胸腺瘤的影像诊断及分期.ppt

MRI表现 肿瘤的包膜和瘤内的纤维分隔提示肿瘤侵袭性较低 PET/CT Thymic hyperplasia in a 16-year-old boy who had undergone chemotherapy for osteosarcoma 4 months earlier. (a) Contrast-enhanced chest CT scan shows thymic enlargement. (b) PET/CT scan obtained to monitor for osteosarcoma recurrence or metastases shows diffuse FDG uptake in the thymus (arrow). At 7-month follow-up PET/CT, the uptake had resolved, a finding consistent with thymic hyperplasia. a b PET/CT Stage IVa thymoma in a 50-year-old man. (a) Contrast-enhanced chest CT scan shows a primary mass (M) and a pleural drop metastasis (arrow). (b) On an axial fused FDG PET/CT image, the primary tumor (M) and the drop metastasis (arrow) are FDG avid. Pleural recurrence in a 38-year-old woman with previously treated stage IVa thymoma. (a) Postoperative baseline CT scan shows normal right basilar pleura adjacent to the attachment of the diaphragm to the chest wall (arrow). (b) Follow-up contrast-enhanced chest CT scan obtained 2 years later shows increased diaphragmatic pleural thickening (arrow). (c) Axial fused FDG PET/CT image shows FDG-avid pleural recurrence (arrow). 女性，25岁，胸腺增生伴重症肌无力 a.同相位T1WI；b.反相位T1WI a b 胸腺瘤X线表现 偏侧性前纵隔肿块 边界清楚 边缘光滑或呈分叶状 进展期X线征象 与肺的交界面不规则 膈肌升高（膈麻痹） 胸膜结节（胸膜转移） 侵袭性胸腺瘤 男，55岁，无明显临床症状 膈神经受累（右膈面抬高）男，60岁 胸膜转移 女，36岁 CT表现 前纵隔肿块 边缘光滑或呈分叶状 多发生于胸腺的一叶 CT表现 典型表现为均匀强化 约1/3因肿瘤坏死、出血或囊变而出现不均匀强化 CT表现 囊性病变里的软组织结节 提示该病变是囊性胸腺瘤而非先天性囊肿 胸腺瘤钙化 细点状 沿包膜线条状 肿瘤内粗大钙化 血管受侵征象 内腔轮廓不规则 被病灶包绕或闭塞消失 血管腔内软组织肿块，可延续至心腔内 胸膜播散 单或多发胸膜结节或肿块 平滑、结节状，或弥散分布 多见于前纵隔胸腺瘤同一侧 胸腔积液不常见，即使已经发生胸膜转移 肿瘤侵袭性依据 分叶状或形态不规则 瘤内囊变、坏死区 多灶性钙化 进展期征象 直径7cm以上 与Ⅲ～Ⅳ期分级具有高度相关性 周围脂肪浸润 分叶状轮廓 以下表现提示胸腺瘤可能性较小… 纵隔淋巴结广泛转移 胸腔积液 肺转移 Stage I in MDCT and Masaoka staging system WHO type A ，Masaoka stage I stage II in MDCT and Masaoka staging system stage Ⅲ in MDCT and Masaoka staging system stage Ⅲ in MDCT and Masaoka staging system stage Ⅲ in MDCT and Masaoka staging system stage Ⅲ in MDCT and Masaoka staging system stage Ⅳ in MDCT and Masaoka staging system