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目的 进一步认识胸部神经鞘瘤的CT表现 ,提高诊断准确率。方法 对 3 5例 ( 3 7个肿瘤 )首先行CT平扫 ,再行增强扫描。每例留取大体和组织学标本 ,将CT所见与病理组织进行比较。结果 3 7个肿瘤按CT增强所见分为 2组 :不均匀强化组和无明显强化组。不均匀强化组分为 4种类型 :( 1)弥漫性形态不规则的非均匀性强化 :共 2 0个 ( 5 4 .1% )。 ( 2 )多发性低密度区或囊变区伴轻度放射状强化 :6个 ( 16.2 % )。 ( 3 )边缘强化伴中间低密度区 :5个 ( 13 .5 % )。 ( 4 )中央强化而周围呈低密度 :1个 ( 2 .7% )。无明显强化组 :5个 ( 13 .5 % ) ,表现为强化不明显 ,呈均匀性低密度。在病理上将 3 7个肿瘤根据其病理学特点分为 2种组织类型 :AntoniA型 (束状型 ) ;AntoniB型 (网状型 )。将肿瘤的CT表现尤其是增强表现与各病理类型进行比较 ,发现病灶呈非均匀性强化的 ,其病理组织绝大多数为AntoniA型 ,而强化不明显者主要为AntoniB型。结论 两种病理组织类型是CT表现复杂化及误诊的主要原因。恶性神经鞘瘤的CT特征性表现与肿瘤大小、密度及强化形式无关 ,而边缘不光整及对周围结构的侵犯破坏则高度提示恶性的可能性。
Objective To further understand the CT manifestations of thoracic schwannoma and improve the diagnostic accuracy. Methods Totally 35 cases (37 tumors) underwent CT plain scan first and then enhanced scan. In each case, gross and histological specimens were collected and compared with those seen in CT. Results 3 7 tumors were divided into 2 groups according to CT enhancement: inhomogeneous enhancement group and no obvious enhancement group. Inhomogeneous strengthening components are classified into four types: (1) irregular heterogeneity of diffuse irregularities: a total of 20 (54.1%). (2) multiple low-density or cystic area with mild radial enhancement: 6 (16.2%). (3) Edge enhancement with intermediate low density area: 5 (13.5%). (4) Central enhanced and low density around: 1 (2.7%). No significant enhancement group: 5 (13.5%), showed no obvious enhancement, was uniform low density. Pathologically, 37 tumors were divided into two types according to their pathological features: AntoniA type (bundle type) and AntoniB type (reticular type). The CT findings of the tumor, especially the enhanced performance compared with the various pathological types, found that the lesions were non-uniform enhancement, the vast majority of the pathological tissue AntoniA type, while the enhancement is not obvious mainly AntoniB type. Conclusion The two types of pathological tissue are the main reasons for the complicated CT findings and misdiagnosis. CT manifestations of malignant schwannoma tumor size, density and enhanced form has nothing to do with the edge of the whole body and the surrounding structure of the violation is highly suggestive of the possibility of malignancy.