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。

The value of MRI in the differential diagnosis of pleural tumor LUO Liangping*, CHEN Jincheng, ZHU Bin, et al. *Medical Imaging Center, the First Affiliated Hospital, Jinan University Medical College, Guangzhou 510630, China

Objective To explore the role of MR imaging (MRI) in the differential diagnosis of pleural tumor. Methods Forty five cases of pleural tumor (8 benign and 37 malignant) were examined with both CT and MRI. The morphologic features of pleural lesions and MR signal intensity on T 1 weighted, T 2 weighted, and contrast enhanced T 1 weighted images were evaluated. Results On CT images, it was found that 30 cases were with diffuse pleural thickening (29 malignant and 1 benign), 28 with mediastinal pleural involvement (27 malignant and 1 benign), 23 with circumferential or irregular pleural thickening (22 malignant and 1 benign), and 9 with infiltration of the chest wall or diaphragm (only in malignant patients). On MR images, it was found that 32 cases were with diffuse pleural thickening (31 malignant and 1 benign), 29 with mediastinal pleural involvement (27 malignant and 2 benign), 24 with circumferential or irregular pleural thickening (23 malignant and 1 benign), and 11 with infiltration of the chest wall or diaphragm (only in malignant patients). According to the above mentioned morphologic features, CT had a sensitivity of 83.8% and a specificity of 62.5% in the detection of pleural malignancy, as compared to 86.5% and 62.5% by MRI, respectively. In combination with signal intensity and morphologic features, MRI had a sensitivity of 97.3% and aspecificity of 100% in the detection of pleural malignancy. Conclusion According to the morphological features only, MRI allowed a similar value in the detection and diagnosis of pleural tumor compare with CT. In combination with signal intensity and morphologic features, MRI is more useful and, therefore, superior to CT in differentiation of malignant from benign pleural tumor.