侵袭性胸腺瘤的CT诊断及评价

目的分析侵袭性胸腺瘤的ＣＴ表现以便于分期和计划治疗。材料与方法分析２６例手术及病理证实的侵袭性胸腺瘤的ＣＴ所见，着重观察病变的密度，对周围纵隔结构的侵犯、胸膜种植以及纵隔外转移情况。结果２６例侵袭性胸腺瘤ＣＴ均显示为前纵隔软组织肿块，１６例密度不均，肿块不规则侵犯邻近器官２４例，主要表现在纵隔胸膜受侵７例，肺受侵９例，胸膜种植３例，心血管结构受侵２０例，以及心膈角区和腹腔受侵３例。结论ＣＴ在显示胸膜、心包和肺实质侵犯方面极其有效，对病变范围可进行可靠的评价，常规ＣＴ扫描可进行准确的分期和决定治疗方案。     

CT扫描对侵袭性胸腺瘤的诊断价值

目的　探讨侵袭性胸腺瘤的CT表现及其诊断价值。方法　回顾性分析 13例经手术、病理证实为侵袭性胸腺瘤的CT表现。结果　 13例侵袭性胸腺瘤CT均显示为前纵隔软组织肿块。 10例密度不均 ,肿块不规则侵犯邻近结构 11例。主要表现在胸膜种植 3例 ,心血管结构侵犯 9例 ,以及腹腔受侵 1例。结论　常规CT扫描在侵袭性胸腺瘤的诊断与鉴别诊断中具有重要作用     

胸腺瘤的CT和平片分析

目的　探讨胸腺瘤的X线与CT诊断价值。方法　分析 30例经手术病理证实的胸腺瘤X线和CT表现 ,并与病理对照。结果　 18例非侵袭性胸腺瘤 ,胸片仅发现 15例 ,CT扫描 10例 ,均为前纵隔软组织肿块 ,边界清楚 ,密度均匀。 12例侵袭性胸腺瘤 ,肿瘤侵犯邻近器官 ,CT显示纵隔胸膜受侵 3例 ,心包受侵 2例 ,大血管结构受侵 2例 ,胸膜种植 3例 ,胸腔积液 2例 ,腹腔受侵和纵隔淋巴结转移各 1例 ;胸片仅能显示 1例肿瘤侵犯纵隔胸膜和 1例胸膜种植。结论　CT扫描在胸腺瘤的发现和判别侵袭性方面明显优于X线平片并且是可靠预测胸腺瘤侵袭性的检查方法。     

恶性胸腺瘤的CT与MRI诊断

目的：分析侵袭性胸腺瘤及胸腺癌的CT及MRI表现，探讨其鉴别诊断要点。方法：复习经病理组织学证实的18例侵袭性胸腺瘤及9例胸腺癌的CT、MRI所见，重点观察肿瘤的大小、密度、边缘改变，对周围纵隔结构的侵犯。结果：18例侵袭性胸腺瘤、9例胸腺癌CT、MRI均表现为前纵隔不规则软组织肿块。前者肿瘤直径大于8cm者15例（83％），病灶内密度及信号不均匀12例。心血管受侵16例，后者肿块直径在8cm以上者7例（77.8％),肿块内密度及信号不均6例，心知管受累8例，纵隔肺门淋巴结转移1例，肺内转移3例，双侧肾上腺及肝脏转移1例。结论：虽然侵袭性胸腺瘤和胸腺癌的影像学表现相似，但胸腺癌更具有侵袭性，胸外转移常见，病理组织学检查有助于两者的鉴别。     

螺旋CT对胸腺瘤的诊断及其临床价值

目的：通过螺旋CT(spiral CT，SCT)分析胸腺瘤的影像学表现并判断其良恶性的临床价值。方法：搜集经手术病理证实的胸腺瘤30例。其中非侵袭性胸腺瘤(noninvasive thymoma，NIT)即良性胸腺瘤22例，侵袭性胸腺瘤(invasive thymorrm，IT)即恶性胸腺瘤8例。通过SCT分析胸腺瘤的瘤体形态、密度、强化特点、肿块与纵膈结构关系等影像学表现，并与病理结果相对照，研究胸腺瘤良恶性即有无侵袭性的对应关系。结果：1、SC丁诊断NIT20例，其主要表现为前上纵膈内密度均匀的圆形或类圆形轻度强化的软组织肿块，与纵膈心脏大血管分界清晰。2、SCT诊断IT7例，主要表现为前中上纵膈内分叶状、不规则形软组织肿块，密度不均，强化不一且或伴有囊变坏死区，肿瘤与心脏大血管脂肪环破坏，心包积液、纵膈胸膜浸润以及上腔静脉受压变形等。结论：SCT对胸腺瘤的良恶性(即侵袭性)判断具有较高的准确性，为临床术前治疗方案的确定以及判断其预后具有较高的指导价值。     

侵袭性胸腺瘤与非侵袭性胸腺瘤的CT诊断与鉴别

目的：用多层螺旋CT扫描诊断胸腺瘤并评价其侵袭性。资料与方法：对CT诊断为胸腺瘤并经手术病理证实的23个病例进行对照分析。结果：胸腺瘤为前纵膈内类圆形或不规则的软组织肿块，其有否侵袭性主要取决于是否侵犯胸膜，是否累及邻近结构。结论：多层螺旋CT对胸腺瘤的诊断及对其侵袭性的评价有较高价值。     

侵袭性胸腺瘤与非侵袭性胸腺瘤的螺旋CT诊断

目的：评价螺旋CT对胸腺瘤的诊断价值。方法：对32例经临床、手术、病理证实胸腺瘤的CT表现进行回顾性分析,其中22例进行增强扫描。结果：侵袭性胸腺瘤18例（其中B型15例,C型3例）,其中15例形态不规则,16例边界不清晰,17例累及邻近纵隔结构,脂肪间隙消失,16例显示内部密度不均匀,实质部分呈明显不均匀强化,5例为灌铸型。非侵袭性胸腺瘤14例（其中A型2例,AB型12例）,其中13例形态规则,11例肿块密度均匀,4例增强扫描实质部分呈轻度均匀强化。结论：螺旋CT对判断B型、C型胸腺瘤与A型、AB型胸腺瘤准确性较高,对指导临床治疗及判断预后有重要临床意义。     

CT对侵袭性与非侵袭性胸腺瘤诊断和判断预后价值分析

目的 探讨胸腺瘤的CT征象与Masaoka临床-病理分期以及预后影响因素的相关性.方法 回顾性分析45例经手术病理证实为胸腺瘤患者术前的CT资料和一般临床资料,比较侵袭性与非侵袭性胸腺瘤的CT表现,并对7例复发患者的CT征象进行相关性分析.结果 45例中,非侵袭性胸腺瘤11例,侵袭性胸腺瘤34例,CT上二者在形态不规则、边缘毛糙/不清、肿瘤内有囊变/坏死或钙化、纵隔脂肪层浑浊/消失、大血管浸润、心包受侵以及不均匀强化中有显著差异(P<0.05).7例患者术后出现复发或转移,与边缘毛糙/不清、淋巴结肿大、胸膜受侵、大血管浸润及其他脏器受侵有显著相关性(P<0.05).结论 CT有助于术前鉴别侵袭性与非侵袭性胸腺瘤,为设计合理治疗方案以及术后判断预后提供有价值的信息.     

胸腺瘤的螺旋CT诊断

目的：评价CT对胸腺瘤的诊断价值。方法：对43例经临床、手术、病理证实胸腺瘤的CT表现进行回顾性分析。结果：侵袭性胸腺瘤23例,形态不规则,边界欠清晰,有不同程度胸膜和／或心包膜增厚、受侵,其中15例内部密度不均匀,实质部分呈轻-中度强化。非侵袭性胸腺瘤20例,形态规则,边界清晰,内部密度均匀,实质部分呈轻度均匀强化。结论：CT检查对胸腺瘤有较高的诊断价值,对指导临床治疗有重要意义。     

恶性胸腺瘤WHO病理分类及其CT表现

目的:分析恶性胸腺瘤的CT表现,以便于分类、分期和选择治疗。方法:分析21例手术及病理证实的WHO分类恶性胸腺瘤的CT表现,与手术病理相对照。结果:恶性胸腺瘤WHO分类B1型3例,B2型6例,B3型4例,C型(胸腺癌)8例。CT表现:心脏大血管受侵11例,主要表现肿块的心脏大血管接触面(mass-cardiovascular inferface,MCI)呈灌铸型生长。纵隔胸膜-肺受侵13例,主要表现为肿块-肺接触面(mass-pulmonary interface,MPI)增厚呈尖角或锯齿征。胸膜种植3例。肺门、肺内转移4例。C型(胸腺癌)更具侵袭性,远处转移多见。结论:CT能准确显示恶性胸腺瘤周围侵犯范围、胸膜种植及远隔转移。可准确分期和决定治疗方案,并对分类及预后作出评估。     

Imaging of an invasive malignant thymoma on PET Scan: CT and histopathologic correlation

Thymomas are common primary mediastinal neoplasms. They can be benign or malignant. The diagnosis of malignant thymomas is based on capsular invasion, cellular atypia and distant metastases. We present a case of invasive malignant thymoma as diagnosed on PET and CT scan with histologic correlation and review of literature. A seventy year old Asian man presented with cough and dyspnea. A CT scan showed an anterior mediastinal mass, and a PET scan showed a hypermetabolic mass in the corresponding location. Resection of the mass revealed a minimally invasive thymoma based on evidence of capsular invasion. PET scan proved invaluable in correctly diagnosing, staging the lesion, and excluding any extramediastinal involvement.     

Computed tomography and magnetic resonance imaging of mediastinal tumors

We describe the clinical, pathological, and imaging findings of mediastinal tumors with focus on thymic hyperplasia, thymic epithelial tumors, and germ cell tumors, malignant lymphoma, and various cystic masses. Chemical shift magnetic resonance imaging (MRI) is useful in characterization of the normal thymus and differentiation of hyperplastic thymus and thymic tumors. In contrast to noninvasive thymomas, invasive thymomas and thymic carcinomas show a more aggressive growth pattern. Local invasion and pleural spread are characteristic of invasive thymoma and mediastinal lymphadenopathy and distant metastasis suggest thymic carcinomas. Mature teratoma typically shows various computed tomography (CT) attenuation, and MR signal intensity depending on its contents and fat tissue and bone within the lesions are its characteristic findings. Seminomas typically have homogenous internal CT attenuation and MR signal intensity with minimal contrast enhancement. Nonseminomatous malignant germ cell tumors characteristically show prominent internal degenerative changes and invasion to the adjacent structures. In mediastinal lymphomas, a residual mass is common after treatment and MRI provides important information in distinguishing viable tumors from residual benign masses. Some mediastinal cysts may reveal high attenuation similar to solid lesions on CT depending on their contents and MRI can be useful in the differentiation of cystic masses from solid lesions.     

Mediastinal lymph node involvement in non-small cell lung cancer: evaluation with 99mTc-tetrofosmin SPECT and comparison with CT.

In patients with non-small cell lung cancer (NSCLC), surgical resection offers the best chance of cure. The preoperative assessment of mediastinal lymph node involvement is crucial to selecting those patients for whom surgery is indicated. METHODS: To evaluate the possible clinical role of (99m)Tc-tetrofosmin scintigraphy in the presurgical detection of mediastinal node metastases from NSCLC, we performed a prospective comparative study with CT on 83 patients (48 men, 35 women; age range, 38-81 y) with primary NSCLC (36 adenocarcinomas, 39 epidermoid squamous cell carcinomas, and 8 large cell anaplastic carcinomas). They underwent chest SPECT 20 min after (99m)Tc-tetrofosmin injection (740 MBq intravenously). The metastatic involvement of mediastinal nodes was assessed by histologic examination after mediastinoscopy or thoracotomy. Both chest CT and (99m)Tc-tetrofosmin scintigraphy were performed within 2 wk before the surgical staging. RESULTS: Metastatic mediastinal lymph nodes were found in 35 patients. (99m)Tc-Tetrofosmin imaging in assessing the mediastinal involvement yielded a sensitivity of 85.7%, a specificity of 89.6%, and an accuracy of 88.0%; CT results were 68.6%, 75.0%, and 72.3%, respectively. SPECT accuracy was significantly higher than CT accuracy (P < 0.05). However, precise anatomic localization of (99m)Tc-tetrofosmin uptake in the mediastinum was not always present on SPECT images. (99m)Tc-Tetrofosmin SPECT precisely detected the presence or absence of lymph node metastases in 33 of the 36 patients with positive CT findings (enlarged mediastinal nodes with a short axis > or =1 cm), with an accuracy (91.7%) significantly higher (P < 0.05) than that of CT (66.7%). CONCLUSION: (99m)Tc-Tetrofosmin SPECT is a useful presurgical noninvasive method to assess mediastinal lymph node involvement in NSCLC. In particular, it could play a clinical role in reducing the number of invasive staging surgical procedures in selected patients, especially in those with enlarged lymph nodes at CT. Fusing SPECT with CT images could further improve the interpretation of the scintigraphic data.     

Computed tomography and thymoma: distinctive findings in invasive and noninvasive thymoma and predictive features of recurrence

Purpose

Our goal was to assess the computed tomo graphy (CT) imaging findings of thymoma and to correlate these features with Masaoka staging system and prognosis.

Materials and methods

CT findings of thymoma were analysed in 58 patients who had undergone surgery between January 2002 and September 2007. All cases were classified according to the Masaoka staging system. The presence of various CT findings was correlated with tumour invasiveness and recurrence. In statistical analysis, a p value <0.05 was interpreted as significant.

Results

The study found 26 noninvasive thymomas and 32 invasive thymomas. Invasive thymomas were more likely to be greater in size (p<0.01), with lobulated or irregular contours (p<0.02), a necrotic or cystic component (p<0.04), foci of calcification (p<0.05) and heterogeneous contrast enhancement (p<0.01) than were noninvasive thymomas. Disease progression developed in nine of 58 patients. Tumour recurrence and metastasis correlated with greater size (p<0.04), lobulated or irregular contours (p<0.01), complete mediastinal fat obliteration (p<0.01), great vessel invasion (p<0.01) and pleural implants (p<0.02).

Conclusions

CT is useful in differentiating invasive from noninvasive thymomas and plays an important role in evaluating and treating these patients for multimodal therapy with neoadjuvant approaches. Moreover, CT findings may serve as predictors of postoperative recurrence or metastasis.     

子宫内膜病变的CT诊断价值

目的 探讨子宫内膜病变CT增强扫描的表现，评价CT在子宫内膜病变诊断及内膜癌分期中的价值。资料与方法 回顾性分析50例经病理证实的子宫内膜病变的CT增强表现，包括内膜癌43例，恶性中胚叶混合瘤、非霍奇金淋巴瘤(NHL)各1例，内膜增生4例，息肉1例。对43例子宫内膜癌进行分期对比。结果 50例病变CT检出47例(94％)，未显示3例(6％)，定性诊断正确37例(74％)。43例内膜癌诊断正确35例(81．4％)，3例未显示，3例漏诊；分期正确27例(62．8％)，低估病变10例(23．3％)，高估病变6例(14．0％)。病变表现：全部病变为密度低于子宫肌壁的软组织影，边缘不清晰、分叶或不规则49例，密度均匀27例，不均匀23例，伴有子宫前后径增大35例(70％)，内膜增厚47例(94％)。肌壁内缘模糊、不规则、肌层变薄、厚薄不均19例；官颈大、密度变低或不均匀7例；子宫外缘模糊1例，盆腔、腹膜后淋巴结转移6例，肺或卵巢转移各1例，均为子宫内膜癌外侵表现。结论 CT扫描对子宫内膜病变的诊断及分期均有价值。     

Staging of esophageal carcinoma: comparison of results with endoscopic sonography and CT

We compared the results of endoscopic sonography and CT in the preoperative staging of 46 patients with esophageal carcinoma studied prospectively. All patients had surgery and 44 had pathologic examination of the mediastinal and celiac lymph nodes. The results of CT and endoscopic sonography were compared with surgical and pathologic findings. A total of 51 tumors were found in 46 patients. Sonographic estimation of tumor extension through the different layers of the esophagus was correct in 37 (73%) of all 51 tumors and in 22 (85%) of the 26 tumors in which the examination was complete. The echoendoscope (13-mm diameter) could not pass through the tumor in 23 cases (50%). Infiltration to adjacent organs was found in 15 cases at surgery. In four of these 15, the extension was detected by CT; in seven of the 15 cases, it was detected by sonography. False-negative determination of tumor extension occurred with endoscopic sonography in patients with stenotic tumor. There were no false-positive results with either CT or endoscopic sonography. For detection of mediastinal lymph-node involvement, the sensitivity of CT was 48%. The sensitivity of sonography was 50% if metastatic nodes unexplored by sonography were included, or 84% if only cases in which stenosis was passed were considered. Statistical comparison revealed that sonography was superior to CT for the detection of metastases to lymph nodes. CT and endoscopic sonography provide complementary information. When the echoendoscope can be maneuvered past the tumor, sonography can be used accurately to define extension through the layers of the esophagus, extension to the adjacent organs, and involvement of the lymph nodes. When the tumor cannot be passed by the echoendoscope, CT is superior to sonography for detection of mediastinal extension.     

Non-invasive lymphatic staging of lung neoplasms: comparative study with computerized tomography and endoscopic ultrasonography]

INTRODUCTION: A prospective comparative study with pathology was performed at the National Cancer Institute, Milan, to assess the clinical value of Computed Tomography (CT) and endoscopic ultrasound (EUS) for nodal staging in lung cancer. MATERIAL AND METHODS: In three years, 71 patients with histological diagnosis of non-small-cell lung cancer were operated on. They underwent CT and EUS examinations to identify mediastinal lymphadenopathies after major nodal involvement had been excluded by chest X-ray. Diagnostic staging was completed in two weeks prior to treatment. Patients received complete tumor removal and radical lymphadenectomy (55 patients), invasive staging with node resection and sampling (11 patients), or mediastinoscopy (5 patients). Blinded interpretation of CT alone, EUS alone, and CT and EUS together were performed, with systematic correlation of imaging findings and pathological results. RESULTS: The frequency of mediastinal involvement was 42.2%. A total of 329 nodal stations were dissected or sampled and 755 lymph nodes were examined at histology. On a per-station basis, CT had greater sensitivity (74%) than EUS (56%), but EUS was more specific (83.4% vs 92.7%). The accuracy rates of the two techniques were similar (CT 81%, EUS 83%). A site by site analysis showed highest sensitivity (100%) in the lower right paratracheal nodes for CT, and in the superior left paratracheal and subcarinal nodes for EUS. When the EUS and CT images were studied together by specialists on a per-station basis, sensitivity, specificity, and accuracy increased to 85%. CONCLUSIONS: Endoscopic ultrasound should be part of the routine preoperative diagnostic approach to non-small-cell lung cancer, because of its high specificity. Results can be improved when EUS and CT are combined, which suggests that these imaging modalities should be used together in selected patients for the noninvasive staging of non-small-cell lung cancer to identify local lymphatic spread.