Metintas Muzaffer, Ucgun Irfan, Elbek Osman, Erginel Sinan, Metintas Selma, Kolsuz Mustafa, Harmanci Emel, Alatas Fusun, Hillerdal Gunnar, Ozkan Ragip, Kaya Tamer
Department of Chest Diseases, Osmangazi University Medical Faculty, Eskişehir, Turkey.
Eur J Radiol. 2002 Jan;41(1):1-9. doi: 10.1016/s0720-048x(01)00426-0.
To investigate the computed tomography (CT) features of malignant pleural mesothelioma (MPM) cases, comparing them to those in other malignant and benign pleural diseases.
We reviewed the CT findings of 215 patients; 99 with MPM, 39 with metastatic pleural disease (MPD), and 77 with benign pleural disease. The findings were evaluated in univariate and multivariate analysis for differentiation of pleural diseases.
In patients with MPM, the most common CT features were circumferential lung encasement by multiple nodules (28%); pleural thickening with irregular pleuropulmonary margins (26%); and pleural thickening with superimposed nodules (20%). In the majority (70%) of cases, there was rind-like extension of tumor on the pleural surfaces. In multivariate analysis, the CT findings of "rind-like pleural involvement", "mediastinal pleural involvement", and "pleural thickness more than 1 cm" were independent findings in differentiating MPM from MPD with the sensitivity/specificity values of 70/85, 85/67, and 59/82, respectively. "Rind-like pleural involvement", "mediastinal pleural involvement", "pleural nodularity" and "pleural thickness more than 1 cm" were independent findings for differentiation of malignant pleural diseases (MPM+MPD) from benign pleural disease with the sensitivity/specificity values of 54/95, 70/83, 38/96, and 47/64, respectively. Invasion of thoracic structures such as pericardium, chest wall, diaphragm, mediastinum, with pleural disease and nodular involvement of fissures, was detected infrequently; however, since these invasions were not seen in benign pleural diseases, it was concluded these invasions, if detected on a CT scan, directly suggested malignancy.
A patient has extremely high probability of malignant pleural disease if one or more of these CT findings are found and the possibility of MPM is high. These findings may be important for patients in bad state or patients who do not want any invasive biopsy procedures. It is also possible to identify cases with a low probability of malignant disease.
探讨恶性胸膜间皮瘤（MPM）病例的计算机断层扫描（CT）特征，并与其他恶性和良性胸膜疾病的特征进行比较。
我们回顾了215例患者的CT检查结果，其中99例为MPM，39例为转移性胸膜疾病（MPD），77例为良性胸膜疾病。对这些检查结果进行单因素和多因素分析，以鉴别胸膜疾病。
在MPM患者中，最常见的CT特征是多个结节环绕肺脏（28%）；胸膜增厚伴不规则胸膜肺边缘（26%）；胸膜增厚伴结节（20%）。在大多数（70%）病例中，肿瘤在胸膜表面呈条索状延伸。在多因素分析中，“条索状胸膜受累”、“纵隔胸膜受累”和“胸膜厚度超过1cm”的CT表现是鉴别MPM与MPD的独立表现，其敏感性/特异性值分别为70/85、85/67和59/82。“条索状胸膜受累”、“纵隔胸膜受累”、“胸膜结节”和“胸膜厚度超过1cm”是鉴别恶性胸膜疾病（MPM+MPD）与良性胸膜疾病的独立表现，其敏感性/特异性值分别为54/95、70/83、38/96和47/64。很少检测到胸膜疾病伴有对心包、胸壁、膈肌、纵隔等胸部结构的侵犯以及叶间裂的结节状受累；然而，由于这些侵犯在良性胸膜疾病中未见，因此得出结论，这些侵犯如果在CT扫描中检测到，则直接提示恶性肿瘤。
如果发现一项或多项这些CT表现，则患者患恶性胸膜疾病的可能性极高，且MPM的可能性很大。这些表现对于病情较差或不希望进行任何侵入性活检程序的患者可能很重要。也有可能识别出恶性疾病可能性较低的病例。
