Rebner M, Gross B H, Robertson J M, Pennes D R, Spizarny D L, Glazer G M
Comput Radiol. 1987 May-Jun;11(3):103-10. doi: 10.1016/0730-4862(87)90033-3.
CT is an important modality for imaging mediastinal masses, and certain CT attenuation features (fat, calcium, or water attenuation, contrast enhancement) are well known to suggest specific diagnoses. In a series of 132 consecutive patients with tissue-proven mediastinal masses, these specific CT features were present in only 16. We evaluated the ability of CT to differentiate soft tissue mediastinal masses based on morphology and distribution of disease. Metastatic disease and lymphoma accounted for 69% of masses in this series, and CT could not generally differentiate them. However, CT was helpful in differential diagnosis in certain settings. CT demonstration of multiple mediastinal masses when conventional radiographs showed a single mass generally excluded diagnoses such as thymoma and teratoma. CT demonstration of a single middle mediastinal mass, frequently missed by conventional radiography, made metastatic disease a much more likely diagnosis than lymphoma. Finally, CT demonstration of certain ancillary findings strongly favored a diagnosis of lymphoma (axillary adenopathy) or metastatic disease (solitary pulmonary mass, focal liver lesions, bone lesions).
CT是纵隔肿块成像的重要方式，某些CT衰减特征（脂肪、钙化或水样衰减、对比增强）有助于做出特定诊断，这一点广为人知。在一组连续132例经组织学证实的纵隔肿块患者中，只有16例具有这些特定的CT特征。我们基于疾病的形态和分布评估了CT鉴别软组织纵隔肿块的能力。转移性疾病和淋巴瘤占该组肿块的69%，CT通常无法区分它们。然而，在某些情况下CT有助于鉴别诊断。当传统X线片显示单个肿块而CT显示多个纵隔肿块时，通常可排除胸腺瘤和畸胎瘤等诊断。CT显示单个中纵隔肿块（传统X线检查常漏诊），提示转移性疾病的可能性远大于淋巴瘤。最后，CT显示某些伴随表现强烈支持淋巴瘤（腋窝淋巴结肿大）或转移性疾病（孤立性肺肿块、肝脏局灶性病变、骨病变）的诊断。
