石棉相关性恶性腹膜间皮瘤的CT 诊断

目的 分析石棉相关性恶性腹膜间皮瘤的CT 表现,以期提高认识.方法 17 例病理证实的石棉相关性恶性腹膜间皮瘤患者纳入研究,男1 例,女16 例,年龄36～79 岁,平均53 岁.螺旋CT 全腹部扫描,层厚5 mm,平扫后以3 ml/s 注射非离子型碘对比剂90 ml,动脉期（延迟30 s）和门脉期（延迟70s）采集.2 位资深CT 诊断医生共同回顾性评价分析.结果 全部病例出现肠系膜增厚、混浊和腹水（100%）,其中10 例为中大量,3 例包裹;大网膜增厚16 例（94%）,其中14 例呈饼状,10 例显示增粗血管影,3 例形成大网膜肿块,明显强化;腹膜结节状及条状增厚12 例（82%）;5 例形成盆腔肿块（29%）,其中2 例部分囊性;伴淋巴结增大8 例（47%）.同时在膈面层面范围内显示胸膜斑15 例（88%）、胸腔积液5 例以及合并恶性胸膜间皮瘤1 例.结论 石棉相关性恶性腹膜间皮瘤的CT 表现有一定特征性,广泛的网膜、系膜、腹膜增厚及腹水,结合胸膜斑和石棉接触史病史,有助于诊断.

CT diagnosis of asbestos-related malignant peritoneal mesothelioma

Objective To study the CT diagnostic features of asbestos-related malignant peritoneal mesothelioma （AR-MPM）. Methods Seventeen patients （1 male,16 female;age range：36-79 years, mean 53 years） with pathologically proved AR-MPM were enrolled in our study. Spiral CT with slice-thickness of 5ram was acquired in the 30 sec delayed arterial phase and 70 sec delayed portal phase after intravenous administration of 90 mL of nonionic iodinated contrast media at 3 mL/s injection rate. The CT images were reviewed by two experienced radiologists. Results Mesentery thickening and cloudiness with ascites were seen in all patients （100%）. There were omentum thickenning in 16 patients （94%）, nodular or linear peritoneal thickening in 12 patients （71%）, and pelvic masses in 5 patients （29%）. Pieural plaques were also noted in 15 patients （88%）, pleural effusions in 5 patients, and malignant pleural masses in one patient （6%）. Conclusion CT findings of AR-MPM are to some extent characteristic. Extensive thickening of omentum, mesentery, and peritoneum with ascities, pieural plaques and history of asbestos exposure would suggest the diagnosis of AR-MPM.