实验性大鼠恶性胸膜间皮瘤的CT表现

目的探讨大鼠恶性胸膜间皮瘤(MPM)特征性CT征象。方法W istar大鼠100只,右侧胸膜腔闭式染尘法注入石棉纤维混悬液,每月1次,每次20 mg/m l,连续2月,石棉总剂量为40 mg,对照组用同样方法注入灭菌生理盐水,大鼠垂死时或死亡后立即CT扫描及尸解病理检查。整个动物实验历时2年。结果得到实验组MPM 66例,胸膜增生14例,阴性12例。对照组4只胸膜增生,10只阴性,无胸膜间皮瘤。根据病理改变分为MPM组66例,非MPM组26例,对照组非MPM组14例。胸膜增厚的形态、厚度在实验组MPM组与实验非MPM组及对照组均有差异,结节状胸膜增厚只出现在MPM组,其它组无,特异性为100%。胸膜的平均CT值MPM组其它两组无差异。MPM组胸腔肿块发生率达94.5%,可为肿瘤、脓肿或包裹性积液,其中肿瘤性肿块62.5%。MPM的纵隔改变包括纵隔增宽,纵隔胸膜增厚、不规则及纵隔的移位,以纵隔不规则增宽、纵隔胸膜的改变与非MPM组比较差异有显著性。胸水与临床及尸解相比少见。未见胸内淋巴结肿大。结论大鼠MPM具有一些较特征性的CT征象。     

实验性大鼠恶性胸膜间皮瘤动物模型的建立及影像检查的意义

目的建立一种简便、实用、诱发率高、较接近人体恶性胸膜间皮瘤(MPM)的动物模型，进行影像和病理的研究及对照。方法Wistar大鼠100只，右侧胸膜腔闭式染尘法注入石棉纤维混悬液40mg，对照组20只，注入等量灭菌生理盐水。每隔1～3个月对实验组10～30只，对照组3—5只大鼠胸部CT扫描，动态观察MPM的发生情况，不处死大鼠而待其自然死亡，死亡鼠先行CT扫描后再做病理学检查，整个实验周期历时2年。结果对照组中无自发性MPM。实验组有效动物为95只，其中有MPM68只，诱发率71．6％。68只中胸膜不典型增生13只，胸膜阴性14只。病理表现分为结节型、斑片型和巨块型；组织学分为纤维型、上皮型和混合型。3～8个月内CT扫描胸膜无异常，9—24个月开始出现MPM的多种形式改变，如胸膜增厚，增厚胸膜密度不均匀；肿块；纵隔增宽；纵隔胸膜改变；邻近组织(心包、心脏、膈肌、胸、肺)的浸润及远距离的转移等较特征性的MPM征象。其中结节状胸膜增厚仅发生在MPM，最早发生在250d。结论该模型与临床有较好的对应性，弥补了临床上很难获得新鲜、不同肿瘤时期肿瘤组织标本的缺陷；不同时期CT检查有阶段性改变和特征性的征象。可用于影像学等多种研究，是较好的实验动物模型。     

青石棉所致胸膜间皮瘤CT分析

目的分析因环境接触青石棉所致胸膜间皮瘤病例的CT征象。方法对55例经证实的胸膜间皮瘤病例CT表现进行回顾性分析。结果在55例中,局限型胸膜间皮瘤1例并恶变,伴少量胸水;弥漫型胸膜间皮瘤54例,其中无胸水13例,少或中等量胸水30例,大量胸水11例。右下胸膜间皮瘤伴对侧胸水4例。CT表现为胸膜增厚>2cm,呈花边状、结节状或软组织肿块,增强有强化。结论CT对确定胸膜间皮瘤部位、范围及随访方面作用较大。     

弥漫型胸膜间皮瘤的CT诊断

目的 探讨弥漫型胸膜间皮瘤的CT表现.资料与方法 回顾性分析经病理证实的6例弥漫型胸膜间皮瘤患者的CT影像资料.结果 CT显示弥漫型胸膜间皮瘤的主要征象是:广泛性、不均匀胸膜增厚(6/6),纵隔侧胸膜受累(5/6),胸膜增厚＞1cm(6/6),胸膜结节(3/6)和肿块(2/6),患侧胸腔积液(5/6).此外,CT还显示了弥漫型胸膜间皮瘤累及纵隔、心包、叶间胸膜、胸壁、膈肌部位等的表现.结论 弥漫型胸膜间皮瘤的CT表现具有一定特征,因此对临床可疑病例应常规进行胸部CT检查;CT表现不仅能提示诊断,而且能够显示病变的范围和程度,对治疗方案的选择有指导意义.     

胸膜间皮瘤的CT诊断

目的:回顾性分析胸膜间皮瘤的CT表现,评估CT诊断胸膜间皮瘤的价值.材料和方法:20例胸膜间皮瘤均经病理证实,其中开胸术14例,全麻下胸膜活检3例,CT导引下经皮穿刺活检1例,胸腔镜下活检2例,均作了CT检查.结果:20例胸膜间皮瘤中,良性6例,恶性14例.局限性结节样或团块状胸膜增厚9例,良性6例,恶性3例;结节或肿块＜5cm6例,其中良性5例;肿块与胸壁夹角为锐角者4例均为良性;平扫及增强密度较均匀者5例,均为良性.11例弥漫性胸膜增厚均为恶性,其中胸膜增厚＞1cm以上9例,环状增厚呈盔甲状5例,纵隔胸膜受侵10例,9例伴有胸水,7例手术证实有胸壁或横膈侵犯.14例恶性胸膜间皮瘤中,Butchard Ⅰ期5例,Ⅱ期5例,Ⅲ期3例Ⅳ期1例.结论:CT能很好地显示病变的部位、形态、大小、密度、范围,与周边组织的关系,有否远处转移,可鉴别病变的良、恶性并对恶性病例进行分期,对临床的治疗有非常重要的指导作用.     

CT联合血清SMRP早期诊断大鼠恶性胸膜间皮瘤的研究

目的:探讨CT联合血清可溶性间皮素相关蛋白(SMRP)在提高早期诊断恶性胸膜间皮瘤(MPM)中的价值,为早期诊断MPM提供实验依据及理论基础.方法:采用右侧胸腔注射青石棉纤维混悬液诱发大鼠MPM,对大鼠行胸腹部CT平扫及增强扫描,对病变进行CT分期,并比较CT对MPM不同分期的诊断价值.分析不同分期MPM的SMRP表达...     

无显性胸水的肺癌胸膜播种性转移:影像学检出和诊断

目的提高对无显性胸水的肺癌胸膜播种性转移的影像学检出和诊断水平。方法对12例无明显胸水征象而经手术和病理证实有胸膜播种性转移的肺癌病例的胸部平片、普通CT和高分辨率CT(HRCT)等影像学表现进行回顾性分析;并结合文献比较上述各种影像学手段对此种肺癌胸膜播种性转移的检出和诊断价值。结果本组12例肺癌胸膜播种性转移中,胸部平片、CT和HRCT对其检出率分别为8.3%、58.3%和91.7%。HRCT对肋胸膜和纵隔胸膜转移检出率为54.5%,对叶间胸膜转移的检出率为85.7%。胸壁胸膜播种性转移的HRCT表现有:(1)胸膜面毛糙和棘状小突起;(2)胸膜面凹凸不平;(3)胸膜面散在2~3 mm大小结节;(4)胸膜面5~10 mm左右圆形或半圆形结节;(5)胸膜面正常。叶间胸膜播种性转移的HRCT表现有:(1)叶间胸膜均匀增厚;(2)叶间胸膜不均匀增厚;(3)叶间胸膜上散在2~3 mm结节;(4)2~3 mm结节与增厚的叶间胸膜一起构成串珠状改变;(5)叶间裂附近成堆或散在2~3 mm结节,酷似位于肺实质内。结论HRCT是检出和诊断肺癌胸膜播种性转移的最佳影像学技术。     

肺结节少见CT征象对病变的诊断价值

目的探讨肺结节的少见CT征象,提高周围型肺癌的诊断正确率。方法回顾分析经手术病理或临床治疗证实的186例肺内结节(139例周围型肺癌和47例其它肺内结节)的少见CT征象(多囊状透亮影、肿瘤胸膜侧的模糊小片状影、磨玻璃影)在肺癌和其它结节中的出现率。结果多囊状透亮影和肿瘤胸膜侧模糊小片状影在肺癌中出现率明显高于肺内其它结节(P<0.05)。磨玻璃影在肺癌和其它结节的出现率无显著差异。在肺癌中,磨玻璃影在细支气管肺泡癌中的出现率明显高于其它类型肺癌(P<0.001)。结论多囊状透亮影和肿瘤胸膜侧模糊小片状影对肺癌的诊断有较高价值,肺癌中磨玻璃影的出现常提示细支气管肺泡癌的可能。     

免疫功能正常者肺隐球菌病CT诊断

目的 探讨免疫功能正常患者肺隐球菌病的CT表现.方法 回顾性分析本院收治的经穿刺或手术病理证实的免疫功能正常患者肺隐球菌病10例.所有患者均行CT平扫,其中8例行CT增强扫描.结果 10例肺隐球菌病表现为结节病变6例,其中单发结节4例,多发结节2例;肿块型3例,均为单发肿块;1例病变较弥漫,表现为两肺结节、斑片状混合病灶.10例中有9例病灶累及胸膜引起不同程度胸膜增厚,但所有病例均未见胸腔积液.7例可见增粗的肺血管深入病灶内.结节、肿块型周边出现环状毛玻璃影5例.结论 CT表现对肺隐球菌病的诊断有一定的提示作用,最终诊断依靠病理或病原学、血清学检查.     

恶性胸膜间皮瘤与结核性脓胸的CT征象分析

目的 探讨CT对恶性胸膜间皮瘤与结核性脓胸的诊断和鉴别诊断价值.方法 回顾性分析22例恶性胸膜间皮瘤及50例结核性脓胸患者的CT检查资料,评估CT对恶性胸膜间皮瘤与结核性脓胸的诊断和鉴别诊断价值.结果 恶性胸膜间皮瘤组与结核性脓胸组对比,规则性胸膜增厚、结节状胸膜增厚、肿块状胸膜增厚、环形胸膜增厚、叶间裂胸膜受累、纵隔胸膜受累及患侧胸廓体积缩小等影像学征象发生率二者差异均具有统计学意义(P =0.000 ～0.03).胸腔积液严重程度、纵隔淋巴结肿大、肺内受累及胸壁受累等影像学征象发生率两组之间未发现统计学差异(P=0.123～1.00).结论 胸膜增厚的形态学特点及患侧胸廓体积缩小等影像学征象有助于恶性胸膜间皮瘤与结核性脓胸的鉴别诊断.     

CT findings and serum ca 125 levels in malignant peritoneal mesothelioma: report of 11 new cases and review of the literature

The aim of this study was to review and reappraise the clinical and CT features of malignant peritoneal mesothelioma (MPM), and to discuss differential diagnosis. The history, clinical, and laboratory data, and imaging studies of 11 patients with a histologically proven diagnosis of MPM, were retrospectively reviewed. Our patients consisted of 7 women and 4 men, with a median age of 48 years (age range 40-55 years). There was a definite history of significant asbestos exposure in 6 patients. Abdominal swelling (9 of 11) was the most common presenting symptom. The mean serum CA-125 (normal value 1.2-32 U/ml) level was 230 U/ml (range 19-1000 U/ml). The most common radiological findings were extensive or moderate amounts ascites (11 of 11), irregular or nodular peritoneal thickening (11 of 11), omental involvement (10 of 11), mesentery involvement (9 of 11), pleural thickening, plaques or calcification (7 of 11), pleural effusion (6 of 11), and bowel wall thickening (5 of 11). Two patients had large upper abdominal masses. Computed tomography findings of MPM are nonspecific and inadequate to pinpoint specific diagnosis. The diagnosis requires histological demonstration which is commonly made by an image or laparoscopic-guided biopsy. Pleural changes suggesting asbestosis combined with CT findings and high CA-125 levels can suggest, but are not diagnostic of, mesothelioma. Suggesting the diagnosis of MPM is important because histological and immunohistochemical tests are needed for diagnostic accuracy.     

Computed tomography findings in 66 patients with malignant pleural mesothelioma due to environmental exposure to asbestos

We aimed to investigate the computed tomography (CT) findings of malignant pleural mesothelioma (MPM) caused by environmental asbestos exposure. We retrospectively reviewed CT scans of 66 patients, which were performed before any invasive procedure was done. Pleural effusion (80.3%), pleural thickening (77.2%), volume contraction (37.9%), involvement of mediastinal pleura (31.8%) and interlobar fissure (28.8%) were the most common CT findings of MPM. Although none of these findings are pathognomonic for MPM, they may provide valuable clues for the differential diagnosis, at least in patients with a history of asbestos exposure.     

Computed tomography features in malignant pleural mesothelioma and other commonly seen pleural diseases.

OBJECTIVE: To investigate the computed tomography (CT) features of malignant pleural mesothelioma (MPM) cases, comparing them to those in other malignant and benign pleural diseases. MATERIALS AND METHODS: We reviewed the CT findings of 215 patients; 99 with MPM, 39 with metastatic pleural disease (MPD), and 77 with benign pleural disease. The findings were evaluated in univariate and multivariate analysis for differentiation of pleural diseases. RESULTS: In patients with MPM, the most common CT features were circumferential lung encasement by multiple nodules (28%); pleural thickening with irregular pleuropulmonary margins (26%); and pleural thickening with superimposed nodules (20%). In the majority (70%) of cases, there was rind-like extension of tumor on the pleural surfaces. In multivariate analysis, the CT findings of "rind-like pleural involvement", "mediastinal pleural involvement", and "pleural thickness more than 1 cm" were independent findings in differentiating MPM from MPD with the sensitivity/specificity values of 70/85, 85/67, and 59/82, respectively. "Rind-like pleural involvement", "mediastinal pleural involvement", "pleural nodularity" and "pleural thickness more than 1 cm" were independent findings for differentiation of malignant pleural diseases (MPM+MPD) from benign pleural disease with the sensitivity/specificity values of 54/95, 70/83, 38/96, and 47/64, respectively. Invasion of thoracic structures such as pericardium, chest wall, diaphragm, mediastinum, with pleural disease and nodular involvement of fissures, was detected infrequently; however, since these invasions were not seen in benign pleural diseases, it was concluded these invasions, if detected on a CT scan, directly suggested malignancy. CONCLUSION: A patient has extremely high probability of malignant pleural disease if one or more of these CT findings are found and the possibility of MPM is high. These findings may be important for patients in bad state or patients who do not want any invasive biopsy procedures. It is also possible to identify cases with a low probability of malignant disease.     

Multidetector CT Findings and Differential Diagnoses of Malignant Pleural Mesothelioma and Metastatic Pleural Diseases in Korea

ObjectiveTo compare the multidetector CT (MDCT) features of malignant pleural mesothelioma (MPM) and metastatic pleural disease (MPD).ResultsPleural thickening was the most common CT finding in MPM (96.1%) and MPD (93.8%). Circumferential pleural thickening (31.1% vs. 10.9%, odds ratio [OR] 3.670), thickening of fissural pleura (83.5% vs. 67.2%, OR 2.471), thickening of diaphragmatic pleura (90.3% vs. 73.4%, OR 3.364), pleural mass (38.8% vs. 23.4%, OR 2.074), pericardial involvement (56.3% vs. 20.3%, OR 5.056), and pleural plaque (66.0% vs. 21.9%, OR 6.939) were more frequently seen in MPM than in MPD. On the other hand, nodular pleural thickening (59.2% vs. 76.6%, OR 0.445), hilar lymph node metastasis (5.8% vs. 20.3%, OR 0.243), mediastinal lymph node metastasis (10.7% vs. 37.5%, OR 0.199), and hematogenous lung metastasis (9.7% vs. 29.2%, OR 0.261) were less frequent in MPM than in MPD. When we analyzed MPD from extrathoracic malignancy (EMPD) separately and compared them to MPM, circumferential pleural thickening, thickening of interlobar fissure, pericardial involvement and presence of pleural plaque were significant findings indicating MPM than EMPD. MPM had significantly lower occurrence of hematogenous lung metastasis, as compared with EMPD.ConclusionAwareness of frequent and infrequent CT findings could aid in distinguishing MPM from MPD.     

Morphologic and functional imaging of malignant pleural mesothelioma

Malignant pleural mesothelioma (MPM) is an aggressive tumor that arises from the pleura and frequently extends to adjacent structures. MPM cells produce and respond to many angiogenic factors, such as vascular endothelial growth factor (VEGF). VEGF expression in MPM is correlated with microvascular density, which is associated with poor survival. CT has been widely used as the primary imaging modality for the clinical evaluation of MPM. Major findings include nodular pleural thickening, unilateral pleural effusion, and tumor invasion of adjacent structures. CT tends to underestimate early chest wall invasion and peritoneal involvement and has well-known limitations in the evaluation of lymph node metastases. Perfusion CT can evaluate the microvasculature of tumors, while its disadvantages, such as high radiation exposure or side effects from iodinated contrast, limit its use in both research and clinical settings. MRI can provide additional information to CT. Because of its excellent contrast resolution, MRI is superior to CT, both in the differentiation of malignant from benign pleural disease, and in the assessment of chest wall and diaphragmatic involvement. Perfusion MRI is the most promising technique for the assessment of the tumor microvasculature. In MPM, therapeutic effects of chemotherapy can be monitored with perfusion MRI. It has been shown that FDG-PET is useful for the differentiation of benign from malignant lesions, for staging and monitoring metabolic response to therapy against MPM, and that it has prognostic value. An initial report on PET/CT imaging of MPM has shown increased accuracy of overall staging, improving the assessment of tumor resectability. PET/CT seems to be superior to other imaging modalities in detecting more extensive disease involvement, and identifying unsuspected occult distant metastases.     

Pleural disease in silicosis: pleural thickening, effusion, and invagination

PURPOSE: To retrospectively evaluate pleural disease on images from patients with autopsy-proved silicosis. MATERIALS AND METHODS: The study had institutional review board approval, and informed consent from relatives of diseased subjects was waived. Lung specimens were obtained at autopsy in 110 men (mean age, 72 years) who had been followed up radiologically for a mean of 14.8 years. Computed tomographic (CT) scans obtained within 2 years before death were examined for presence of pleural thickening; shape, composition, size, and subpleural location of progressive massive fibrosis (PMF); and pleural invagination (bandlike structure between lesion and pleura). Lung specimens were reviewed and compared with CT findings. Serial chest radiographs and CT scans were reviewed for presence of pleural effusion. Association between radiographic findings and pleural invagination was analyzed with chi2 and Student t tests. Multiple logistic regression analysis was used to find predictive variables for pleural invagination. RESULTS: Pleural effusion was found in 12 (11%) patients at chest radiography and CT, and thickening was found in 64 (58%) patients at CT; the latter finding was significantly more frequent with complicated silicosis (P < .001). At CT, 128 PMF lesions were seen, 39 (30%) of which showed pleural invagination; CT scans showed pleural thickening in 36 (92%) of these 39 lesions. In 17 (44%) PMF lesions, CT scans depicted a bandlike structure that was pathologically confirmed to represent invaginated pleura in all cases. Pathologic presence of invagination was significantly associated with pleural thickening (P < .001), ipsilateral pleural effusion (P < .01), interstitial fibrosis (P < .05), and the nearness of PMF to the pleura (P < .005). Multiple logistic regression analysis showed that pleural thickening (odds ratio, 62.51; 95% confidence interval [CI]: 5.564, 70.2) and pleural effusion (odds ratio, 25.865; 95% CI: 1.992, 335.8) were significant CT variables associated with presence of pathologic pleural invagination (P = .001 and .013, respectively). Five PMF lesions had radiographic features of rounded atelectasis. CONCLUSION: Various pleural abnormalities can occur in silicosis, especially in advanced disease.     

CT of pleural abnormalities in lymphangioleiomyomatosis and comparison of pleural findings after different types of pleurodesis

OBJECTIVE: The objective of our article was to describe the spectrum and frequency of pleural abnormalities on CT in patients with lymphangioleiomyomatosis (LAM) and the pleural findings associated with different types of pleurodesis (talc, mechanical, and chemical) performed to treat the complications of pleural disease in these patients. MATERIALS AND METHODS: Two hundred fifty-eight patients with LAM underwent CT of the chest. Pleural abnormalities assessed included pleural thickening, presence of a pleural mass, areas of high attenuation, effusion, and pneumothorax. In patients who had had pleurodesis, the CT findings were correlated with the type of procedure performed. RESULTS: One hundred thirty-three (52%) of 258 patients had pleurodesis (unilateral, 68/133; bilateral, 65/133). Pleural abnormalities were more common in patients who had pleurodesis (101/133, 76%) than in those who had not (47/125, 38%) and were more prevalent on the operated side than on the unoperated side of those 68 patients who had unilateral pleurodesis. The frequencies of findings for the group without pleurodesis versus the group with pleurodesis were pleural thickening (26% vs 65%), effusion (10% vs 13%), loculated effusion (2.4% vs 11%), pneumothorax (1.6% vs 10%), areas of high attenuation (1.6% vs 23%), and mass (0.8% vs 14%), respectively. Areas of high attenuation in the pleura were present in all types of pleurodesis (mechanical, 8%; chemical, 13%; talc, 40%) and in two patients who had had repeated thoracentesis or pleurectomy. Pleural masses were present in patients who had had all types of pleurodesis (mechanical, 10%; chemical, 9%; talc, 24%) and in one patient who had had thoracentesis and thoracostomy; the masses commonly enhanced and did not change in size over time. CONCLUSION: Pleural abnormalities are common in patients with LAM as complications of the disease itself and as sequelae of pleurodesis and other pleura manipulations. Pneumothorax and pleural effusion result from the underlying pathophysiology of LAM, whereas areas of high attenuation and masses develop after all types of pleurodesis and other manipulations of the pleura (i.e., thoracentesis, thoracostomy).     

CT findings in malignant pleural mesothelioma related to nonoccupational exposure to asbestos and fibrous zeolite (erionite).

Endemic malignant pleural mesothelioma (MPM) in Turkey is related to two mineral fibers, tremolite asbestos and fibrous zeolite (erionite). Thirteen cases of MPM from the Cappadocian area, where the soil is rich in erionite, and 29 cases of MPM, from villages whose occupants have high asbestos exposure, were examined by CT. The CT findings of the two groups of MPM were compared with respect to the configuration of the pleural lesions, stage of disease, fissural involvement, pleural effusion, presence of calcified pleural plaques, and chronic fibrosing pleuritis. In erionite-related MPM the pleural lesions were flat and smooth in 69.1%; in asbestos-related MPM the lesions were nodular in 55.1%. Stage IV disease, calcified pleural plaques, and chronic fibrosing pleuritis were more common in the erionite-related MPM. The rest of the findings were similar in both groups. The early radiological diagnosis of erionite-related MPM may be even more difficult because of the similarity of the pleural lesions to chronic fibrosing pleuritis.     

良恶性胸腔积液的CT特征

目的 分析良恶性胸腔积液及胸膜增厚的cT表现，探讨两者间的不同特点。方法 分析145例经临床及病理证实的良恶性胸腔积液（良性68例，恶性77例）的CT征象。结果 145例胸腔积液中有115例伴有不同程度的胸膜增厚，根据其形态的不同可分为6种类型（恶性4型，良性2型）。结论 仅凭胸腔积液的密度不能区别其良恶性，胸膜的增厚有鉴别诊断意义，恶性胸腔积液的特点为胸膜明显增厚，一般大于10mm，且厚薄不均匀。良性胸膜增厚较轻，多小于10mm，且均匀一致。