原发性纵隔肿瘤X线诊断(附255例X线分析)

目的 探讨原发性纵隔肿瘤的Ｘ线诊断与误诊原因，并进一步评价Ｘ线检查对该类肿瘤的临床价值。材料与方法 分析原发性纵隔肿瘤２５５例的Ｘ线表现（全部病例均有胸部正、侧位片，５８例有胸部ＣＴ片，３例进行了胸部ＭＲＩ检查），并对照分析本组Ｘ线、ＣＴ检查结果与手术病理结果。探讨原发性纵隔肿瘤的诊断步骤及各步骤的Ｘ线诊断依据。提出并研究“典型胸膜外征”、“非典型胸膜外征”与“沟征”的形成机理与诊断价值，探讨肿块

X-ray Diagnosis of Primary Mediastinal Tumors--An Analysis of 255 Cases

Objective To study the Xray diagnosis of primary mediastinal tumors, to analyze the causes of misdiagnosis, and to make a further evaluation of Xray in clinical management of these tumors.Materials and Methods Imaging findings, including chest films (all cases), CT scans (n=58) and MRI (n=3), in 255 patients with primary mediastinal tumors were retrospectively analyzed. Comparisons between Xray, CT and pathological findings were made. The diagnostic algorithm was investigated. A deep study of the mechanism producing extrapleura sign, nontypical extrapleura sign and groove sign was conducted. The relationship of the mass with the trachea and esophagus was studied.Results The misdiagnosed rate of plain Xray films was 37.6%, significantly higher than that of CT (P<0.01). The nontypical extrapleura sign and groove sign were the main cause leading to misdiagnosis.Conclusion Primary mediastinal tumors are prone to be misdiagnosed on plain Xray films only. Precise understanding of extrapleura sign, nontypical extrapleura sign and groove sign as well as the relationship of the mass with the trachea and esophagus is the key point to avoid misdiagnosis.