Taka Masashi, Kobayashi Satoshi, Mizutomi Kaori, Inoue Dai, Takamatsu Shigeyuki, Gabata Toshifumi, Matsumoto Isao, Ikeda Hiroko, Kobayashi Takeshi, Minato Hiroshi, Abo Hitoshi
Department of Radiology, Kanazawa University Graduate School of Medical Sciences, 13-1, Takara-machi, Kanazawa City, Ishikawa 920-8641, Japan.
Department of Thoracic Surgery, Kanazawa University, 13-1, Takara-machi, Kanazawa City, Ishikawa 920-8641, Japan.
Eur J Radiol. 2023 May;162:110767. doi: 10.1016/j.ejrad.2023.110767. Epub 2023 Mar 11.
Mediastinal masses have various histopathological and radiological findings. Although lymphoma is the most common type of tumor, thymic epithelial and neurogenic tumors are common in adults and children, respectively, but several other types are difficult to distinguish. No previous review has simply and clearly shown how to differentiate mediastinal masses.
We conducted a review of the latest mediastinal classifications and mass differentiation methods, with a focus on neoplastic lesions. Both older and recent studies were searched, and imaging and histopathological findings of mediastinal masses were reviewed. Original simple-to-use differentiation flowcharts are presented.
Assessing localizations and internal characteristics is very important for mediastinal mass differentiation. The mass location and affected organ/tissue should be accurately assessed first, followed by more qualitative diagnosis, and optimization of the treatment strategy. In 2014, the International Thymic Malignancy Interest Group presented a new mediastinal clinical classification. In this classification, mediastinal masses are categorized into three groups according to location: prevascular (anterior)-, visceral (middle)-, and paravertebral (posterior)-compartment masses. Then, the internal characteristics and functional images are evaluated.
Differentiation of mediastinal masses is very difficult. However, if typical imaging findings and clinical characteristics are combined, reasonable differentiation is possible. In each patient, proper differential diagnosis may contribute to better treatment selection.
纵隔肿块有多种组织病理学和影像学表现。虽然淋巴瘤是最常见的肿瘤类型，但胸腺上皮肿瘤和神经源性肿瘤分别在成人和儿童中较为常见，不过其他几种类型则难以区分。以往尚无综述能简单明了地展示如何鉴别纵隔肿块。
我们对最新的纵隔分类和肿块鉴别方法进行了综述，重点关注肿瘤性病变。检索了既往及近期的研究，并对纵隔肿块的影像学和组织病理学表现进行了回顾。给出了原创的易于使用的鉴别流程图。
评估纵隔肿块的定位和内部特征对于鉴别诊断非常重要。首先应准确评估肿块位置及受累器官/组织，随后进行更具定性的诊断，并优化治疗策略。2014年，国际胸腺恶性肿瘤兴趣小组提出了一种新的纵隔临床分类。在此分类中，纵隔肿块根据位置分为三组：血管前（前）、内脏（中）和椎旁（后）间隙肿块。然后，评估内部特征和功能影像。
纵隔肿块的鉴别非常困难。然而，如果结合典型的影像学表现和临床特征，进行合理鉴别是可行的。对每位患者进行恰当的鉴别诊断可能有助于更好地选择治疗方法。
