胸壁神经鞘瘤的MSCT表现分析

An investigation on the features of schwannoma in the chest wall in multi-slice CT images

目的探讨胸壁神经鞘瘤的多层螺旋CT(MSCT)表现,以进一步提高其诊断正确率。方法回顾性分析6例经手术病理证实为胸壁神经鞘瘤的MSCT表现及临床资料,并复习文献。结果男4例,女2例,平均41.6岁。6例均为肋间隙单发病灶,4例位于右侧胸壁,2例位于左侧胸壁。平均直径约3.8 cm,2例直径大于5 cm。MSCT上5例肿块边界清晰,肺组织受压推移,1例与肺组织粘连,边界模糊。4例形态呈规则类圆形,2例边缘分叶状。平扫1例密度较为均匀,增强呈明显均匀强化。5例密度不均匀,表现为囊实性软组织肿块,增强后呈不均匀轻-中度强化。6例病灶均未见出血及钙化。邻近肋骨3例见压迫性骨质吸收,1例骨质硬化,4例相应肋间隙增宽,未见胸腔积液。结论胸壁神经鞘瘤具有一定特征性的影像学表现,结合临床,可提高其诊断正确率。

Objective To investigate the multi-slice CT （MSCT） findings of Schwannoma in the chest wall, and the possibility of improving its diagnosis with this imaging modality. Methods Six cases of pathologically/surgically confirmed chest wall Schwannoma were retrospectively collected and the MSCT images were analyzed. The results were compared to literature. Results Among the 6 patients, 4 cases were male, 2 were female, with an average of 41.6. All of them were single lesions on the rib gap; 4 cases located fight chest wall, 2 cases located left chest wall. The mean size of the tumors was 3.8 cm, in which 2 were more than 5 cm. On plain MSCT 5 lesions showed clear boundary in which lung tissue were compressed and elapsed, I adhered to adjacent lung tissue and had blurred boundary. 4 cases had regular round shape, 2 were lobulated. The density was homogeneous in 1 case and showed obviously enhanced evenly and was inhomogenous in 5 cases （cystic-solid soft tissue mass which were lightly to moderately enhanced unevenly after enhancement scan）. And there were no hemorrhage and calcification observed in 6 cases. 3 cases were seen with oppressive absorption of adjacent fibs, 1 case was osteosclerosis, and 4 cases were corresponding 4ib gap widened. All lesions had no pleural effusion. Conclusions The Schwannoma of chest wall has certain characteristic in MSCT images. Combined with other methods, it can improve the accuracy in diagnosis while the final diagnosis would still depend on pathology.