Yi Chin A, Lee Kyung Soo, Choe Yeon Hyeon, Han Daehee, Kwon O Jung, Kim Seonwoo
Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-Dong, Kangnam-Ku, Seoul 135-710, Korea.
J Comput Assist Tomogr. 2004 Jan-Feb;28(1):34-9. doi: 10.1097/00004728-200401000-00005.
The purpose of this study was to present the computed tomography (CT) findings of pulmonary artery sarcoma in 7 patients with a focus on the distinguishing features of pulmonary embolic disease.
For the 9 years from December 1993 to November 2002, we treated 7 patients with pathologically proven pulmonary artery sarcoma, and during the 2 years from December 2000 to November 2002, we treated 40 patients with acute (n = 33) or chronic (n = 7) pulmonary embolism. In these patients, pulmonary embolism was diagnosed from serial CT or clinical findings. Two chest radiologists, blinded to the diagnoses, independently reviewed the scans of all 47 patients in random order, and the so-documented CT features of sarcoma and pulmonary embolism were compared by using Fisher exact test or the generalized estimating equations test.
The two most frequent CT findings of pulmonary artery sarcomas were a low-attenuation filling defect occupying the entire luminal diameter of the main (n = 1) or proximal (n = 6) pulmonary artery and an expansion of any segment of the pulmonary artery with extensive intraluminal filling defect, as observed in six (86%) of 7 patients. In contrast, the finding of a lesion occupying the entire luminal diameter at the level of proximal pulmonary arteries was absent in all 40 patients with pulmonary embolism (P < 0.0001) (kappa = 0.9111). Expansion of the pulmonary arteries was seen in one (3%) of 40 patients with pulmonary embolism (P < 0.0001) (kappa = 0.9108). Extraluminal extension was observed in 5 of 7 (71%) patients with sarcoma, but in no patient with an embolism (P < 0.0001) (kappa = 0.8773).
CT can help differentiate pulmonary artery sarcoma from pulmonary embolism by indicating a low-attenuation filling defect occupying the entire luminal diameter of the proximal or main pulmonary artery, expansion of the involved arteries, or extraluminal tumor extension.
本研究旨在呈现7例肺动脉肉瘤患者的计算机断层扫描（CT）表现，重点关注与肺栓塞疾病的鉴别特征。
1993年12月至2002年11月的9年间，我们治疗了7例经病理证实的肺动脉肉瘤患者；2000年12月至2002年11月的2年间，我们治疗了40例急性（n = 33）或慢性（n = 7）肺栓塞患者。在这些患者中，肺栓塞通过系列CT或临床检查结果得以诊断。两位对诊断不知情的胸部放射科医生，以随机顺序独立审阅了所有47例患者的扫描影像，并采用Fisher精确检验或广义估计方程检验对记录的肉瘤和肺栓塞的CT特征进行比较。
肺动脉肉瘤最常见的两项CT表现为：一个低密度充盈缺损占据主肺动脉（n = 1）或近端肺动脉（n = 6）的整个管腔直径，以及肺动脉任何节段的扩张并伴有广泛的管腔内充盈缺损，7例患者中有6例（86%）出现上述表现。相比之下，40例肺栓塞患者中均未出现近端肺动脉水平占据整个管腔直径的病变（P < 0.0001）（kappa = 0.9111）。40例肺栓塞患者中有1例（3%）出现肺动脉扩张（P < 0.0001）（kappa = 0.9108）。7例肉瘤患者中有5例（71%）观察到管腔外扩展，但肺栓塞患者中无一例出现（P < 0.0001）（kappa = 0.8773）。
CT可通过显示占据近端或主肺动脉整个管腔直径的低密度充盈缺损、受累动脉的扩张或管腔外肿瘤扩展，帮助鉴别肺动脉肉瘤与肺栓塞。
