影像特征存在着一定的差异性;CT影像学对肿瘤包膜不整、肺侵犯、心包侵犯和大血管侵犯阳性预测率高,但对胸膜侵犯的阴性预测率低;采用CT可以准确进行临床分期,有利于决定治疗方案及预后的判断。

OBJECTIVE.. To analyse the imaging features of thymoma, and investigate the diagnostic value of CT in pathology of thymoma. METHODS： Totally 58 cases of thymoma were retro- spective analysed in terms of clinical date of CT imaging,and clinical stage,pathology. RESULTS： Characteristics of CT with thymoma were mainly irregular and uneven density clumps, invasion with pleura, pericardium and lung. Characteristic of CT with type A and AB thymoma were significantly different from type B thymoma and thymus cancer about tumor form, edge, density, reinforcement, local invasion and metastasis（P〈0.05）. Compared with pathology after surgery,the rates of positive predictive using CT about pleura invasion, pericardium invasion and vascular invasion were 100.0 %, and the rates of positive predictive using CT about involucrum invasion and lung invasion were 97.4% and 90.9%. On the other hand,the rates of negative predictive using CT about involucrum invasion, lung invasion, pericardium invasion and vascular invasion were 90.0% ,93.8% ,92.5% and 92.6% ,but the rate of negative predictive using CT about pleura invasion was only 28.9%. Clinical stage using CT was similar to pathological stage （χ2 =0.23,P=0.97）. CONCLUSIONS： Characteristic of CT with type A and AB thymorea are significantly different from type B thymoma and thymus cancer. The rates of positive predictive using CT about pleura invasion, pericardium invasion, vascular invasion, involucrum invasion and lung invasion were high, but the rate of negative predictive using CT about pleura invasion is low. The clinical stage using CT will be accuratel.