不同CT征象对胸腺瘤与常见纵隔恶性肿瘤的诊断及鉴别诊断

目的:分析不同CT征象对胸腺瘤与常见纵隔恶性肿瘤的诊断及鉴别诊断临床价值。方法:选择2011年3月-2014年6月期间我院收治的经手术及穿刺病理及临床随访证实的90例纵隔肿瘤患者，其中非侵袭性胸腺瘤30例，侵袭性胸腺瘤28例，纵隔恶性肿瘤32例。所有肿瘤患者均行平扫及增强扫描，利用MSCT的动态增强及MPR成像，分析三种类型纵隔肿瘤的CT图像特征，比较三种肿瘤基本特点的差异性。结果:经过MSCT的动态增强技术及MPR技术成像分析，非侵袭性胸腺瘤患者CT成像的形态规则28例，欠规则2例，边缘光滑27例，欠光滑3例，毛糙0例，密度均匀27例，欠均匀3例，与侵袭性胸腺瘤和纵隔恶性肿瘤CT成像的形态是否规则、边缘是否光滑、密度是否均匀的差异性比较明显，两两比较均具有显著性差异（P<0.05）。非侵袭性胸腺瘤患者CT成像的MCI形态凸出型27例，平坦型3例，灌注型0例，周围脏器间隙清晰29例，部分层面清晰1例，间隙不清晰0例，周围组织分界清晰30例，分界不清0例，与侵袭性胸腺瘤和纵隔恶性肿瘤CT成像的MCI形态类型、周围脏器间隙是否清晰以及周围组织分界是否清晰差异性显著，两两比较具有明显差异性（P<0.05）。经过MSCT的动态增强技术及MPR技术分析，非侵袭性胸腺瘤患者CT成像经过强化，强度变化不明显24例，轻度强化6例，不均匀强化0例，伴有胸腔积液1例，无胸腔积液29例，纵隔、腋窝与颈部基本无患者具有肿大淋巴结，与侵袭性胸腺瘤和纵隔恶性肿瘤CT成像的强化特点、是否伴有胸腔积液、有无肿大淋巴结等差异性显著，两两比较具有明显差异性（P<0.05）。结论:利用MSCT动态增强技术和MPR技术，能够明显区分非侵袭性胸腺瘤、侵袭性胸腺瘤与纵隔恶性肿瘤，为临床诊断提供了技术支持，是一种值得推广的区分三种类型肿瘤的鉴别方法。

Different signs CT diagnosis and differential diagnosis of mediastinal thymoma and com-mon malignancy

Objective:To investigate the different CT signs of mediastinal thymoma and common malignancy diagnosis and differential diagnosis.Methods:After surgery and biopsy and clinical follow-up confirmed 90 cases of mediastinal tumors included non-invasive thymoma 30 cases，28 cases of invasive thymoma and mediastinal 32 cases of malignant tumors.All patients underwent unenhanced and enhanced scans using dynamic contrast-enhanced MSCT and MPR imaging to analyse three types of mediastinal tumor CT image features，compare the basic characteristics of tumor differentiation.Results:Dynamic contrast-enhanced MSCT imaging technology and MPR technology analysis showed non-invasive thymoma patients with CT imaging of morphological in 28 cases，2 cases due to the rules，smooth edge in 27 cases，3 cases less smooth，rough 0 case，density 27 cases，less uniform three cases with invasive thymoma and mediastinal malignancies whether CT imaging of morphological rules，the edge was smooth，the density was uniform obvious differences，pairwise comparisons were significant differences（P<0.05）.MCI form of non-invasive thymoma patients with CT imaging in 27 cases of protruding type，flat type 3 cases，filling the mold 0 case，29 cases clear space around the organs，and some level of clarity one case，the gap was not clear 0 case，30 cases surrounding tissue boundaries clear，unclear boundaries 0 case with invasive thymoma and mediastinal malignancies CT imaging MCI morphological types，as well as the surrounding organs were clear gaps surrounding tissue boundaries were clear differences significant pairwise comparison （P<0.05).Through dynamic enhanced MSCT technology and MPR technical analysis，non-invasive thymoma patients with CT imaging hardened，the intensity did not change significantly in 24 cases，six cases of mild enhancement，heterogeneous enhancement 0 case accompanied by pleural effusion，pleural effusion 29 cases no，mediastinal，armpits and neck almost no patients had lymph nodes with invasive thymoma and mediastinal malignancies enhanced CT imaging features，whether accompanied by chest differences effusion，with or without lymph node enlargement significantly，pairwise comparisons with a significant difference（P<0.05).Conclusion:The use of technology and dynamic contrast-enhanced MSCT MPR technology can clearly distinguish non-invasive thymoma，invasive thymoma and mediastinal malignancies，clinical diagnostics provide technical support.