后纵隔非神经源性肿块影像分析

Analysis of the Imaging Features of the Non-neurogenic Tumors in the Posterior Mediastinum

目的探讨后纵隔非神经源性肿块影像表现,提高对该类病变的诊断水平。方法回顾性分析经病理证实31例后纵隔非神经源性肿块的影像表现。结果支气管囊肿13例,均为单发、圆形或类圆形、边缘光滑囊性包块。孤立性纤维瘤3例,1例见粗大迂曲动脉。脂肪肉瘤3例,2例见脂肪及软组织混杂成分。脂肪瘤1例。血管瘤2例,1例见点状钙化及粗大血管影。间叶性错构瘤1例,内见小灶脂肪样密度影及钙化。巨淋巴结增生症2例,明显均匀强化。巨细胞多形性未分化肉瘤1例,明显不均匀强化。单纯囊肿2例。髓外造血2例,髓脂肪瘤1例,均为脊柱两侧多发肿块。结论支气管囊肿为后纵隔神经源性肿瘤外最常见脊柱旁肿块,余病变发生率均较低下。丘状、分叶形态、不典型“哑铃征”有助于提示非神经源肿瘤,且出现“哑铃征”时应重点观察椎管内侵入及脊髓受压情况。MR对支气管囊肿、血管瘤等鉴别有较大作用,在病变累及椎间孔、椎管时显示优于CT。

Objective To investigate the imaging features of the non-neurogenic tumors in the posterior mediastinum in order to improve the diagnostic level.Methods The imaging features of 31 cases with non-neurogenic tumors in the posterior mediastinum confirmed by pathology were analyzed retrospectively.Results There were 13 cases of bronchogenic cysts,all of which were single smoothly rounded or oval cystic masses.There were 3 cases of solitary fibrous tumors,1 of which showed a thickened and tortuous vascular.There were 3 cases of liposarcoma,2 of which showed mixed fat and soft tissue.There were 1 case of lipoma.There were 2 cases of hemangioma,1 of which showed mottled calcifications and thickened vascular.There were 1 case of hamartoma alternating with fat and calcifications.There were 2 cases of Castleman’diseases with obvious homogeneous enhancement.There 1 case of giant cell undifferentiated pleomorphic sarcoma with obvious heterogeneous enhancement.There were 2 cases of cysts.There were 2 cases and 1 case of extramedullary hematopoiesis and myelolipoma,which showed as bilateral paraspinal masses.Conclusion The bronchogenic cysts were the most frequent masses of the non-neurogenic tumors in the posterior mediastinum,others were rare.The mass with mound like,lobulated borders and atypical“dumbbell”signs were indicated non-neurogenic tumors.It should lay emphasis on the invasion of spinal canal and compression of spinal cord when atypical“dumbbell”signs showed up.MR were essential in the differential diagnosis of bronchogenic cyst and hemangioma,and were superior to CT in demonstrating the extending of tumors through the intervertebral foramina to spinal canal.