基于高分辨率CT特征鉴别早期恶性胸膜间皮瘤与胸膜转移瘤  

Differentiation of early malignant pleural mesothelioma and metastatic pleural disease on high-resolution CT features

作　　者：蔡博韬 李晓光[2] 李晔 申奥 张静 王冰 侯代伦 CAI Botao;LI Xiaoguang;LI Ye;SHEN Ao;ZHANG Jing;WANG Bing;HOU Dailun(Department of Radiology,Imaging Center,Harbin Chest Hospital,Harbin 150000,China;Department of Medical Imaging,Zoucheng People's Hospital of Shandong,Jining 272000,China;Department of Radiology,Beijing Chest Hospital,Capital Medical University,Beijing 101100,China;Department of Radiology,Beijing Institute of Tuberculosis Thoracic Oncology,Beijing 101100,China)

机构地区：[1]黑龙江省哈尔滨市胸科医院影像中心,黑龙江哈尔滨150000 [2]山东省邹城市人民医院医学影像科,山东济宁272000 [3]首都医科大学附属北京胸科医院放射科,北京101100 [4]北京市结核病胸部肿瘤研究所放射科,北京101100

出　　处：《医学影像学杂志》2023年第6期988-992,共5页Journal of Medical Imaging

基　　金：北京市通州区高层次人才发展支持计划领军人才(编号:YHLD2019029)。

摘　　要：目的探讨高分辨率CT(HRCT)特征对早期恶性胸膜间皮瘤(MPM)与胸膜转移瘤(MPD)的鉴别诊断价值,以提高两种疾病的首诊准确率。方法选取72例行HRCT检查的胸膜病变患者(MPM组41例,MPD组31例),并通过病理学确诊。比较两组HRCT特征,分类变量进行单因素χ^(2)检验,定量变量进行独立样本t检验或非参数检验。结果MPD组血清癌胚抗原显著增高(P<0.05),两组间性别和年龄差异无统计学意义(P均>0.05)。MPM组以胸膜单侧受累多见,胸膜增厚多呈弥漫、环形及肿块样,可伴胸膜钙化斑及叶间胸腔积液,增强扫描胸膜及淋巴结多呈均匀强化(P均<0.05),MPD组以胸膜双侧受累多见,胸膜增厚多呈局限性及结节样,胸膜钙化斑罕见,增强扫描胸膜及淋巴结多呈不均匀强化(P均<0.05)。结论MPM组与MPD组在胸膜受累范围、胸膜增厚形态、胸膜钙化斑、淋巴结肿大及强化特征存在差异,HRCT有助于两种疾病的早期鉴别诊断。Objective The aim of this study was to investigate the differential diagnostic value of high-resolution CT(HRCT)imaging features on early malignant pleural mesothelioma(MPM)and metastatic pleural disease(MPD),in order to improve the accuracy of the first diagnosis of the two diseases.Methods We retrospectively analyzed 72 patients(41 cases of MPM,31 cases of MPD),all of whom underwent HRCT and passed pathology to confirm the diagnosis.Two sets of HRCT features were compared,with a one-way χ^(2) test for categorical variables and a stand-alone sample t-test or a nonparametric test for quantitative variables.Results The serum carcinoembryonic antigen of MPD was significantly increased(P<0.05),and there was no significant difference between sex and age between the two groups(P>0.05).MPM was more common with unilateral pleural involvement,pleural thickening was mostly diffused,circular and mass-like can be accompanied by pleural calcification plaques and interlobarular pleural effusion,the enhanced scanning of the pleura and lymph nodes were more uniformly strengthened(P<0.05),MPD was more common with bilateral pleural involvement,pleural thickening was mostly limited and nodularlike,pleural calcification plaque was rare,and the enhanced scanning pleura and lymph nodes was more unevenly strengthened(P<0.05).Conclusions There are differences between MPM and MPD in the range of pleural involvement,pleural thickening morphology,pleural calcification plaque,lymphadenopathy and strengthening characteristics.HRCT is helpful for the early differential diagnosis of the two diseases.

关 键 词：恶性胸膜间皮瘤 胸膜转移瘤 体层摄影术 X线计算机 

分 类 号：R734.3[医药卫生—肿瘤] R814.42[医药卫生—临床医学]