恶性腹膜间皮瘤的CT特点分析  

CT Findings of Malignant Peritoneal Mesothelioma

作　　者：宋慧[1] 郑国启[1] 陈跃峰[2] 魏思忱[1] 杨雨鑫[1] 孙鑫义[1] 康立清[2] 张力[2] 

机构地区：[1]河北省沧州市中心医院消化内科,061001 [2]河北省沧州市中心医院医学影像科,061001

出　　处：《临床放射学杂志》2014年第6期876-880,共5页Journal of Clinical Radiology

摘　　要：目的总结恶性腹膜间皮瘤(MPM)的CT影像学特点并探讨其发病机制。方法搜集病理学证实的53例MPM患者的临床资料,针对腹腔积液、壁腹膜、肠系膜、大网膜、胸膜改变、实体脏器浸润及转移情况等影像学表现进行回顾性分析,探讨CT征象与石棉接触史及病理类型的关系,并采用卡方检验。结果 53例MPM患者中,弥漫型42例,局限型11例。弥漫型与局限型两组中石棉接触史比较(χ2=0.032,P=0.857);上皮型与混合型病理类型比较(χ2=0.097,P=0.755),差异均无统计学意义。53例中直接征象为不规则或结节性腹膜增厚(46例)、大网膜增厚(50例)、肠系膜受累(27例),腹腔或盆腔囊实性包块(11例),腹部脏器浸润(43例);间接征象为腹腔积液(52例),其中少量(13例)或无腹腔积液(1例)患者占34%,右侧心膈角淋巴结肿大(14例)和肺胸膜石棉改变(49例)。最严重病变位于右侧腹(24例)。结论腹膜、大网膜、肠系膜增厚、右侧病变优势、无或少量腹腔积液、右心膈角淋巴结肿大、无远处脏器和淋巴结转移及肺胸膜石棉改变等表现可以提示MPM,但确诊仍依靠病理学检查。Objective To summarize CT imaging characteristics of malignant peritoneal mesothelioma （MPM）. Methods The clinical manifestations and imaging features of 53 patients histopathologically proved MPM were retrospectively analyzed. The imaging features, incliuding the presence and location of ascites, peritoneal, mesenteric, omental involvement, enlarged lymph nodes, solid abdominal viscera infiltration and metastases was analyzed. Chi square test was applied to investigate the relationship between asbestos exposure history and CT features as well as that between pathological types and CT features. Results 42 cases were diffuse malignant peritoneal mesothelioma type （ DMPM ） , and 11 cases were limited malignant peritoneal mesothelioma （ LMPM ） type. There was no significant difference of asbestos exposure his- tory between DMPM and LMPM group （ X2 = 0. 032, P = 0. 857 ）. There was no significant difference of pathologic type be- tween DMPM and LMPM group （ X2 = 0. 097,P = 0. 755 ）. CT signs of MPM were irregular or nodular peritoneal thickening （46 cases） , omental thickening （50 cases）, mesenteric involvement （27 cases） , abdominal or pelvic cystic or solid mass （ 11 cases）, abdominal viscera infiltrates （43 cases）. Indirect CT signs of MPM were ascites （52 cases） , slight（ 13 cases） or no（ 1 case） ascites （34%） , right cardiophrenic nodes enlarged （14 cases） and pleural plaques （49 cases）. The most serious lesions located in right upper quadrant （24 cases ）. Conclusion CT findings , including peritoneal, omental or mesenteric thickening, mainly involving right peritoneum, right cardiophrenic nodes enlargement, no or slight ascites and asbestos changes of pleura can suggest MPM.

关 键 词：间皮瘤 腹膜 体层摄影术 X线计算机 

分 类 号：R735.5[医药卫生—肿瘤]