【作者】 张缨；

【导师】 罗良平；

【作者基本信息】 暨南大学 ， 影像医学， 2003， 硕士

【摘要】 目的：探讨CT与MRI对良、恶性胸膜病变的鉴别诊断价值。 材料与方法：对56例胸膜病变患者进行了CT检查，其中29例同时行MRI检查，20例加做HR-MRI检查。比较分析CT与MRI、常规MRI与HR-MRI对良恶性胸膜病变的鉴别诊断价值。 结果：1、CT检查显示，环绕形胸膜增厚在MPM、MPD的发生率分别为56％、18％，两者之间有显著性差异(P＜0.05)。胸膜病变侵犯纵隔结构、膈肌、胸壁仅见于MPM与MPD。结节状胸膜增厚在MPM、MPD、BPD中的发生率无显著性差异(P＞0.05)。2、MRI检查显示，纵隔胸膜受累、环绕形或不规则胸膜增厚、弥漫性胸膜增厚及胸壁、膈肌受侵等征象在良、恶性胸膜病变的出现率有显著性差异(P＜0.05)；虽然HR-MRI对胸壁的解剖结构(尤其是早期胸壁浸润)的显示比常规MRI优越，但二者对本组良、恶性胸膜病变的鉴别诊断作用无显著性差异(P＞0.05)。3、结合病变形态学与信号特点，MRI对良恶性胸膜病变的鉴别诊断价值优于CT(P＜0.05)。 结论：1、环绕形胸膜增厚有助于鉴别MPM与MPD。胸膜病变侵犯纵隔结构、膈肌、胸壁有助于诊断恶性胸膜病变。2、将MRI形态学与信号特征相结合有助于良、恶性胸膜病变的鉴别诊断。3、与常规MRI相比，HR-MRI对胸壁解剖结构(尤其是早期胸壁浸润)的显示更优越。更多还原

【Abstract】 Objective: To explore the role of CT and MRI in the differential diagnosis of benign and malignant pleural disease.Material and Methods: Fifty-six cases of pleural disease were examined with CT, 29 cases of them were also examined with MRI and 20 cases were examined with high resolution MRI (HR-MRI) at the same time. In this thesis, the diagnostic value between CT and MRI, ordinary MRI and HR-MRI in the benign and malignant pleural disease were comparatively evaluated.Results: 1 .Examined with CT, the incidence rate of circumferential pleural thickening in the MPM and MPD was56% and 18%, respectively. It revealed significant difference between MPM and MPD (P<0.05). Mediastinal structures involvement, infiltration of the chest wall and/or diaphragm were only observed in the MPM and MPD. The difference of incidence rate of nodular pleural thickening in MPM, MPD and BPD was not significant (P>0.05). 2.Examined with MRI, mediastinal pleural involvement, circumferential pleural thickening, irregularity of pleural contour, diffuse pleural thickening and infiltration of the chest wall and /or diaphragm were significant different between malignant and benign pleural disease (P<0.05). Compared with ordinary MRI, although the HR-MRI had the advantage on displaying the anatomic structure of the chest wall, especially the infiltration of the chest wall in the early stage, the diagnostic values of them on benign and malignant pleural disease were not of statistic significant difference (P>0.05). 3.Using morphologic features in combination with signal intensity features, MR was more superior to CT in differentiation of malignant from benign pleural disease (P<0.05). Conclusion: 1.Examined with CT, circumferential pleural thickening was the most useful feature in distinguishing MPM from MPD. Mediastinal structures involvement, infiltration of the chest wall and/or diaphragm directly suggested malignancy. 2. Combining the morphologic features and signal features, MRI was more helpful fordifferentiation of malignant from benign pleural disease. 3.Compared with ordinary MRI, HR-MRI had advantage on displaying the anatomic structure of chest wall, especially in the detection of malignant chest wall infiltration in the early stage.更多还原