Malignant pleural mesothelioma: Computed tomography and correlation with histology
Malignant pleural mesothelioma: Computed tomography and correlation with histology
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DOI：
10.1016/j.ejrad.2008.02.004
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发表时间：
2009-06-01
影响因子：
3.3
通讯作者：
Mueller, Nestor L.
中科院分区：
文献类型：
--
作者：
Seely, Jean M.;Nguyen, Elsie T.;Mueller, Nestor L.
目的：回顾胸膜间皮瘤的计算机断层扫描（CT）影像学表现，并将CT与组织学亚型相关联。材料和方法：回顾两个学术机构1997年至2006年的病理报告，以确定确诊的胸膜间皮瘤患者。诊断基于经胸针吸活检、手术活检或切除获得的标本的组织学结果。所有组织学切片均由肺部病理学家审查。由两名独立的放射科医生对92名患者的CT扫描进行盲法和随机顺序审查。完成Kappa分析以评估观察者间的一致性。80例患者中，CT成像和组织学诊断之间没有显着的延迟进行了评估，Logistic回归分析，以相关的CT和组织学findings.Results：72的92间皮瘤上皮，15肉瘤，5混合组织学。所有患者（77例男性，15例女性，平均年龄68岁）CT均显示胸膜增厚; 79例患者（86%）的增厚为结节状，87例患者（95%）为纵隔增厚。42例（46%）患者出现同侧容量丢失。80例患者（87%）出现胸腔积液，19例患者（21%）出现较大胸腔积液（>2/3半胸）。非典型特征包括3例患者（3%）的双侧疾病和9例患者（10%）的自发性气胸。内乳淋巴结肿大48例（52%），贲门淋巴结肿大42例（46%）。观察者间一致性极佳（平均kappa = 0.89）。同侧体积丢失与肉瘤性或混合性间皮瘤有关（p = 0.004）。使用逻辑回归分析，其他CT表现与组织学亚型无关。结论：同侧体积丢失最常见与肉瘤或混合性间皮瘤。其余的影像学表现对预测恶性间皮瘤的组织学亚型没有帮助。(C)2008爱思唯尔爱尔兰有限公司保留所有权利。
Objective: To review the computed tomography (CT) imaging findings of pleural mesothelioma at presentation and to correlate the CT with the histological subtype.Materials and methods: Pathology reports from 1997 to 2006 were reviewed at two academic institutions to identify patients with proven pleural mesothelioma. Diagnosis was based on histologic findings in specimens obtained by transthoracic needle biopsy, surgical biopsy or resection. All histology slides were reviewed by a lung pathologist. CT scans, available in 92 patients, were reviewed blindly and in random order by two independent radiologists. Kappa analysis was completed to assess inter-observer agreement. Eighty patients in whom there was no significant delay between CT imaging and histological diagnosis were assessed by logistic regression analysis to correlate CT and histologic findings.Results: Seventy-two of the 92 mesotheliomas were epithelial, 15 sarcomatous, and 5 of mixed histology. All patients (77 male, 15 female, mean age 68 years) had pleural thickening on CT; the thickening was nodular in 79 patients (86%) and mediastinal in 87 (95%). lpsilateral volume loss was seen in 42 patients (46%). Pleural effusions were present in 80 patients (87%), being large (>2/3 hemithorax) in 19 patients (21%). Atypical features at presentation included bilateral disease in three patients (3%), and spontaneous pneumothoraces in nine patients (10%). Internal mammary lymphadenopathy was observed in 48 patients (52%) and cardiophrenic lymphadenopathy in 42 (46%). Inter-observer agreement was excellent (average kappa = 0.89). lpsilateral volume loss was associated with sarcomatous or mixed mesothelioma (p = 0.004). Using logistic regression analysis, other CT findings did not correlate with histological subtype.Conclusions: lpsilateral volume loss is most frequently associated with sarcomatous or mixed mesothelioma. The remaining imaging findings are not helpful in predicting the histological subtype of malignant mesothelioma. (C) 2008 Elsevier Ireland Ltd. All rights reserved.