前纵隔淋巴瘤的CT特征与分型初探  

A Preliminary Study on CT Features and Classification of Anterior Mediastinal Lymphoma

作　　者：黄日升[1] 蔡雅丽[1] 汪林[1] 陈杰云[1] 麻海龙[1] 杨子江[1] HUANG Risheng;CAI Yali;WANG Lin(Department of Medical Imaging,Affiliated Quanzhou First Hospital of Fujian Medical University,Quanzhou,Fujian Province 362000,P.R.China)

机构地区：[1]福建医科大学附属泉州第一医院影像科,362000

出　　处：《临床放射学杂志》2020年第7期1332-1336,共5页Journal of Clinical Radiology

摘　　要：目的分析前纵隔淋巴瘤的CT特征及其影像学分型。方法回顾性分析经病理证实的24例前纵隔淋巴瘤患者的CT资料,观察肿块及其邻近组织的CT特征;并根据肿块有无坏死及坏死程度进行分型。结果肿块位于前纵隔跨中线两侧生长16例,位于右前纵隔5例,位于左前纵隔3例;前纵隔单发肿块15例,多发肿块融合或较大肿块伴周围小结节9例。24例中,肿块实性部分平扫CT值为25~52 HU。增强扫描可见23例肿块实性部分轻中度强化(CT值较平扫增高12~30 HU);1例肿块实性部分明显强化(CT值较平扫增高48 HU)。10例合并心包积液,16例合并胸腔积液(其中1例右侧胸膜弧带状增厚)。18例肿块不同程度包绕主动脉、主肺动脉、内乳动脉、上腔静脉、头臂静脉,且其中10例上腔静脉受压变窄。6例肿块侵及前胸壁,2例侵及左肺,2例侵及右肺。12例中纵隔淋巴结肿大,8例锁骨上窝淋巴结肿大。CT分型为Ⅰ型(无坏死型)8例、Ⅱ型(部分坏死型)10例、Ⅲ型(明显坏死型)6例;其中Ⅰ型均经CT明确诊断,Ⅱ型CT误诊3例,Ⅲ型CT误诊5例。结论前纵隔淋巴瘤CT表现具有一定的特征性,可根据肿块坏死情况进行分型,从而提高术前诊断准确性,并进行有针对性的鉴别诊断。Objective To Analyze the CT features and typing of anterior mediastinal lymphoma.Methods CT data of 24 cases of anterior mediastinal lymphoma diagnosed by pathology were retrospectively analyzed,and the types of the tumors were classified according to the presence and absence of necrosis and the degree of necrosis.Results The mass was located on both sides of the anterior mediastinum transcentral line in 16 cases,on the right anterior mediastinum in 5 cases,and on the left anterior mediastinum in 3 cases.There were 15 cases of single anterior mediastinal mass and 9 cases of multiple conglomerate masses or a large mass with peripheral nodules.The CT values of the solid part of 24 cases were 25-52 HU on the plain scan.The CT values of the solid part of 23 cases were mild to moderate enhancement with the CT values increased to 12-30 HU compared with that on the plain scan.The CT value of the solid part of another case was significantly enhanced with the CT value increased 48 HU.There were 10 cases of pericardial effusion and 16 cases of pleural effusion,among which 1 case was associated with right pleural arc-band thickening.There were 18 cases with varying degrees of compression surrounding the aorta,main pulmonary artery,internal mammary artery,superior vena cava,brachiocephalic vein,and 10 cases with varying degrees of compression narrowing of superior vena cava.Lesions invaded the anterior chest wall in 6 cases,the left lung in 2 cases,and the right lung in 2 cases.There were 12 cases of mediastinal lymph node enlargement and 8 cases of supraclavicular lymph node enlargement.There were 8 cases of TypeⅠ(no necrosis),10 cases of TypeⅡ(had partial necrosis)and 6 cases of TypeⅢ(obvious necrosis).All the lesions of TypeⅠwere diagnosed correctly by CT,while 3 lesions of TypeⅡand 5 lesions of TypeⅢwere misdiagnosed by CT.Conclusion The CT findings of anterior mediastinal lymphoma have certain characteristics.CT typing can help to improve the diagnostic accuracy and to carry out targeted differential diagnos

关 键 词：前纵隔 淋巴瘤 体层摄影术 X线计算机 分型 

分 类 号：R734.5[医药卫生—肿瘤]