胸壁神经鞘瘤的多排螺旋CT表现及诊断价值

Manifestation and diagnostic value of MDCT for neurolemmoma of chest wall

目的分析胸壁神经鞘瘤的多排螺旋CT(MDCT)表现,提高对其诊断水平。方法回顾性分析15例经病理证实的胸壁神经鞘瘤的MDCT和临床资料。结果 15例均为单发肿瘤,位于右侧胸壁9例,左侧胸壁6例。肿瘤形态多较规则,6例呈类圆形,9例梭形,最大直径约3.7～13.4 cm,平均6.3 cm。瘤-肺界面均光整,13例肿瘤与胸壁广基底相邻,二者夹角呈钝角;2例较大肿瘤的瘤体主体在肺内,与胸壁夹角呈锐角。肿瘤CT平扫呈不均匀较低密度,8例内见斑片状、条状相对略高密度区,2例见钙化。增强扫描强化程度及强化方式多样,多呈轻～中度不均匀强化,以岛状分布的片状、线条状、斑点状强化多见。2例较大肿瘤内侧见压迫性肺不张,7例病灶周边胸膜增厚,2例伴有胸腔积液,9例相邻肋骨间隙增宽,肋骨见弧形压迹。结论 MDCT对胸壁神经鞘瘤的诊断及鉴别诊断具有较大价值。

Objective To analyse the manifestation of MDCT for neurolemmoma of chest wall, and improve its diagnostic accuracy. Methods The MDCT findings and clinical data of 15 cases of neurolemmoma of chest wall proved by surgery and pathology were analysed retrospectively. Results All 15 cases had single tumor,which was located in right in 9 and in left chest wall in 6 cases. Six cases showed oval shape and 9 fusiformis shape. The maximal diametre was 3.7 - 13.4 cm,the average number was 6.3 cm. The interface between the tumor and lung was smooth. Tumors in 13 cases contacted the chest wall with broad base, the included angle was obtuse angle. The main body of 2 big tumors was located in the lung, the included angle between the tumor and chest wall was acute angle. All tumors showed asymmetrical low density on non-contrasted scan. Eight cases accompanied with high density area of spot or strip shape,2 cases accompanied with calcification. On enhanced scan, the enhanced degree and pattern were various, most tumors showed slight to moderate asymmetrical enhancement, with isle, spot and strip shapes. Two cases of big tumors accompanied with the atelectasis of the inner lung tissue, 7 cases showed the thickening of corresponding pleura, 2 cases showed pleural effussion, 9 cases showed the enlargement of local interval of ribs and curve compression seen in ribs. Conclusion MDCT showed important value for the diagnosis and identification for neurolemmoma of chest wall.