胸部恶性神经鞘膜瘤的影像表现  

Radiologic apperance of thoracis malignant nerve sheath tumors

作　　者：邵江[1] 朱晓华[1] 陈美[1] 马骏[1] 

机构地区：[1]上海市肺科医院,200433

出　　处：《中华放射学杂志》2001年第4期292-294,共3页Chinese Journal of Radiology

摘　　要：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 Malignant nerve sheath tumors arising in the thorax are rare.We analyzed the radiologic apperance in order to improve diagnostic accuracy. Methods Posteroanterior radiograph was taken in ten cases.Computed tomograph both plain and enhanced study was performed in 8 cases.The diagnosis was established by surgery in eight cases,and CT guided percutaneous biopsy in 2 cases. Results Four tumors were located in the mediastinum,2 in the lung,3 in the chest wall and 1 in the diaphragm.Eight patients had solitary mass, 1 multipul masses and another 1 with disseminated disease.Obvious compression of the lung and trachea was seen in 3 patients,pulmonary infitration in 1 patient and compression of ribs in 3 patients,2 with bone destruction.Pleural effusion was evident in 4 patients. Six patients (7 lesions)allowed CT-pathologic correlation.Of them 3 had relatively smooth margin(complete capsule could be seen in pathology), 4 were irregular.Two lesions had network-intensities(cystic spaces of varying sizes within solid mass),4 lesions had heterogeneous enhancement(related to hemorrhagic and necrotic areas in pathology), 1 lesion had homogenerous fluid density(corresponding to cystic changes). Conclusion It is difficult to disting-uish thoracis malignant nerve sheath tumor from the benign one. Low-density areas could not represent malignant nerve sheath tumors. Irregular tumor margin is suggestive of malignancy.Invasion of adjacent structures is important feature of malignancy.

关 键 词：胸部肿瘤 神经鞘膜 CT 诊断 

分 类 号：R730.4[医药卫生—肿瘤]