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。     

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.     

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诊断分析

目的 分析胸腺瘤的CT征象,提高胸腺瘤的诊断及鉴别诊断.方法 报告31例经手术、病理证实为胸腺瘤的CT表现.结果 27例(87.1%)位于前中上纵隔,其中,良性胸腺瘤11例,肿块与心脏血管接触面(MCI)呈凸出型8例,平坦型1例,凹陷型2例.恶性胸腺瘤20例,MCI呈灌铸型18例,凹陷型2例;肿块不规则侵犯邻近结构11例,心包积液6例,心包、胸膜多发结节状转移2例,胸腔积液4例,肺内炎症2例,肺内、骨、纵隔淋巴结转移各2例,肝、胰腺转移各1例.结论 CT对胸腺瘤的良恶性诊断及鉴别诊断有较高价值.     

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。     

侵袭性胸腺瘤的CT表现及病理对照

目的：分析侵袭性胸腺瘤的CT表现，评价CT对其临床分期的准确性。资料与方法：回顾分析32例经手术病理证实的侵袭性胸腺瘤的CT所见，通过对病变的密度、周围纵隔结构的侵犯、胸膜肿植以及纵隔外转移情况的观察进行分期，并和病理分期进行比较。结果：侵袭性胸腺瘤的CT表现主要有：分叶状或不规则肿块；密度不均匀；局灶性钙化；邻近结构的脂肪层消失；侵及心包、胸膜、肺及其他器官。CT对临床分期判断准确性为87．5％，特异性为90％，敏感性为83．3％。结论：CT对侵袭性胸腺瘤术前分期及病变范围的显示准确，对确定手术方案，评价治疗效果及判断复发具有重要意义。     

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。     

胃间质瘤:螺旋CT表现与手术病理对照

目的:分析胃间质瘤的螺旋CT表现,评价螺旋CT鉴别胃间质瘤良恶性价值。方法:对29例胃间质瘤患者行螺旋CT扫描,对肿瘤的部位、大小、形态、增强特点、肿瘤与邻近器官的关系及有无转移进行回顾性分析,结果与手术病理对照。结果:良性6例,交界性5例,恶性18例。CT表现:肿物多具有壁在性、外生性特点(23例),腔内型6例。除5例良性肿物密度均匀外,其余均表现密度不均匀。6例高度恶性肿物表现边缘强化,中心大片低密度。病理所见:肿瘤实性部分为由梭形细胞和(或)上皮样细胞组成,变性、出血、囊变及坏死在CT均表现为低密度。肿物内伴斑点样钙化1例。胰腺、脾受侵各1例,胃壁受侵7例。多平面重建图像(MPR)排除横断面诊断胰岛细胞瘤和肝癌各1例。合并肝转移2例,淋巴结转移1例。结论:胃间质瘤的CT表现与其病理组织学相关。螺旋CT特别是MPR图像,在肿瘤的检出、判断肿瘤与周围器官的关系及有无转移上发挥重要作用,在判断肿瘤的良恶性上仍有困难。     

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.     

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.     

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.     

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.     

MSCT对胸腺上皮肿瘤WHO简化病理分型的鉴别诊断价值

目的探讨多层螺旋CT(MSCT)对低危型、高危型胸腺瘤及胸腺癌的鉴别诊断价值。方法回顾性分析经病理(穿刺或手术)证实的67例胸腺上皮肿瘤,基于WHO病理分型简化为低危型胸腺瘤、高危型胸腺瘤及胸腺癌三组,并对其CT征象进行统计分析。结果67例TETs中,低危型胸腺瘤30例(A型3例、AB型20例、B1型7例),高危型胸腺瘤22例(B2型11例、B3型11例),胸腺癌15例。高危型胸腺瘤、胸腺癌较低危型胸腺瘤易表现为边缘分叶或不规则(P均<0.05)及易出现对心包侵犯(P均<0.05);胸腺癌较低危型胸腺瘤易出现增强后密度不均、囊变坏死及胸膜转移(P均≤0.003);胸腺癌较低危型、高危型胸腺瘤易出现纵隔淋巴结肿大(P均≤0.002);纵隔大血管侵犯在三组间两两比较均有统计学差异(P均<0.05)。结论MSCT对TETs的WHO简化病理分型鉴别诊断具有重要价值。     

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.     

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.     

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。