关键词：纵隔发；肿瘤；X线；体层摄影术，X线计算机；诊断应用
【摘要】 目的 探讨原发性纵隔肿瘤的X线诊断与误诊原因，并进一步评价X线检查对该类肿瘤的临床价值。 材料与方法 分析原发性纵隔肿瘤255例的X线表现(全部病例均有胸部正、侧位片，58例有胸部CT片，3例进行了胸部MRI检查)，并对照分析本组X线、CT检查结果与手术病理结果。探讨原发性纵隔肿瘤的诊断步骤及各步骤的X线诊断依据。提出并研究“典型胸膜外征”、“非典型胸膜外征”与“沟征”的形成机理与诊断价值，探讨肿块与气管、食管的关系。 结果 统计结果分析表明，单纯X线平片检查误诊率高达37.6%，显著高于CT检查(P<0.01)，肿块出现“非典型胸膜外征”及“沟征”是其主要的误诊原因。结论 原发性纵隔肿瘤单纯应用X线平片检查易被误诊，而正确认识“典型胸膜外征”、“非典型胸膜外征”与“沟征”及肿块与气管、食管的关系是避免X线误诊的关键。
X-ray Diagnosis of PrimaryMediastinal TumorsAn Analysis of 255 Cases
WANG Yunhua
(Department of Radiology, No.2 Affiliated Hospital of Hunan Medical University, Changsha, Hunan Province 410011, P.R.China)
【ABSTRACT】 Objective To study theX-ray diagnosis of primary mediastinal tumors, to analyze the causes of misdiagnosis, andto make a further evaluation of X-ray in clinical management of these tumors. Materialsand Methods Imaging findings, including chest films (all cases), CT scans (n=58) and MRI(n=3), in 255 patients with primary mediastinal tumors were retrospectively analyzed.Comparisons between X-ray, CT and pathological findings were made. The diagnosticalgorithm was investigated. A deep study of the mechanism producing extra-pleura sign,non-typical extra-pleura sign and groove sign was conducted. The relationship of the masswith the trachea and esophagus was studied. Results The misdiagnosed rate of plainX-ray films was 37.6%, significantly higher than that of CT (P<0.01). The non-typicalextra-pleura sign and groove sign were the main cause leading to misdiagnosis. Conclusion Primarymediastinal tumors are prone to be misdiagnosed on plain X-ray films only. Preciseunderstanding of extra-pleura sign, non-typical extra-pleura sign and groove sign as wellas the relationship of the mass with the trachea and esophagus is the key point to avoidmisdiagnosis.
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