胸壁原发神经源性肿瘤CT检测结果及分析

目的探讨胸壁神经源性肿瘤CT及病理表现,提高对本病的认识.方法回顾性分析经手术及病理证实的7例胸壁神经源性肿瘤的CT表现,并结合文献复习其病理特征.为鉴别诊断,同时还复习3例恶性肉瘤的CT表现.结果5例神经鞘瘤中4例良性,CT平扫密度均匀1例,3例不太均匀,增强后呈明显均匀强化1例,轻～中度不均匀强化1例,2例良性有肩胛骨或肋骨邻近骨质压迫吸收.1例低度恶性平扫密度不均,增强后有轻度强化,邻近锁骨、肋骨受压并骨质破坏吸收,邻近肌间隙及上纵隔受侵犯.1例神经纤维瘤病灶单发,CT平扫密度较均匀,增强后病灶呈轻度不均匀强化,邻近肋骨受压吸收.1例神经纤维瘤病病灶多发,CT平扫病灶密度不均匀,未行增强扫描.其他3例胸壁原发肿瘤均为肉瘤,其中纤维肉瘤2例,滑膜肉瘤1例.结论CT发现胸壁特别是椎旁区的软组织肿块,边缘光滑,多提示良性神经源性肿瘤,若肿瘤边缘不光滑、形态不规则并向周围组织浸润则为恶性神经源性肿瘤的特征.

Diagnosis of primary neurogenic tumor on chest wall using CT imaging

Objective To discuss manifestations of neurogenic tumors on chest wall on CT imaging and pathology. Methods 7 patients with neurogenic tumors on chest wall confirmed surgically and pathologically were reviewed. To facilitate differential diagnosis, 3 cases of malignant sarcoma were reviewed for their features on CT. Results 4 out of 5 cases of neurinoma were benign,with one case showing even density on plain CT scan,3 were poorly even,one case showed obvious evenness after enhancement,and 1 case was poorly evenly enhanced,2 benign cases had compression absorption of surrounding bone of scapula or ribs. One case of moderate malignancy was un- even in plain scan and slightly enhanced after enhancement procedure,and neighboring bone of scapula and rib were compressed and destroyed and absorbed,and neighboring muscular interspace and upper mediastinum were involved. One case showed single lesion of neurofibroma,displaying relatively even density on plain scan and moderate unevenness after enhancement procedure, as well as compression and absorption of neighboring ribs. One case of neurofibroma had multiple lesions,showing uneven density on plain scan. This case did not undergo enhanced scan. The remaining 3 cases were all sarcoma including 2 cases of fibrosarcoma and one case of synovial sarcoma. Conclusion Mass of soft tissues that are situated on chest wall or paravertebral area and with smooth edge are suggestive for benign neurogenic tumor. On the contrary, rough edge and coarse shape and infiltration into neighboring tissues are characteristic for malignant ones.