磁共振成像在良、恶性胸膜疾病鉴别诊断中的作用

摘要

Objective　To explore the role of magnetic resonance imaging (MRI) in distinguishing malignant from benign pleural disease.rnMethods　All 64 patients were examined with both computed tomography (CT) and MRI. The morphologic features of pleural lesions and MR signal intensity on T1-weighted, T2-weighted and contrast-enhanced T1-weighted images were evaluated.rnResults　Mediastinal pleural involvement, circumferential pleural thickening, nodularity, irregularity of pleural contour, and infiltration of the chest wall and/or diaphragm were most suggestive of a malignant cause on CT and MR images. Contrary to what has been reported in the literature, pleural thickness greater than 1?cm either on CT or on MRI did not reveal a significant difference between malignant and benign pleural disease (P>0.05, chi-square test). Using morphologic features in combination with signal intensity features, MRI had a sensitivity of 98% and a specificity of 92% in the detection of pleural malignancy. rnConclusions　Compared with those on CT, the morphologic features on MRI allowed a mostly equal and in some cases superior detection and evaluation of the spread of pleural disease. In combination with signal intensity and morphologic features, MRI is very useful in distinguishing malignant from benign pleural disease.%目的探讨磁共振成像在良、恶性胸膜疾病鉴别诊断中的作用。rn方法对64例胸膜疾病患者同时进行了CT和MRI检查。评估分析了胸膜疾病的CT和MRI形态学特点以及分别在T1WI、T2WI和增强T1WI上的信号特点。rn结果无论在CT或MRI图象上，纵隔胸膜受累、环绕形胸膜增厚，结节状、轮郭不规则以及胸壁和／或横膈受累等征象均强烈提示恶性胸膜病变。与既往文献报道不同的是，胸膜增厚>1cm对良、恶性胸膜病变的鉴别无意义（P>0.05,χ2检验）。结合形态学及信号特点，MRI对诊断良、恶性胸膜病变的敏感度为98％，特异度为92％。rn结论单纯依据其形态学特点，MRI除了对某些特定胸膜病变的发现和范围的评估优于CT外，对绝大多数胸膜疾病的诊断价值与CT相当。但当MR信号与形态学特点结合时，其对良、恶性胸膜疾病的鉴别诊断价值则明显优于CT。