MSCT对胸腺上皮肿瘤WHO简化病理分型的鉴别诊断价值

The value of MSCT in the differential diagnosis of thymic epithelial tumors of WHO simplified pathological classification

目的探讨多层螺旋CT(MSCT)对低危型、高危型胸腺瘤及胸腺癌的鉴别诊断价值。方法回顾性分析经病理(穿刺或手术)证实的67例胸腺上皮肿瘤,基于WHO病理分型简化为低危型胸腺瘤、高危型胸腺瘤及胸腺癌三组,并对其CT征象进行统计分析。结果67例TETs中,低危型胸腺瘤30例(A型3例、AB型20例、B1型7例),高危型胸腺瘤22例(B2型11例、B3型11例),胸腺癌15例。高危型胸腺瘤、胸腺癌较低危型胸腺瘤易表现为边缘分叶或不规则(P均<0.05)及易出现对心包侵犯(P均<0.05);胸腺癌较低危型胸腺瘤易出现增强后密度不均、囊变坏死及胸膜转移(P均≤0.003);胸腺癌较低危型、高危型胸腺瘤易出现纵隔淋巴结肿大(P均≤0.002);纵隔大血管侵犯在三组间两两比较均有统计学差异(P均<0.05)。结论MSCT对TETs的WHO简化病理分型鉴别诊断具有重要价值。

Objective To explore the value of MSCT in the differential diagnosis of low risk,high risk thymoma and thymic carcinoma.Methods The CT imaging of 67 patients with TETs confirmed by pathology(needle biopsy or surgery)were reviewed retrospectively,who were classified into 3 groups as low-risk thymomas,high-risk thymomas and thymic carcinomas,as well as the CT signs were analyzed statistically.Results In all of the 67 cases,there were 31 low-risk thymomas(3 in type A,20 in type AB,and 7 in type B1),22 high-risk thymomas(11 in type B2 and 11 in type B3),and 15 thymic carcinomas.High-risk thymomas and thymic carcinomas were more likely to have lobulated or irregular contours(P<0.05),pericardial invasion(P<0.05)than low-risk thymomas.Thymic carcinomas was more likely to have necroticor cystic component(P=0.003),heterogeneous contrast-enhancement(P=0.003)and pericardial invasion(P=0.002)than low-risk thymomas.Thymic carcinomas were more likely to have lymphadenopathy(P=0.001,0.002)than low-risk thymomas and high-risk thymomas.There were significant statistical differences in great vessels invasion between three groups(P<0.05).Conclusion MSCT imaging findings are valuable for distinguishing WHO simplified pathological subtypes of TETs.