胸膜间皮瘤的现代影像学诊断与分期

IF 0.7 4区 医学 Q4 SURGERY
Zentralblatt fur Chirurgie Pub Date : 2025-08-01 Epub Date: 2025-05-19 DOI:10.1055/a-2576-6585
Sabine Franckenberg, Olivia Theissen-Lauk, Thomas Frauenfelder
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引用次数: 0

摘要

胸膜间皮瘤(PM)是一种高度侵袭性的肿瘤,主要与先前接触石棉有关。症状通常在接触后20至50年才出现。根据PM的组织学亚型,预后不同,但中位生存时间仅为12-18个月。成像在PM患者的管理中起着核心作用,特别是在评估可操作性和治疗反应方面。然而,由于其罕见,复杂的形态和同时侵袭多个组织层的倾向,PM对放射学提出了独特的挑战。对比增强计算机断层扫描(CT)是胸膜间皮瘤(PM)诊断、术前计划和治疗监测的中心成像方式。理想情况下,CT应包括胸部和腹部,以捕捉整个胸膜间隙。CT确定的肿瘤厚度和体积是PM患者生存的重要预后因素。此外,PET/CT使用放射性标记的氟脱氧葡萄糖(18F-FDG),为肿瘤代谢提供了额外的有价值的见解。由于PM通常具有代谢活性,因此PET/CT在检测较小病变、隐匿转移和评估形态学模糊病变方面特别有效。另一方面,磁共振成像(MRI)由于其优越的软组织对比,特别是在肿瘤范围和邻近结构浸润的可视化方面,比CT具有明显的优势。动态对比增强成像、扩散加权成像和4D序列提供了有价值的附加信息。根据国际间皮瘤兴趣小组(iMig)专家小组的“最佳实践”,我们概述了常见的成像方式,包括传统的x射线,CT, MRI和PET/CT。此外,我们讨论了基于TNM分类(肿瘤,淋巴结,转移)的分期,评估肿瘤的局部侵袭(T),淋巴结累及(N)和转移(M)的存在。我们还介绍了评估治疗反应的例子,并强调了诊断成像的最新发展。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
[Modern Radiological Approaches to the Diagnosis and Staging of Pleural Mesothelioma].

Pleural mesothelioma (PM) is a highly aggressive tumour, mainly associated with prior asbestos exposure. Symptoms typically do not manifest until 20 to 50 years after exposure. Depending on the histological subtype of PM, the prognosis varies, though the median survival time is only 12-18 months. Imaging plays a central role in the management of PM patients, particularly in assessing operability and treatment response. However, PM presents a unique challenge for radiology due to its rarity, complex morphology, and tendency to invade multiple tissue layers simultaneously. Contrast-enhanced computed tomography (CT) is the central imaging modality in the diagnosis, preoperative planning and therapy monitoring of pleural mesothelioma (PM). Ideally, CT should include both the thorax and abdomen to capture the entire pleural space. Tumour thickness and volume, as determined by CT, are important prognostic factors for patient survival in PM. In addition, PET/CT, using radioactively labelled fluorodeoxyglucose (18F-FDG), offers additional valuable insights into tumour metabolism. Since PM is typically metabolically active, PET/CT is particularly effective in detecting smaller lesions, occult metastases, and assessing morphologically ambiguous lesions. Magnetic resonance imaging (MRI), on the other hand, offers distinct advantages over CT, due to its superior soft tissue contrast, particularly in visualizing tumour extent and infiltration of adjacent structures. Dynamic contrast-enhanced imaging, diffusion-weighted imaging, and 4D sequences provide valuable additional information. On the basis of the "Best Practices" of the expert panel from the International Mesothelioma Interest Group (iMig), we provide an overview of the common imaging modalities, including conventional X-ray, CT, MRI, and PET/CT. Additionally, we discuss staging based on the TNM classification (Tumour, Node, Metastasis), which evaluates the local invasion of the tumour (T), lymph node involvement (N), and the presence of metastases (M). We also present examples of assessing treatment response and highlight recent developments in diagnostic imaging.

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来源期刊
CiteScore
1.00
自引率
14.30%
发文量
116
审稿时长
6-12 weeks
期刊介绍: Konzentriertes Fachwissen aus Forschung und Praxis Das Zentralblatt für Chirurgie – alle Neuigkeiten aus der Allgemeinen, Viszeral-, Thorax- und Gefäßchirurgie.
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