良、恶性胸腔积液的CT鉴别诊断

目的评价良、恶性胸腔积液的CT特征性表现.资料与方法回顾性分析38例恶性胸腔积液和56例良性胸腔积液的CT征象.结果良性积液中,双侧占41.1%,胸膜增厚占19.6%,呈弥漫均匀增厚,纵隔胸膜受累占10.7%,胸膜外脂肪层明确显示占71.4%,厚度＞3 mm占41.1%,平均厚度5.7 mm;恶性积液中,双侧占15.8%,胸膜增厚占57.9%,主要呈不规则弥漫或局限性增厚,累及纵隔胸膜占36.8%,胸膜外脂肪层显示占60.5%,＞3 mm占26.3%,平均2.9 mm.结论单侧、大量积液且张力高,胸膜不规则增厚,纵隔胸膜受累对恶性诊断有特异性;而胸膜无或轻度弥漫规则增厚,胸膜外脂肪层增厚多提示良性.     

MRI在良、恶性胸膜肿瘤鉴别诊断中的价值

目的：探讨磁共振成像在良、恶性胸膜肿瘤鉴别诊断中的作用。方法：对45例胸膜肿瘤患者（良性8例,恶性37例）进行了CT和MRI检查。评估分析良、恶性胸膜肿瘤的CT和MRI形态学特点及其分别在T1WI、T2WI和增强T1WI上的信号特点。结果：在CT图像上,共出现弥漫性胸膜增厚30例（恶性29例,良性1例）,纵隔胸膜受累28例（恶性27例,良性1例）、环绕或不规则胸膜增厚23例（恶性22例,良性1例）,胸壁或膈肌浸润9例（全部为恶性）;在MRI上,共出现弥漫性胸膜增厚32例（恶性31例,良性1例）,纵隔胸膜受累29例（恶性27例,良性2例）、环绕或不规则胸膜增厚24例（恶性23例,良性1例）,胸壁或膈肌浸润1例（全部为恶性）。根据前述形态学特点,CT与MRI对诊断胸膜恶性肿瘤总的敏感性分别为83．8％和86．5％,总特异性均为62．5％。结论形态学及信号特点,MRI对诊断良、恶性肿瘤病变的敏感性为97．3％,特异性为100％。结论：单纯依据其形态学特点,MRI对胸膜肿瘤的发现与诊断价值与CT相仿。但当MR信号与形态学特点结合时,其对良、恶性胸膜肿瘤的鉴别诊断价值则明显优于CT。     

胸膜原发性肿瘤的影像学诊断(附26例分析)

目的：分析胸膜原发性肿瘤的影像学特点，探讨胸膜原发性肿瘤与肺内肿块鉴别诊断的要点。方法：回顾性分析26例经手术病理证实的原发性胸膜肿瘤的影偈学资料，其中，胸膜间皮瘤20例，胸膜神经鞘瘤4例，神经纤维瘤1例及胸膜纤维脂肪瘤1例。结果：胸膜间皮瘤影偈学表现为3种类型；单发胸膜肿块型，多发胸膜肿块及结节状胸膜增厚型，胸膜积液为主型，单发肿块良，恶性均有，多发性肿块或结节状胸膜增厚伴胸腔积液时，多见于恶性弥漫型胸膜间皮瘤，胸膜神经鞘瘤，神经纤维瘤及胸膜纤维脂肪瘤均具有良性肿瘤的特征。结论：胸膜原发性肿瘤虽无特征性影像学表现，仔细综合分析各种影像学征象特点，对提高本病的诊断具有重要价值。     

1.5T磁共振1H-MRS鉴别良恶性胸腔积液的初步研究

目的：探讨磁共振波谱对良、恶性胸腔积液的鉴别诊断价值。方法收集行胸腔穿刺抽液的胸腔积液标本46例,其中原发病确诊为良性者20例（包括肺结核14例、肺炎6例）,原发病确诊为恶性者26例（包括原发性肺癌18例、乳腺癌5例、肝癌2例、胃癌1例）。对胸腔积液标本进行离心处理,然后利用1.5T磁共振对胸腔积液标本进行波谱采集,分析良恶性胸腔积液的波谱特征。结果胸腔积液的波谱图中主要的代谢峰有乳酸、胆碱、肌酸、肌醇及脂质等。主要代谢物波峰下面积比较：乳酸：结核性（5.19±1.31）、炎性（6.08±1.56）和恶性胸腔积液（2.40±0.43）的乳酸峰下面积差异有统计学意义（F=8.45,P<0.01）;胆碱：结核性（2.75±0.91）、炎性（3.27±1.21）和恶性胸腔积液（6.76±1.73）的胆碱峰下面积差异有统计学意义（F=2.98,P<0.01）;肌醇：结核性（2.71±1.19）、炎性（2.25±0.81）和恶性胸腔积液（5.83±2.08）的肌醇峰下面积差异有统计学意义（F=38.49,P<0.01）。结核性和炎性胸腔积液中乳酸（t=-1.04,P＞0.05）、胆碱（t=-0.58,P＞0.05）和肌醇（t=1.19,P＞0.05）波峰下面积差异无统计学意义。结论良、恶性胸腔积液具有不同的波谱特征,利用磁共振波谱对良、恶性胸腔积液进行鉴别具有一定的临床应用价值。     

局部胸膜增厚与肺内孤立结节（SPN）的相关性探讨

目的 探讨孤立性肺结节（sPN）与邻近胸膜的相关性。方法 回顾分析38例胸膜下孤立肺结节的CT表现，按其性质与邻近胸膜改变对照，分析其相关性。结果 38例胸膜下孤立肺结节中恶性者9例，发现胸膜凹陷6例，胸膜无改变2例，胸膜增厚1例；良性结节29例，发现胸膜增厚22例，胸膜凹陷4例，胸膜无改变3例。结论 局部胸膜增厚和胸膜凹陷对鉴别SPN的良恶性有一定意义。     

胸膜间皮瘤的平片及CT表现

目的：探讨胸膜间皮瘤在胸片及螺旋CT中的表现特点，对胸膜间皮瘤的影像表现更深一步认识。方法：对12例经穿刺及手术病理证实的胸膜间皮瘤患者，用DR摄片及GEFⅡ螺旋CT，自肺尖至膈顶连续扫描，层厚10mm，螺距1．5：1。结果：局限性胸膜增厚、结节影2例，广泛性胸膜不规则增厚并多发结节影8倒，伴有胸腔积液6例，巨大胸内肿物2例。右侧8例，左侧4例。结论：影像表现呈多样性，无特异性。局限性多为良性，弥漫多发结节影及巨大肿块者多为恶性．     

胸壁肿块的CT诊断

目的分析胸壁肿块的CT表现,提高其诊断水平。方法 30例临床证实的胸壁肿块患者均经CT平扫,10例又经增强扫描。对所有患者的CT表现进行了回顾性分析。结果在CT像上,胸壁结核(5例)表现为胸壁内软组织密度肿块影;细菌性脓肿(4例),表现为局限性软组织肿块影,密度不均匀;脂肪瘤(4例)表现为胸壁内局限性脂肪密度肿块影;神经源性肿瘤(5例)表现为胸壁内密度均匀、边界清楚的软组织肿块影;血管瘤(1例)表现为左侧胸壁散在条状迂曲的软组织密度肿块影,增强后明显强化;胸膜间皮瘤(3例),其中良性者(2例)表现为局限性胸膜增厚,恶性者(1例)表现为弥漫性胸膜增厚伴胸腔积液;胸膜转移瘤(3例)表现为胸膜结节状增厚;肋骨转移瘤(4例)表现为胸膜结节状增厚;Askin瘤(1例)表现为右侧胸壁内及胸膜处软组织肿块影伴邻近肋骨骨质破坏。结论 CT对胸壁肿块的定位及良、恶性鉴别具有重要价值,尤其64排螺旋CT及其后处理技术更有利于其诊断与鉴别诊断。     

血管内皮生长因子、癌胚抗原及端粒酶联合检测对良恶性胸腔积液的鉴别诊断价值

目的 探索胸腔积液中血管内皮生长因子（vascular endothelial growth factor,VEGF）、癌胚抗原（carcinoembryonic antigen,CEA）及端粒酶单项和联合检测在良恶性胸腔积液中的诊断价值.方法 选取70例胸腔积液患者,包括恶性胸腔积液34例,良性胸腔积液36例.采用ELISA法检测VEGF和CEA在两组病例胸腔积液中的表达,端粒酶的表达采用PCR-ELISA法检测.结果 VEGF、CEA及端粒酶在恶性胸腔积液患者组中的表达明显高于良性组（P＜0.05）;在单项检测中,VEGF的敏感性最高73.53％,其阳性预测值最高83.33％;CEA的特异性最高88.88％;联合检测中VEGF＋ CEA的敏感性最高91.17％,CEA＋端粒酶的特异性低于VEGF＋CEA和VEGF＋端粒酶.结论 VEGF、CEA及端粒酶在良恶性胸腔积液的鉴别诊断中具有较高价值,联合检测可提高诊断的敏感性.     

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。     

164例结核性胸腔积液的CT诊断

目的：探讨结核性胸腔积液的CT表现，研究结核性胸腔积液与肺结核相关性。方法：对164例平片诊断为结核性胸腔积液的CT表现进行回顾性分析。结果：164例结核性胸腔积液合并肺结核病灶112例，胸膜增厚130例，HRCT40例发现胸膜下小空洞10例，胸膜下结核灶8例，结核性肉芽肿16例。结论：CT对结核性胸腔积液有较大诊断价值，是评价和随访证实为或怀疑为结核性胸腔积液最有效的检查方法。     

Evaluation of CT findings for diagnosis of pleural effusions

Computed tomography studies are usually used to assess patients with pleural effusions, and radiologists should be aware of the significance of different CT findings for the diagnosis of the effusion. The purpose of this study was to evaluate CT findings for etiological diagnosis of pleural effusions. Contrast-enhanced CT of the chest of 211 patients with pleural effusion of definite diagnosis were evaluated. The CT images were evaluated for the presence and extent of pleural effusion, thickening or nodules, extrapleural fat and other changes in the mediastinum or lung. The CT scans were read by two independent observers and correlation between them was evaluated. Comparison of CT findings between benign and malignant effusions, between exudates and transudates, and between empyemas and the other parapneumonic effusions were carried out. Kappa values for most CT findings were > 0.85. Loculation, pleural thickening, pleural nodules, and extrapleural fat of increased density were only present in exudative effusions. Multiple pleural nodules and nodular pleural thickening were the only pleural findings limited to malignant pleural effusions. The signs were also more frequently seen in empyemas than in other parapneumonic effusions. Computed tomography findings can help to distinguish between transudates and exudates. Although there is some overlap between benign and malignant pleural effusions, pleural nodules and nodular pleural thickening were present almost exclusively in the latter. Although differences between CT findings of empyemas and the other parapneumonic effusions exist, there is no finding which can definitely differentiate between them. Received: 27 January 1999; Revised: 24 June 1999; Accepted: 24 August 1999     

CT未检出原发灶的胸腔积液或肺不张患者18F-FDG显像结果分析

目的评价^18F-脱氧葡萄糖(FDG)符合线路显像(DHTC)寻找CT未能发现原发灶的胸腔积液或肺不张患者的肺癌原发灶，及其对肺癌伴有胸腔积液的患者胸腔积液良恶性鉴别诊断的价值。方法110例CT未发现肺部原发病灶但疑为肺癌及肺癌转移可能的胸腔积液或肺不张患者(其中胸腔积液8．4例，肺不张26例)，进行^18F-FDG DHTC检查。结果38例患者最终确诊为肺癌，其中伴有胸腔积液30例，伴有肺不张8例；另72例为肺部良性病变。^18F-FDG DHTC对CT未能找到原发灶的胸腔积液或肺不张患者肺癌诊断的灵敏度、特异性和准确性分别为97％、78％和85％。30例伴有胸腔积液的肺癌患者中，21例确诊为恶性胸腔积液。^18F-FDG DHTC对良恶性胸腔积液鉴别诊断的灵敏度为86％，特异性为8／9例。结论^18F-FDG DHTC是寻找胸腔积液或肺不张患者肺癌原发灶灵敏可靠的方法，并对良恶性胸腔积液的鉴别诊断有一定的临床价值。     

Evaluation of pleural disease using MR and CT. With special reference to malignant pleural mesothelioma

Purpose: To evaluate MR imaging and CT in differentiating malignant pleural mesothelioma from other malignancies or benign pleural disease.Material and Methods: Thirty-four patients (18 pleural mesotheliomas, 9 other malignancies, 7 benign pleural diseases) were examined using enhanced CT and MR. Two radiologists reviewed the CT and two others the MR images. Comparisons were made between the diagnostic groups and the imaging methods.Results: The abnormalities commonly found in malignant disease, but significantly less frequently in benign pleural disease, were focal thickening and enhancement of interlobar fissures. In mesothelioma, enhancement of interlobar fissures, tumour invasion of the diaphragm, mediastinal soft tissue or chest wall, were significantly more often observed than in other malignancies and MR was the most sensitive method. In other malignancies, invasion of bony structures was a more common finding and was also better shown by MR. The contrast-enhanced T1 fat-suppressed (CET1fs) sequence detected these features better than other MR sequences.Conclusion: MR, especially the CET1fs sequence in three planes, gave more information than enhanced CT. Focal thickening and enhancement of interlobar fissures were early abnormalities indicating malignant pleural disease. MR could be clinically useful for differentiating mesothelioma from other pleural diseases.     

The utility of multi-detector computed tomography in the diagnosis of malignant pleural effusion in the patients with ovarian cancer

Purpose

The purpose of this study was to retrospectively assess possible clinical predictors of malignant pleural effusion in patients with ovarian cancer.

Materials and methods

This review was performed on 38 ovarian cancer patients that showed pleural effusion in a CT scan and who underwent thoracocentesis before treatment. CT scans were obtained using a 4-channel multi-detector CT scanner. Fisher's exact test was used to determine the probability of malignant pleural effusion as a function of; amount of ascites, lymph node enlargement, amount of pleural effusion, pleural nodules, and pleural thickening.

Results

Sixteen (42.1%) of the 38 patients had malignant pleural effusion and malignant pleural effusion amounts were greater than those with nonmalignant effusion.Pleural nodules were more frequently found in the malignant pleural effusion group (eight [50%] patients) than in the nonmalignant group (zero [0%] patient) (p < 0.001). Supradiaphragmatic lymph node enlargement (with short axis diameter 1 cm or more) was more frequent in malignant group (12 [75%] patients) than in the nonmalignant group (two [9.1%] patients) (p < 0.001).

Conclusion

The probability of malignant pleural effusion in patients with ovarian cancer was found to be correlated with the amount of pleural effusion, the presence of pleural nodules, and supradiaphragmatic lymph node enlargement.     

Thoracic computed tomography in patients with suspected malignant pleural effusions

AIM: To assess the role of contrast-enhanced computed tomography (CT) prospectively in patients with suspected malignant pleural effusions.MATERIALS AND METHODS: Forty consecutive patients referred for the investigation of a suspected malignant pleural effusion had contrast-enhanced thoracic CT, thoracoscopy, thoraco-centesis and pleural biopsy, either percutaneously or at thoracoscopy. Final diagnoses were based on histopathological or cytological analysis (n = 30), autopsy findings (n = 3) or clinical follow-up (n = 7). The pleural surfaces were classified at contrast-enhanced CT as normal or abnormal and, if abnormal, as benign or malignant in appearance using previously established CT criteria for malignant pleural thickening by two observers unaware of the pathological diagnosis.RESULTS: Pleural effusions were malignant in 32 patients and benign in eight patients. Pleural surfaces assessed at CT showed features of malignancy in 27 out of 32 patients with a malignant effusion (sensitivity 84%, specificity 100%). Overall, CT appearances indicated the presence of malignancy in 28 of 32 (87%) patients. All eight patients with benign pleural disease were correctly diagnosed by CT.CONCLUSION: Contrast-enhanced CT is of value in patients with suspected malignant pleural effusions. The previously established criteria for malignant pleural thickening of nodularity, irregularity and pleural thickness >1 cm are reliable in the presence of a pleural effusion.     

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。     

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.