胸膜孤立性纤维瘤的CT诊断及鉴别

目的分析胸膜孤立性纤维瘤（pleural solitary fibrous tumor,PSFT）的CT表现,提高诊断水平。方法回顾性分析9例经手术及病理学证实的PSFT的CT资料。结果 9例均表现为胸腔内单发的软组织肿块,位于左侧胸腔6例,右侧胸腔3例。肿瘤最大直径4.3~18.7 cm,平均14.3 cm,其中7例体积较巨大,周边稍呈分叶状,2例较小者呈类圆形。CT平扫肿瘤较密实,呈等或略低密度,6例密度不均,见2种密度区混杂分布,3例密度较均匀;增强扫描7例不均匀强化,强化方式多样而程度变化较大,5例巨大者轻、中度强化和显著强化同时存在;7例见肿瘤内血管明显强化。4例周围见轻度压迫性肺不张,3例少量胸腔积液。9例瘤-肺界面均较光整,邻近肋骨结构均正常,未见明显骨质增生及压迹或骨质破坏,周边见胸膜局限掀起呈胸膜尾征。结论 PSFT的CT表现有一定特征性,CT对其诊断及鉴别具有较大价值。

Characteristic manifestations of pleural solitary fibrous tumors on CT scan

Objective To review the manifestations of pleural solitary fibrous tumors（PSFTs） on CT scan.Methods CT manifestations of PSFTs in 9 patients confirmed by surgery and pathology were analyzed retrospectively.Results CT scan demonstrated solitary mass of soft tissue density in thoracic cavity of all 9 cases（6 left,3 right）.The mean maximal diameter of tumors was 14.3 cm（4.3 ~ 18.7 cm）.Seven cases presented huge tumors with small irregular lobes,2 presented oval-shape.All tumors presented equal or slightly low density on plain CT scan,6 showed heterogeneous density and 3 showed homogeneous density.On enhanced CT,7 cases showed uneven enhancement with various enhanced degree and pattern,and 5 huge tumors showed a mixture of mild,middle and prominent enhancement.Blood vessels were markedly enhanced in 7 tumors,atelectasis was observed in tumor-adjacent lung in 4 cases and hydrocele of thoracic cavity was shown in 3 cases.The interface between tumor and lung was regular in all 9 cases and adjacent ribs were normal,without obvious oppression,osteosclerosis or impairment,and adjacent pleura was raised presenting pleural tail sign.Conclusion Pleural solitary fibrous tumors present characteristic features on CT scan,which can be used for diagnosis or differential diagnosis of PSFTs.