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目的 分析原发于胸部的恶性神经鞘膜瘤的影像表现 ,并与手术病理对照 ,以提高鉴别诊断能力。方法 10例 (11个病灶 )全部摄正侧位片。 8例行CT检查 ,先平扫 ,再行增强扫描。经手术证实 8例 ,CT引导下肺穿刺活检证实 2例。 6例 (7个病灶 )行CT与病理对照。结果 肿瘤位于纵隔 4例 ,肺内 2例 ,胸壁 3例 ,横膈 1例。病灶呈孤立肿块型 8例 ,多发肿块型 1例 ,弥漫肿块型 1例。肺、支气管明显压迫 3例 ;肺浸润 1例 ;肋骨受压变形 3例 ,其中伴骨质破坏 2例 ;胸水 4例。CT表现 :病灶边缘较光整 3个 (病理上均有完整包膜 ) ,边缘毛糙 4个。病灶呈网格样强化 2个 (病理见实质肿块内多个大小不一的囊腔 ) ,不均匀强化 4个 (非强化区与病理上出血坏死区相符 ) ,病灶呈均匀液性密度 1个 (病理示肿瘤囊性变 )。结论 胸部良、恶性神经鞘膜瘤的CT诊断有很大限度 ,肿瘤内低密度区并不是恶性神经鞘膜瘤的特征性表现 ,肿瘤边界不光整则提示恶性可能 ,邻近结构受侵破坏是提示恶性病变的重要征象。
Objective To analyze the imaging manifestations of malignant nerve sheath tumors that originate in the chest and compare them with surgical pathology to improve the differential diagnosis ability. Methods 10 cases (11 lesions) were all taken positive and lateral radiographs. 8 routine CT examination, first plain scan, and then enhanced scan. Eight cases were confirmed by surgery, and 2 cases were confirmed by CT-guided lung biopsy. Six cases (7 lesions) were compared between CT and pathology. Results The tumor was located in 4 mediastinums, 2 in the lungs, 3 in the chest wall, and 1 in the diaphragm. The lesions were isolated masses in 8 cases, multiple masses in 1 case, and diffuse masses in 1 case. The lungs and bronchus were significantly compressed in 3 cases; pulmonary infiltration in 1 case; rib compression and deformation in 3 cases, including bone destruction in 2 cases; pleural effusion in 4 cases. CT findings: The lesions were more marginal than the lesions (pathologically intact capsules), with 4 margins. The lesions were grid-like enhanced 2 (pathologically seen in multiple solid lumps with different sizes), heterogeneously enhanced 4 (non-enhanced areas consistent with the pathological hemorrhage and necrosis area), the lesion showed a uniform liquid density of 1 (Pathology shows tumor cystic degeneration). Conclusions The CT diagnosis of benign and malignant nerve sheath tumors in the chest is very limited. The low density area in the tumor is not a characteristic feature of the malignant nerve sheath tumor. The malignancy of the tumor boundary indicates the possibility of malignancy, and the destruction of the adjacent structure is a hint. Important signs of malignant lesions.