MSCT对低危型、高危型胸腺瘤及胸腺癌的鉴别诊断价值

【摘要】目的：探讨MSCT对低危型、高危型胸腺瘤及胸腺癌的鉴别诊断价值。方法：将68例经穿刺或手术病理证实的胸腺上皮性肿瘤（TETs）,按WHO简化病理分型分为低危型胸腺瘤、高危型胸腺瘤和胸腺癌三组,对三组的MSCT征象进行统计学分析。结果：68例TETs中,低危型胸腺瘤31例（A型4例、AB型19例、B1型8例）、高危型胸腺瘤15例（B2型9例、B3型6例）、胸腺癌22例。高危型胸腺瘤、胸腺癌均较低危型胸腺瘤更易表现为肿瘤边缘不规则或分叶（P均<0.05);高危型胸腺瘤、胸腺癌均较低危型胸腺瘤更易出现对胸膜/心包、邻近大血管侵犯（P均<0.05）;增强后密度不均及囊变坏死率在胸腺癌和低危型胸腺瘤间均具有显著性差异（P均<0.001）;胸腺癌出现纵隔淋巴结转移较低危型、高危型胸腺瘤更为常见（P<0.05）;而瘤内钙化在三者间两两比较均无明显统计学差异（P均>0.05）。结论：MSCT对WHO简化病理分型的TETs具有一定的鉴别诊断价值。     

胸腺上皮性肿瘤WHO简化病理分型的MSCT表现

目的:分析胸腺上皮性肿瘤(TET)的多层螺旋CT(MSCT)表现及多平面重组(MPR)特征,并探讨其与WHO简化病理分型之间的相关性。方法:回顾性分析40例经手术病理证实的TET患者术前MSCT及MPR图像,并与WHO简化病理分型[低危型胸腺瘤(A、AB、B1)、高危型胸腺瘤(B2、B3)与胸腺癌]进行比较。结果:高危型胸腺瘤与胸腺癌MSCT及MPR征象表现为肿瘤边缘不光整或分叶、形态不规则且强化后瘤内密度不均,以及对邻近结构侵犯,与低危型胸腺瘤有统计学差异﹙P<0.05﹚,胸腺癌纵隔淋巴结增大及远处转移较两组胸腺瘤更为常见,而患者的年龄、性别、肿瘤体积以及瘤内钙化在三组间比较均无明显统计学差异。结论:MSCT扫描及MPR技术对TET的WHO简化病理分型鉴别诊断具有重要价值,为临床治疗方案的选择及判断预后提供信息。     

胸腺上皮性肿瘤的CT表现、Ki-67指数与WHO病理学分型的相关性研究

目的 探讨胸腺上皮性肿瘤(TETs)的CT表现、免疫组织化学Ki-67指数与WHO病理学分型的相关性.方法 回顾性分析45例经穿刺活检或手术病理证实的TETs患者的CT基本特征、定量参数值及Ki-67指数,按简化WHO分型将TETs分为低危组胸腺瘤(A、AB、B1型)、高危组胸腺瘤(B2、B3型)和胸腺癌3组进行统计学...     

胸腺上皮肿瘤WHO病理分型与CT特征的相关性

目的：探讨胸腺上皮性肿瘤（TETs）的WHO病理分型与CT表现的相关性,以提高其CT诊断及临床诊疗水平。方法：回顾性分析经穿刺活检或手术病理证实的66例TETs患者的CT影像学表现。所有患者均行胸部CT平扫及增强扫描,均经组织病理学及细胞免疫组化检查并进行WHO组织病理分型,分析TETs各种组织学类型的CT特征。结果：66例TETs中男39例,女27例,年龄6～77岁。病理分型：A型5例（7．6％）,AB型15例（22．7％）,B1型13例（19．7％）,B2型10例（15．2％）,B3型10例（15．2％）及胸腺癌13例（19．7％）。A、AB、B1型胸腺瘤均呈圆形或类圆形,而80．0％的B3型胸腺瘤及92．3％的胸腺癌呈不规则形;大部分（92．4％）胸腺肿瘤呈中度强化。80．0％B3型胸腺瘤及100％胸腺癌有包膜破坏并侵犯邻近结构;40．0％的B3型胸腺瘤及61．5％的胸腺癌出现心包和（或）胸膜腔积液;随着肿瘤病理分级的增加,周围结构受侵的发生率亦随之升高,分别为15．4％（B1）、40．0％（B2）、80．0％（B3）及100％（胸腺癌）。TETs组织学分类与侵袭危险度CT分级之间存在显著相关性（rs=0．736,P〈0．01）。结论：不同WHO病理分型的TETs的cT表现具有一定特征性,TETs的CT特征反映了其侵袭危险性及组织病理学分型。     

CT平均最大强化程度鉴别胸腺上皮性肿瘤WHO病理亚型及风险分层

【摘要】目的：探讨增强CT（CECT）成像上肿瘤最大强化程度（CEmax）鉴别胸腺上皮性肿瘤（TETs）不同WHO病理亚型和简化风险亚组的价值。方法：回顾性分析经病理证实的62例TETs患者的术前CT图像（平扫及动脉期、静脉期增强扫描）。将肿瘤实性部分在平扫与增强后图像上的的最大CT差值的绝对值定义为CEmax。采用Kruskal-Wallis秩和检验比较CEmax在不同病理亚型和风险亚组间的差异。结果：TETs的6个WHO病理亚型组（A、AB、B1、B2、B3型胸腺瘤和胸腺癌）之间CEmax的差异有统计学意义（P<0.001）。在6个病理亚型中,A型和AB型胸腺瘤的CEmax均显著高于其它亚型（P值均<0.05）,B1型、B2型、B3型胸腺瘤和胸腺癌四者之间差异无统计学意义（P值均>0.05）。B型胸腺瘤（包括B1、B2和B3型）与胸腺癌之间CEmax的差异无统计学意义（P=0.513）。低危胸腺瘤（A、AB、B1型）的CEmax显著高于高危胸腺瘤（B2、B3型）和胸腺癌（P值均<0.05）,但高危胸腺瘤与胸腺癌的CEmax值差异无统计学意义（P=0.551）。结论：平均CEmax值有助于鉴别TETs不同病理亚型及风险分层。     

MSCT在鉴别≤3cm的低、高风险胸腺瘤及胸腺癌中的价值

目的 探讨多层螺旋CT(MSCT)对最大径≤3 cm的胸腺上皮肿瘤(TET)诊断价值.方法 回顾性分析56例经病理证实的最大径≤3 cm的TET病例的病理、影像学资料,根据WHO 2004标准进行组织学分型,将病例分为低风险胸腺瘤组(A/AB/B1型)、高风险胸腺瘤组(B2/B3型)、胸腺癌组(C型),分析各组TET的CT征象,包括病灶的形状、边缘是否光滑、是否伴有棘状突起、是否伴有瘤周小结节、强化程度、胸膜侵犯征象、周围脂肪间隙等.各类型间比较采用χ2检验,样本量过小时,采用Fisher精确试验.结果 低风险胸腺瘤(27例)较高风险胸腺瘤(23例)及胸腺癌(6例)更常表现为规则的类圆形的形态(χ2=73,P<0.001;χ2=116,P<0.001),纵隔-肺界面更易呈膨隆状(χ2=3.41,P=0.046;χ2=7.39,P=0.01);高风险胸腺瘤、胸腺癌较低风险胸腺瘤更常见边缘模糊、棘状突起、胸膜侵犯等征象(P<0.001);胸腺癌较高风险胸腺瘤更常见边缘模糊、棘状突起、胸膜侵犯等征象(χ2=11.5,P=0.009);B2型胸腺瘤与胸腺癌之间的差异有显著性意义(χ2=31.52,P<0.001),然而B3型胸腺瘤与胸腺癌之间无统计学差异(χ2=6.96,P=0.07).结论 MSCT可准确显示病灶的形态、边缘、瘤周情况、强化程度及胸膜侵犯情况,在一定程度上可预测胸腺瘤的组织学分型,可为术前诊断及预后评估提供依据.     

无症状胸腺瘤CT影像特点与其型别的相关性研究

目的探讨无症状胸腺瘤CT影像特点与其型别的相关性。方法回顾性分析2013年2月~2017年2月收治的18例无症状胸腺瘤患者临床资料。依据2004年WHO组织分型标准,将18例患者分为低危组(A、AB和B1)、高危组(B2、B3)和胸腺癌(C)3个亚型组。分析CT表现与WHO组织分型的相关性。结果本组18例胸腺瘤患者包括A型1例(5.56%),AB型2例(11.11%),B1型4例(22.22%),B2型5例(27.78%),B3型4例(22.22%),胸腺癌2例(11.11%)。低危组、高危组9例和胸腺癌组在强化平均CT值、肿块边缘、肿块密度、侵犯纵隔胸膜、侵犯血管结构、侵犯心包和淋巴结转移方面比较存在显著性差异(P0.05)。结论胸腺瘤的CT表现与WHO组织分型具有十分紧密的关系,可通过CT表现肿瘤的边界、密度、周围组织侵犯和强化平均CT值等指标用于无症状胸腺瘤的WHO组织分型鉴别。     

胸腺上皮肿瘤WHO组织学分型与CT征象相关性分析

目的 探讨胸腺上皮肿瘤WHO组织学分型与CT征象的相关性.资料与方法 复习经手术病理证实为胸腺上皮肿瘤的63例患者术前的CT影像资料,按照2004年WHO组织学分型进行重新分型,将观测的CT征象与简化的组织学分型组(低危组胸腺瘤、高危组胸腺瘤、胸腺癌组)对照.结果 63例中,低危组胸腺瘤35例,高危组胸腺瘤16例,胸腺癌组12例.CT显示胸腺癌组更多见不规则轮廓、边缘毛糙/不清、纵隔脂肪层浑浊/消失、淋巴结肿大、胸膜受侵、其他脏器受侵和远处转移等征象;低危和高危组胸腺瘤更多见边缘光滑、分叶和类圆形轮廓、纵隔脂肪层清晰(P＜0.05).结论 不规则轮廓、边缘毛糙/不清、纵隔脂肪层浑浊/消失、淋巴结肿大、胸膜受侵、其他脏器受侵和远处转移应提示胸腺癌的诊断,而边缘光滑、分叶和类圆形轮廓、纵隔脂肪层清晰则提示低危组和高危组胸腺瘤的诊断.CT鉴别低危组和高危组胸腺瘤存在一定困难.     

胸腺瘤螺旋CT表现与其WHO病理分型对照研究

目的：探讨胸腺瘤螺旋CT影像特征与其WHO病理学分型之间的相关性。方法：分析84例病理证实的胸腺瘤的CT影像特征与其WHO分型之间的相关性。结果：螺旋CT征象上表现有分叶、胸膜、心包及大血管受侵犯及尖角征／锯齿征的胸腺瘤,A型、AB型与B型、胸腺癌两大类之间有显著差异（P〈0．05）,而肿块大小、肿块密度均匀与否、纵隔脂肪线存在与否两者之间无显著差异（P〉0．05）。结论：螺旋CT对A型、AB型与B型、胸腺癌可以做出较为正确的分类,但较难区分A型与AB型、B型与胸腺癌。     

胸腺上皮性肿瘤18F-FDG PET/CT显像最大标准化摄取值与WHO病理分型及Masaoka分期的关系

目的 探讨胸腺上皮性肿瘤（TET）术前18F-FDG PET/CT显像最大标准化摄取值（SUV_max）与世界卫生组织（WHO）病理分型及Masaoka分期的关系。 方法 回顾性分析2007年9月至2019年3月于南京医科大学第一附属医院经手术病理学结果证实的40例TET患者的临床资料，其中男性14例、女性26例，年龄32~79岁。分析所有患者的术前18F-FDG PET/CT显像资料，测定病灶的SUV_max。参照WHO(2015) TET病理分型将TET患者分为低危型胸腺瘤（A、AB、B1型）、高危型胸腺瘤（B2、B3型）和胸腺癌（C型）3组；采用Masaoka分期标准将TET患者分为Ⅰ期、Ⅱ期和Ⅲ期 3组；将TET患者分为胸腺瘤（包括低危型胸腺瘤和高危型胸腺瘤）和胸腺癌2组，采用受试者工作特征（ROC）曲线计算SUV_max和曲线下面积（AUC）。3组间的比较采用Kruskal-Wallis秩和检验，2组间的比较采用 Mann-Whitney U检验。 结果 低危型胸腺瘤11例（A型1例、AB型4例、B1型6例），高危型胸腺瘤15例（B2型10例、B3型5例），胸腺癌14例。Masaoka分期:Ⅰ期8例，Ⅱ期17例，Ⅲ期15例。低危型胸腺瘤、高危型胸腺瘤和胸腺癌的中位SUV_max分别为3.78、5.21和10.44，3组间SUV_max的差异有统计学意义（χ2=26.716，P<0.01）；组间的两两比较差异均有统计学意义（Z=3.088、?3.928、4.106，均P<0.01）。Ⅰ期、Ⅱ期、Ⅲ期的中位SUV_max分别为3.74、5.14、10.08，3组间SUV_max的差异有统计学意义（χ2=22.295，P<0.01），组间的两两比较差异均有统计学意义（Z=2.680、3.679、?3.644，均P<0.01）。ROC曲线分析结果:AUC为0.953（95%可变区间:0.891~1.000，P<0.01）；SUV_max=6.81是鉴别诊断胸腺瘤与胸腺癌的最佳临界值。 结论 18F-FDG PET/CT 的参数SUV_max与TET的WHO病理分型及Masaoka分期具有较好的相关性，可为临床制定治疗计划提供参考。     

Thymic epithelial tumors: comparison of CT and MR imaging findings of low-risk thymomas, high-risk thymomas, and thymic carcinomas

OBJECTIVE: To assess the CT and magnetic resonance (MR) imaging findings of thymic epithelial tumors classified according to the current World Health Organization (WHO) histologic classification and to determine useful findings in differentiating the main subtypes. MATERIALS AND METHODS: Sixty patients with thymic epithelial tumor who underwent both CT and MR imaging were reviewed retrospectively. All cases were classified according to the 2004 WHO classification. The following findings were assessed in each case on both CT and MRI: size of tumor, contour, perimeter of capsule; homogeneity, presence of septum, hemorrhage, necrotic or cystic component within tumor; presence of mediastinal lymphadenopathy, pleural effusion, and great vessel invasion. These imaging characteristics of 30 low-risk thymomas (4 type A, 12 type AB, and 14 type B1), 18 high-risk thymomas (11 type B2 and seven type B3), and 12 thymic carcinomas on CT and MR imaging were compared using the chi-square test. Comparison between CT and MR findings was performed by using McNemar test. RESULTS: On both CT and MR imaging, thymic carcinomas were more likely to have irregular contours (P < .001), necrotic or cystic component (P < .05), heterogeneous contrast-enhancement (P < .05), lymphadenopathy (P < .0001), and great vessel invasion (P < .001) than low-risk and high-risk thymomas. On MR imaging, the findings of almost complete capsule, septum, and homogenous enhancement were more commonly seen in low-risk thymomas than high-risk thymomas and thymic carcinomas (P < .05). MR imaging was superior to CT in the depiction of capsule, septum, or hemorrhage within tumor (all comparison, P < .05). CONCLUSION: The presence of irregular contour, necrotic or cystic component, heterogeneous enhancement, lymphadenopathy, and great vessel invasion on CT or MR imaging are strongly suggestive of thymic carcinomas. On MR imaging, the findings of contour, capsule, septum, and homogenous enhancement are helpful in distinguishing low-risk thymomas from high-risk thymomas and thymic carcinomas.     

Does CT of thymic epithelial tumors enable us to differentiate histologic subtypes and predict prognosis?

OBJECTIVE: The aims of our study were to describe the CT findings of thymic epithelial tumors and to correlate these findings with the histopathologic subtypes and prognosis. MATERIALS AND METHODS: The CT findings of thymic epithelial tumors were analyzed in 91 patients who had undergone surgery between May 1995 and June 2002. Two observers, who were unaware of the histopathologic classification made in accordance with World Health Organization (WHO) recommendations and the prognosis of the tumors, retrospectively reviewed the initial CT findings in terms of the contours and shapes of the tumors and the presence of necrosis, calcification, mediastinal fat or great vessel invasion, pleural seeding, contrast enhancement, and lymph node enlargement. These findings were compared with the simplified subgroups of WHO histologic classification (low-risk thymomas [types A, AB, and B1], high-risk thymomas [types B2 and B3], and thymic carcinomas [type C]) and with postoperative recurrence. RESULTS: The study found 31 low-risk thymomas (eight type A, 16 type AB, and seven type B1 tumors), 45 high-risk thymomas (25 type B2 and 20 type B3), and 15 thymic carcinomas (type C). Lobulated contour was more often seen in high-risk thymomas (26/45, 58%; p = 0.0456) and thymic carcinomas (10/15, 67%; p = 0.033) than in low-risk thymomas (9/31, 29%). Mediastinal fat invasion was more often seen in thymic carcinomas (5/15, 33%; p = 0.0133) than in low-risk thymomas (1/31, 3%). Great vessel invasion was seen only in thymic carcinomas (2/15, 13%; p = 0.0244). Tumors with a lobulated or irregular contour, an oval shape, mediastinal fat or great vessel invasion, and pleural seeding showed significantly more frequent recurrence and metastasis (all, p < 0.05). CONCLUSION: Although CT is of limited value in differentiating histologic subtypes according to the WHO classification, CT findings may serve as predictors of postoperative recurrence or metastasis for the thymic epithelial tumors.     

18F-FDG PET/CT of thymic epithelial tumors: usefulness for distinguishing and staging tumor subgroups.

The purpose of our study was to assess the usefulness of integrated PET/CT using 18F-FDG for distinguishing thymic epithelial tumors according to the World Health Organization (WHO) classification. METHODS: Thirty-three patients (age range, 34-68 y; mean age, 54.6 y) with thymic epithelial tumors, who underwent both integrated PET/CT and enhanced CT, were included. The clinicopathologic stages, maximum standardized uptake values (SUVs), and uptake patterns of tumors on integrated PET/CT images, and various enhanced CT findings, are described according to the simplified (low-risk [types A, AB, and B1] and high-risk [types B2 and B3] thymomas and thymic carcinomas) subgroups of the WHO classification. Discriminant analysis was performed to determine the relative capabilities of integrated PET/CT and enhanced CT findings to differentiate tumor subgroups. RESULTS: Tumors included 8 low-risk thymomas, 9 high-risk thymomas, and 16 thymic carcinomas. The maximum SUVs of high-risk thymomas (P < 0.001) and low-risk thymomas (P < 0.001) were found to be significantly lower than those of thymic carcinomas. Homogeneous 18F-FDG uptake within tumors was more frequently seen in thymic carcinomas than in high-risk thymomas (P = 0.027) or low-risk thymomas (P = 0.001). The uptake pattern (homogeneous vs. heterogeneous) on integrated PET/CT images and the presence of mediastinal fat invasion on enhanced CT images were found to be useful for differentiating tumor subgroups. In addition, integrated PET/CT helped detect lymph node metastases, which were not identified on enhanced CT in 2 patients. CONCLUSION: Integrated PET/CT was found to be useful for differentiating subgroups of thymic epithelial tumors and for staging the extent of the disease.     

胸腺上皮性肿瘤世界卫生组织组织学分型与CT影像表现的相关性研究

目的 探讨不同组织类型胸腺上皮性肿瘤(TET)的CT特征.方法 回顾性分析133例经手术病理证实TET的CT表现,并根据WHO 2004年标准对所有病例重新进行组织学分型,分析不同组织类型TET的CT特征.各类型间比较采用x2检验.结果 133例TET病理分型A、AB、B1、B2、B3型和胸腺癌分别为10、17、13、46、30和17例.A型(9例,90.0％)、AB型(15例,88.2％)、B1(10例,76.9％)和B2型(31例,67.4％)胸腺瘤多呈圆形或卵圆形,形状规则且边界光滑;而B3型(21例,70.0％)与胸腺癌(15例,88.2％)肿块呈不规则形或铸型生长,且边界不清楚.胸腺癌坏死囊变发生率最高(15例,88.2％),其次为B3型胸腺瘤(19例,63.3％)和A型胸腺瘤(6例,60.0％),B2和B3型胸腺瘤钙化发生率较高(32例,42.1％),明显高于其他类型TET(8例,14.0％;X2=12.20,P＜0.01).A、AB、B3型TET及胸腺癌高度强化的发生率(39例,52.7％),明显高于B1和B2型(8例,13.6％;x2= 22.01,P＜0.01).结论 根据WHO 2004标准,不同组织类型的TET的CT表现具有一定特征性,CT在一定程度上具有预测TET组织学类型、判断预后的潜力.     

18F-FDG PET/CT Evaluation of Thymomas: a Pictorial Review

The World Health Organization classification divides thymomas according to morphology, epithelial component, and cell atypia. They are grouped into 3 large subgroups: low-risk thymomas (types A, AB, and B1), high-risk thymomas (types B2 and B3), and thymic carcinomas. Tumor subtype represents an independent prognostic factor, which determines therapeutic decision. All thymomas show some degree of ¹⁸F-FDG uptake, which tends to increase with the grade of malignancy; this is related to glucose transporter 1 (GLUT1) expression. This review collects all types of thymomas with illustrative images and provides a guide to get familiar with histological characteristics of the lesions and have them in mind because, even imaging findings can overlap among subtypes, certain characteristics can be combined to make an accurate diagnosis based on ¹⁸F-FDG PET-CT findings.     

Malignant thymic epithelial tumors: CT-pathologic correlation

OBJECTIVE: The purpose of our study was to describe and compare the CT and pathologic findings of atypical thymoma and thymic carcinoma. MATERIALS AND METHODS: Twenty-seven consecutive patients (14 men, 13 women ranging in age from 22 to 77 years [mean age, 52 years]) with pathologically proven atypical thymoma (n = 9) and thymic carcinoma (n = 18) constituted the study population. The chest CT findings in each of the 27 patients were reviewed retrospectively in consensus by two chest radiologists. These findings were correlated with pathologic findings. RESULTS: The tumors were located in the anterior mediastinum, and most tumors had a lobulated margin (24/27, 89%). Atypical thymomas were significantly smaller (mean, 4.7 cm) than thymic carcinomas (mean, 7.2 cm) (p = 0.041) on CT. The findings of invasion of the great vessels, lymph node enlargement, extrathymic metastases, and phrenic nerve palsy were seen only in patients with thymic carcinoma. The frequencies of necrosis, intratumoral calcification, pleural effusion, pleural implants, pericardial effusion, and obliteration of the mediastinal fat plane were not significantly different between atypical thymomas and thymic carcinomas (p > 0.05). Various histologic subtypes were included in thymic carcinoma. The tumor necrosis and calcification seen on CT were confirmed at pathologic examination. CONCLUSION: When a large thymic tumor appears with invasion of the great vessels, lymph node enlargement, phrenic nerve palsy, or extrathymic metastases on CT, thymic carcinoma rather than atypical thymoma should be considered.     

Using the World Health Organization Classification of thymic epithelial neoplasms to describe CT findings

OBJECTIVE: Our purpose was to assess the CT features of various subtypes of thymic epithelial neoplasms on the basis of the 1999 World Health Organization classification. MATERIALS AND METHODS: Thymic epithelial neoplasms in 53 patients who underwent thymectomy were retrospectively assessed histologically according to the 1999 World Health Organization classification. Type A and B neoplasms correspond to thymomas and type C, to thymic carcinoma. The study included four patients with type A, 14 with type AB, nine with type B1, 14 with type B2, four with type B3, and eight with type C epithelial tumors. Two observers independently assessed the CT scans without knowledge of the histologic findings. RESULTS: Type A tumors were more likely to have smooth contours on CT (4/4, 100%) and round shapes (3.5/4, 88%) than any other type of thymic epithelial tumor (all, p < 0.05). Type C tumors had a higher prevalence of irregular contours (6/8, 75%) than any other type of thymic epithelial tumor (all, p < 0.05). Calcification was more frequently seen in type B1 (4/9, 44%), type B2 (8.5/14, 61%), and type B3 (3/4, 75%) tumors than in type AB (2/14, 14%) and type C (0.5/8, 6%) tumors (all, p < 0.05). CONCLUSION: Smooth contours and a round shape are most suggestive of type A thymic epithelial tumor, whereas irregular contours are most suggestive of type C tumor. Calcification is suggestive of type B tumors. CT is of limited value, however, in differentiating type AB, B1, B2, and B3 tumors.