MRI在胸腺上皮性肿瘤与胸腺淋巴瘤鉴别诊断中的价值  

The value of MRI in the differential diagnosis of thymic epithelial tumor and thymic lymphoma

作　　者：段世军 胡玉川 李刚锋 井勇 闫卫强 冯秀龙 辛永康 崔光彬 DUAN Shi-jun;HU Yu-chuan;LI Gang-feng(Department of Radiology,Tangdu Hospital ,the Military Medical University of PLA Airforce,Xi’an 710038,China)

机构地区：[1]空军军医大学唐都医院放射科,西安710038

出　　处：《放射学实践》2020年第5期608-613,共6页Radiologic Practice

基　　金：空军军医大学第二附属医院科技创新发展基金重点项目(No.2017LCYJ004)。

摘　　要：目的:探讨胸腺瘤(Ts)、胸腺癌(TCs)及胸腺淋巴瘤(TLs)的MR影像特征,提高其MRI鉴别诊断能力。方法:回顾性分析经手术病理证实的66例胸腺肿瘤患者的临床及MR影像学特征,根据其病理结果分为Ts、TCs及TLs三组。MR特征主要包括大小、形状、肿瘤信号、内部间隔、纵隔淋巴结、与邻近大血管关系及胸膜腔或心包腔积液,采用单因素方差分析比较三组肿瘤间MR特征的差异。结果:66例胸腺肿瘤包括Ts 24例(36.4%),TCs 16例(24.2%),TLs 26例(39.4%)。三组间肿瘤大小、信号、内部间隔、纵隔淋巴结肿大、与邻近大血管关系及胸膜腔或心包腔积液差异均存在统计学意义(P<0.01)。TLs的最大径显著大于其它两组,最大径≥9 cm者达22例(84.6%)。与其他两组比较,TLs信号更为均匀,均匀者有10例(38.5%),14例(53.8%)信号不均匀,合并多发囊肿。Ts内部间隔发生率最高,达91.7%(22/24),仅3例(11.5%)TLs可见内部间隔,而TCs未见内部间隔。TLs、TCs及Ts合并纵隔淋巴结肿大者分别为15例(57.7%)、9例(56.2%)及9例(56.2%)。TLs、TCs对邻近纵隔内大血管包绕侵犯大于180°者分别为21例(80.8%)和13例(81.3%),明显高于Ts(1例,4.2%)。在合并胸膜腔或心包腔积液上,TLs和TCs分别为20例(76.9%)和6例(37.5%),明显高于Ts的3例(12.5%)。肿瘤形状在三组肿瘤间差异无统计学意义(P值为0.131)。结论:Ts、TCs及TLs的MRI表现具有一定特征性,常规MRI有助于三者的鉴别诊断。Objective:To explore the MR imaging features of thymoma(Ts),thymic carcinoma(TCs)and thymic lymphoma(TLs)and improve its differential diagnosis value.Methods:The clinical and MR imaging features of 66 patients with thymic tumor confirmed by histopathology were retrospectively analyzed.Patients were divided into three groups:Ts,TCs and TLs based on the pathological results.MR findings including tumor size,shape,signal,internal septum,mediastinal lymphadenopathy,relationship with adjacent large vessels,and pleural cavity or pericardial effusion were evaluated.The differences of MR features among Ts,TCs and TLs groups were analyzed using one-way ANOVA.Results:Among 66 cases with thymic tumors,24(36.4%),16(24.2%),26(39.4%)were identified as Ts,TCs and TLs respectively.Tumor size,signal,internal septum,mediastinal lymphadenopathy,relationship with adjacent large vessels,and pleural cavity or pericardial effusion were significantly different among three groups(P<0.01).The maximum diameter of TLs was significantly greater than the other two groups,with 22 cases(84.6%)with a maximum diameter of≥9cm.Compared with the other two groups,the signal of TLs were more homogeneous.In TLs group,10 cases(38.5%)were homogeneous,whereas the other 14 cases(53.8%)were heterogeneous combined with multiple cysts.The internal septum was most common in Ts,reaching 22 cases(91.7%),followed by TLs(3 cases,11.5%),while TCs showed no septum sign.Patients with mediastinal lymphadenopathy were 15(57.7%)in TLs,9(56.2%)in TCs,and 9(56.2%)in Ts.Invasion of mediastinal large vessels greater than 180°were more frequent seen in TLs and TCs,21 cases(80.8%)and 13 cases(81.3%)respectively,compared to Ts(1 case,4.2%).Twenty cases(76.9%)in TLs and 6 cases(37.5%)in TCs presented pleural cavity or pericardial effusion,which was more frequent than in Ts(3 cases,12.5%).However,there were no significant statistical difference in the tumor shape among three groups(P=0.131).Conclusion:The MRI findings of Ts,TCs and TLs are typical.The conventional MRI is helpf

关 键 词：胸腺瘤 胸腺癌 胸腺淋巴瘤 磁共振成像 诊断 鉴别 

分 类 号：R736.3[医药卫生—肿瘤] R445.2[医药卫生—临床医学]