局限型恶性腹膜间皮瘤的多期CT增强表现与病理基础  

Multi-phase enhanced CT findings and pathological basis of localized malignant peritoneal mesothelioma

作　　者：温祖光 龙莉玲[1] 蒋牧良[1] 陈钇地 蒋子健 WEN Zuguang;LONG Liling;JIANG Muliang;CHEN Yidi;JIANG Zijian(Department of Radiology,the First Affiliated Hospital of Guangjci Medical Utuversity , Nanning 530021 ,China)

机构地区：[1]广西医科大学第一附属医院放射科,广西南宁530021

出　　处：《实用放射学杂志》2019年第4期576-579,583,共5页Journal of Practical Radiology

摘　　要：目的探讨局限型恶性腹膜间皮瘤(LMPM)的CT增强表现与病理特征,提高影像诊断准确率。方法收集经病理证实的5例LMPM患者的影像及临床资料,回顾性分析病灶CT增强扫描的特征并与病理结果进行对照研究。结果5例患者均为孤立性嘰实性巨大肿块,病灶形态不规则.最大径8.4~13.3cm.其中1例为多囊性,其余4例为囊实性,囊性部分CT值约13.0~27.8HU,增强扫描未见强化.囊壁及分隔薄厚不均;实性部分平扫CT值约32.6.40.8HU.增强扫描静脉期呈中度强化(△ct值约30.9~38.4HU),静脉期比动脉期强化程度略有增加,平衡期强化程度减低。3例病灶可见分隔及多发血管影,1例见腹膜腔、盆腔积液.腹腔种植转移。该组患者病理类型中1例为上皮型.以囊性成分为主,其余4例为纤维型或双相型.病灶以曩实性为主,其内可见小的囊变、坏死、较多的纤维分隔及供血血管等,部分病灶侵犯周围结构。结论LMPM病理类型多为纤维型及双相型,CT多表现为囊实性肿块,可见分叶及壁结节.蟆壁及分隔薄厚不均.履性部分密度相对较高,增强扫描实性部分中度强化,且静脉期强化较为明显,分隔内可见强化血管影,CT增强扫描结合临床表现有助于做出提示性诊断。Objective lo investigate the enhanced CT fin dings and pathological features of localized malignant peritoneal mesothelioma (LMPM) and improve the accuracy of diagnosis. Methods The imaging and clinical data of 5 cases of LMPM confirmed by pathology were collected,the features of CT enhanced imaging were analyzed retrospectively and compared with the pathological results.Results All of the 5 cases were isolated solid and cystic mass with irregular shape,and the range of maximum diameter of the lesion being 8.4 - 13.3 cm, in which 1 case was polycystic, a nd the other 4 cases were solid and cystic mass.CT value of the cystic part was about 13.0 - 27.8 HU, and no enhancement showed on contrast-enhanced phase. The thickness of cystic wall and separation was uneven, while the CT value of solid part was about 32.6 - 40.8 HU, and moderate enhancement was seen in arterial phase (Act value was about 30.9 - 3&4 HU ),followed by slightly increase of enhancement degree in venous phase,and the decrease of enhancement degree in equilibrium phase. Separation and a lot of vessel shadow were seen in 3 cases while peritoneal cavity, pelvic effusion and intraperitoneal implant metastasis were seen in 1 case.For the pathological types of patients in this group, 1 case was epithelial type,mainly composed of cystic component,and the other 4 cases were fibrous type or biphasic type, mainly composed of cystic and solid, with small cystic degeneration, necrosis, fibrous septum, blood supply vessels, and etc. Some lesions invaded the surrounding st met ure. Conclusion The pathological types of localized malignant peritoneal mesothelioma are mostly fibrous type and biphasic type which CT findings are mostly manifested as cystic and solid masses. Lobulated and wall nodules,uneven thickness of cystic wall and septum can be seen,and the density of cystic partial is relatively higher.Solid part is moderate enhancement, and in venous phase is more obvious with enhanced vascular seen in the septum.CT enhancement combined with clinical manifesta

关 键 词：局限型腹膜间皮瘤 计算机体层成像 病理学 

分 类 号：R735.5[医药卫生—肿瘤] R814.42[医药卫生—临床医学]