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。     

CT在恶性胸膜间皮瘤诊断中的价值

目的探讨CT在恶性胸膜间皮瘤诊断中的价值。资料与方法回顾分析9年来我院经手术或/和病理证实的42例恶性胸膜间皮瘤患者的CT资料,并与12例手术所见作比较。结果结节状或肿块状胸膜增厚(97.6%)是胸膜间皮瘤最常见的CT表现,有诊断性的表现为胸膜增厚>1cm(59.5%),环状胸膜增厚(41.5%),病变累及纵隔胸膜(92.9%)或叶间裂(69.0%),病变侵犯周围胸壁或/和肋骨、纵隔、心包、膈肌等邻近组织或器官(65.9%),1例呈胸内巨大肿块,42.9%病例可见纵隔或/和肺门淋巴结肿大。在CT和手术所见的比较中,CT准确检出了13处(65%)对周围组织或器官的侵犯,漏诊7处(35%)。结论CT在恶性胸膜间皮瘤的诊断、分期上有重要价值,是治疗前的标准诊断方法。     

基于高分辨率CT特征鉴别早期恶性胸膜间皮瘤与胸膜转移瘤

目的 探讨高分辨率CT(HRCT)特征对早期恶性胸膜间皮瘤(MPM)与胸膜转移瘤(MPD)的鉴别诊断价值,以提高两种疾病的首诊准确率。方法 选取72例行HRCT检查的胸膜病变患者(MPM组41例,MPD组31例),并通过病理学确诊。比较两组HRCT特征,分类变量进行单因素χ²检验,定量变量进行独立样本t检验或非参数检验。结果MPD组血清癌胚抗原显著增高(P<0.05),两组间性别和年龄差异无统计学意义(P均>0.05)。MPM组以胸膜单侧受累多见,胸膜增厚多呈弥漫、环形及肿块样,可伴胸膜钙化斑及叶间胸腔积液,增强扫描胸膜及淋巴结多呈均匀强化(P均<0.05),MPD组以胸膜双侧受累多见,胸膜增厚多呈局限性及结节样,胸膜钙化斑罕见,增强扫描胸膜及淋巴结多呈不均匀强化(P均<0.05)。结论 MPM组与MPD组在胸膜受累范围、胸膜增厚形态、胸膜钙化斑、淋巴结肿大及强化特征存在差异,HRCT有助于两种疾病的早期鉴别诊断。     

恶性胸膜间皮瘤的CT评价

目的：主要分析恶性胸膜问皮瘤的CT征象，评价CT对本病的诊断价值。方法：回顾性分析12例经组织学证实的恶性胸膜问皮瘤的CT征象。结果：10例弥漫性恶性胸膜问皮瘤患者中，8例胸膜增厚大于10mm，占67％，胸膜增厚呈结节或肿块状7例，占58％，环状胸膜增厚6例，占50％，纵隔胸膜及叶间膜受侵8例，占67％，8例有半侧胸腔体积缩小，2例表现为单发结节，4例有纵隔淋巴结转移，1例有远处转移，侵犯颈椎。结论：CT在确定恶性胸膜间皮瘤的侵犯范围和程度方面具有重要作用，但本病的最终确诊仍需要病理组织学的证实。     

实验性大鼠恶性胸膜间皮瘤的CT表现与病理对照研究

目的 探讨大鼠恶性胸膜间皮瘤(Malignant pleural mesothelioma,MPM)CT表现.材料与方法对66只Wistar大鼠MPM模型行胸部CT平扫,并尸解及病检.结果 胸膜增厚形态与组织病理类型、分化程度无关.CT显示局限片状增厚18侧、结节形增厚48侧、弥漫环形增厚47侧,19侧CT未显示胸膜增厚.CT胸水发现率为39.13%,多见于上皮型和混合型.镜下MPM向周围组织浸润45例,占68.18%,CT仅显示33.33%.结论 平扫CT不能提示MPM组织类型和分化程度;胸膜增厚的类型与大体病理学改变有一定符合性,但CT不能显示小于3 mm结节和薄的斑片状病灶;CT对胸水显示率低.     

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(附28例报告)

胸膜间皮瘤起源于胸膜及心包膜，根据肿瘤的组织学结构不同，分为良性和恶性。本文收集28例经手术、病理证实的胸膜间皮瘤，进行回顾性分析，重点探讨CT对胸膜间皮瘤的诊断价值。     

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.     

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。     

18F-FDG PET/CT显像在恶性胸膜间皮瘤诊断中的价值

目的 探讨18F-脱氧葡萄糖(FDG)PET/CT显像在恶性胸膜间皮瘤(MPM)诊断中的临床价值及原发肿瘤病灶平均标准摄取值(SUVmax)对患者预后的判断价值.方法 回顾性总结17例2002-2008年临床疑诊MPM患者18F-FDG PET/CT显像资料,测量病灶的SUVmax.将病理检查及临床随访证实的MPM患者按照有无转移分为2组,测定每例患者原发肿瘤病灶的SUVmax,用受试者工作特征(ROC)曲线评价SUVmax对患者转移与否的诊断价值,判断预后.采用SPSS 11.0软件进行t检验.结果 经病理及随访结果证实MPM 12例,良性胸膜病变5例,二者的SUVmax分别为5.78±1.81和2.72±2.51,差异有统计学意义(t=2.8,P<0.05).全身18F-FDG PET/CT显像诊断MPM的灵敏度为100%(12/12),特异性为4/5,准确性为94%(16/17),18F-FDG PET/CT显像有7例MPM伴有骨和(或)淋巴结转移.SUVmaxROC曲线分析表明曲线下面积(AUC)为0.80.结论 全身18F-FDG PET/CT显像对于MPM的诊断有重要价值.原发肿瘤病灶SUVmax越高越易发生转移,预后越差.     

HRCT在检出恶性胸腔积液中胸膜病变的价值

目的 探讨HRCT检出恶性胸腔积液中胸膜病变的价值.方法 回顾分析恶性胸腔积液合并胸膜病变患者40例,复习恶性胸腔积液中胸膜病变的HRCT影像学表现.结果 本组40例患者CT平扫显示胸腔大量积液者12例,中等量或少量积液者28例.CT增强扫描,胸膜病变明显强化,主要表现为结节状强化.结论 HRCT主要用于肺部弥漫性病变的检出,通过本组病例发现HRCT对于检出恶性胸腔积液中的胸膜病变亦有较高价值.     

小儿眼部恶性肿瘤的CT诊断

目的：总结分析小儿眼部恶性肿瘤的CT表现,提高影像诊断水平。方法：回顾性分析经过手术病理、临床证实的儿童眼部恶性肿瘤患者54例,分析其CT影像学改变。其中视网膜母细胞瘤41例,其它肿瘤13例,包括：白血病眼部浸润4例,横纹肌肉瘤3例,淋巴瘤2例,脉络膜黑色素瘤、恶性婴儿色素性神经外胚层瘤、转移性神经母细胞瘤、肌源性转移瘤各1例。结果：视网膜母细胞瘤以眼球内含有钙化的不规则肿块为明确的CT征象;其它肿瘤（如白血病的绿色瘤）多有不规则的生长方式以及周围骨质结构破坏而可以得出恶性肿瘤的诊断,结合临床资料可以得出相对准确的病理诊断;但是横纹肌肉瘤可因病变范围局限且境界清楚而恶性征象不明显。结论：在CT图像上,累及小儿眼部的大部分恶性肿瘤通常都有影像学的恶性征象,对定性诊断有重要的临床应用价值。     

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。     

Three-dimensional evaluation of chemotherapy response in malignant pleural mesothelioma

Objectives

Measurement of tumor response to chemotherapy in malignant pleural mesothelioma (MPM) is problematic because of non-spherical tumor growth patterns and difficulty in choosing target lesion. In this study, we aimed to determine the effectiveness of tumor volume measurement for evaluating chemotherapy response.

Methods

Fifty-seven MPM patients were included. Chemotherapy responses were evaluated by computed tomography (CT) using volumetric method, World Health Organization (WHO), and modified Response Evaluation Criteria in Solid Tumor (RECIST). The tumor volume was measured using the Cavalieri principle of stereological approaches.

Results

According to the volumetric method, median survival was 10.0 months for progressive disease (PD), 14.0 months for stable disease (SD) and 16.0 months for objective response (OR). According to the WHO method, median survival was 11.3, 14.0, and 13.0 months, respectively. For modified RECIST, median survival was 10.0, 14.0, and 14.0 months, respectively. The correspondence between the WHO and modified RECIST methods was substantial (K = 0.66), as was that between the volumetric and WHO methods (K = 0.64); however the correspondence between the volumetric and modified RECIST methods was only moderate (K = 0.52).

Conclusions

The most suitable chemotherapy response measurement technique is the volumetric method because of non-spherical tumor growth patterns in MPM. However, larger studies should be performed to better establish the suitability of this method. We recommend our method for determining the chemotherapy response in mesothelioma cases. However, modified RECIST criteria can also be applied due to favourable prediction of survival, ease of application, and moderate correspondence with the volumetric method.     

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.     

Development of a guideline on reading CT images of malignant pleural mesothelioma and selection of the reference CT films

Purpose

International experts developed a guideline on reading CT images of malignant pleural mesothelioma for radiologists and physicians. It is intended that it act as a supplement to the current International Classification of HRCT for Occupational and Environmental Respiratory Diseases.

Methods

The research literatures on mesothelioma CT features were systematically reviewed. Ten mesothelioma CT features were adopted into the guideline prepared according to experts’ opinion. The terminology of mesothelioma CT features and mesothelioma probability were agreed by consensus of experts. The CT reference films for each mesothelioma feature were selected based on agreement by experts from 22 definite mesothelioma cases confirmed pathologically and immunohistochemically. To support the validity of the mesothelioma probability, 4 experts’ readings of CT films from 57 cases with or without mesothelioma were analyzed by kappa statistics between the experts; sensitivity and specificity for mesothelioma were also assessed.

Results

The mesothelioma CT Guideline was developed, providing the terminology of CT features and the mesothelioma probability, the judgement of severity, the distribution of mesothelioma, and the revised CT reading sheet including mesothelioma items. The CT reference films with ten mesothelioma typical features were selected. The average linearly and quadratically weighted kappa of the agreement on the 4-point scale mesothelioma probability were 0.58 and 0.71, respectively. The average sensitivity and specificity for mesothelioma were 93.2% and 65.6%, respectively.

Conclusion

The evidence-based mesothelioma CT Guideline developed may serve as a good educational tool to facilitate physicians in recognising mesothelioma and improve their proficiency in diagnosis of mesothelioma.