多层螺旋CT检查在恶性胸膜间皮瘤中的临床价值

Clinical Value of Multi-slice Spiral CT in Malignant Pleural Mesothelioma

目的探讨多层螺旋CT检查在恶性胸膜间皮瘤中的临床价值,以提高对该病的诊断及鉴别诊断。方法回顾性分析我院2017年4月至2021年4月经病理学确诊的23例原发恶性胸膜间皮瘤的CT资料。结果23例恶性胸膜间皮瘤病灶均位于一侧胸廓。其中13例胸膜环周状增厚(厚度约1.5~5cm);8例多发结节、肿块状胸膜增厚(厚度约0.5~6cm),2例胸膜局限增厚呈单发肿块样(厚度分别约2cm、4cm);15例胸廓体积缩小,13例累及叶间胸膜,10例累及纵隔胸膜,4例病变胸膜增厚合并状钙化,3例肺门淋巴结转移,2例纵隔淋巴结肿大,2例发生胸壁外侵犯,1例肺内转移,1例肝脏转移,17例均见不等量的胸腔积液合并肺组织不张。CT平扫病变呈等、低或者混杂密度,增强检查呈轻度-明显强化,较大病变内见不强化的液化坏死、囊变。结论恶性胸膜间皮瘤多层螺旋CT表现有一定的特征,对其诊断及鉴别诊断有较大价值。

Objective To explore the clinical value of multi-slice spiral CT in malignant pleural mesothelioma,so as to improve the diagnosis and differential diagnosis of the disease.Methods Retrospective analysis of CT data of 23 cases of primary malignant pleural mesothelioma diagnosed by pathology in our hospital from April 2017 to April 2021.Results 23 cases of malignant pleural mesothelioma lesions were located on one side of the thorax.Among them,13 cases of pleural circumferential thickening(thickness of about 1.5-5 cm);8 cases of multiple nodules and mass-like thickening of the pleura(thickness of about 0.5 cm to 6 cm),2 cases of limited pleural thickening showed a single mass(the thickness is about 2 cm,4 cm respectively);15 cases of thoracic volume reduction,13 cases involving interlobular pleura,10 cases involving mediastinal pleura,4 cases of diseased pleural thickening with calcification,3 cases of hilar lymph node metastasis,2 cases of longitudinal diaphragmatic lymph nodes were enlarged,2 cases had extra-thoracic invasion,1 case had intrapulmonary metastasis,1 case had liver metastasis,and 17 cases had different amounts of pleural effusion and atelectasis.CT plain scan lesions are of equal,low or mixed density.Enhancement examination is mild-significantly enhanced,and non-enhanced liquefaction necrosis and cystic transformation are seen in larger lesions.Conclusion Malignant pleural mesothelioma has certain characteristics with multi-slice spiral CT,which is of great value in its diagnosis and differential diagnosis.