能谱CT成像对侵袭性胸腺瘤与纵隔淋巴瘤的鉴别诊断价值  

Differentiation of Invasive Thymoma from Mediastinal Lymphoma Using Energy Spectrum CT

作　　者：韩引萍 张玉婷[1] 王丹[1] 张学凌[1] 周俊林[1] 

机构地区：[1]兰州大学第二医院放射科,甘肃兰州730030

出　　处：《中国医学影像学杂志》2016年第6期464-467,共4页Chinese Journal of Medical Imaging

摘　　要：目的侵袭性胸腺瘤和纵隔淋巴瘤均为前纵隔常见肿瘤,两者临床表现相似,临床治疗方法截然不同,且影像学鉴别困难。本研究拟评价能谱CT成像对侵袭性胸腺瘤与纵隔淋巴瘤的鉴别诊断价值,以指导临床。资料与方法回顾性分析经病理证实的14例侵袭性胸腺瘤和10例纵隔淋巴瘤患者,术前均行平扫和双期能谱CT增强扫描,应用能谱分析软件,获得不同单能量下的CT值和碘(水)浓度,并定性分析其形态学表现。结果侵袭性胸腺瘤动脉期和静脉期40~80 keV单能量CT值及碘浓度均高于淋巴瘤,水浓度低于淋巴瘤,差异有统计学意义(P<0.05);以静脉期碘浓度9.11(100μg/cm^3)为阈值,诊断侵袭性胸腺瘤的敏感度、特异度均达100%。侵袭性胸腺瘤多呈明显分叶状,密度不均匀,囊变坏死、钙化常见,邻近淋巴结肿大少见,容易浸润纵隔血管间隙,增强扫描表现为中度-显著强化。纵隔淋巴瘤多呈多个结节融合状,病变密度不均匀,囊变坏死多见,但钙化少见,多伴有邻近淋巴结肿大,邻近血管常呈推压移位,增强扫描呈轻-中度强化,除两者囊变坏死率差异无统计学意义(P>0.05)外,其余表现差异均有统计学意义(P<0.05)。结论能谱CT成像对侵袭性胸腺瘤和纵隔淋巴瘤有一定的鉴别诊断价值。Purpose Invasive thymoma and mediastinal lymphoma are common tumors of the anterior mediastinum with similar clinical symptoms, but the treatments are different. It is difficult to distinguish radiographically. This paper aims to evaluate differential diagnosis using spectrum CT imaging in these two entities to guide clinical practice. Materials and Methods Retrospective analysis was performed in 14 patients with invasive thymoma and 10 patients with lymphoma, all pathologically confirmed. All the patients underwent plain and two phases enhanced spectral CT scan. All spectrum imaging data were analyzed with GSI viewer to obtain CT value and iodine（water） concentration on different monochromatic images, and the morphological features were qualitative evaluated. Results The CT value on 40-80 keV monochromatic images and iodine concentration were higher in invasive thymoma than those in mediastinal lymphoma in arterial and venous phases, but water concentration was lower than that in lymphoma（P〈0.05）. The diagnostic sensitivity and specificity for invasive thymoma were 100% when the threshold of iodine concentration was set as 9.11（100 μg/cm^3） in venous phase. Invasive thymoma was mostly lobulated with heterogeneous density. Necrosis, cystic changes, and calcification were common. Lymphadenopathy was rare. It easily infiltrated mediastinal vascular space with moderate to significant contrast enhancement. Mediastinal lymphoma was mostly multiple nodular conglomerate with heterogeneous density. Necrosis and cystic changes were common while calcification was rare. It was often accompanied by neighboring lymphadenopathy. Adjacent vessels were often displaced. There was mild to moderate enhancement. Necrosis and cystic changes were not significantly different（P〈0.05）. The other features were statistically significant（P〈0.05）. Conclusion Energy spectrum CT has certain values in differential diagnosis of invasive thymoma and mediastinal lymphoma.

关 键 词：胸腺瘤 淋巴瘤 纵隔肿瘤 体层摄影术 X线计算机 病理学 外科 诊断 鉴别 

分 类 号：R734.5[医药卫生—肿瘤] R730.42[医药卫生—临床医学]