摘要： 目的 比较原发性纵隔支气管囊肿、胸腺囊肿、心包囊肿CT影像学特征，为纵隔囊肿影像学诊断及鉴别诊断提供依据。方法 收集2015年1月至2020年12月山西医科大学附属长治市人民医院及郑州大学第一附属医院经病理证实的纵隔支气管囊肿28例、胸腺囊肿21例、心包囊肿25例患者的临床资料。所有患者均行胸部CT平扫及增强扫描，比较囊肿部位、大小、密度、分隔、钙化等影像学特征，并对囊肿大小与临床症状的相关性进行分析。结果 原发性支气管囊肿、胸腺囊肿及心包囊肿在纵隔的位置分布及是否合并囊壁钙化比较差异均有统计学意义（均P < 0.05），但在性别及是否合并囊壁分隔比较差异均无统计学意义（均P > 0.05）。原发性支气管囊肿、胸腺囊肿及心包囊肿最小径/最大径比值分别为0.72±0.18、0.68±0.18、0.69±0.22；平扫CT值分别为（19.67±10.70） Hu、（13.83±8.37） Hu、（14.67±9.50） Hu；增强后CT值分别为（21.69±11.92） Hu、（16.88±11.83） Hu、（15.66±8.94） Hu，差异均无统计学意义（均P > 0.05）。囊肿最大径≥5 cm组与囊肿最大径<5 cm组比较合并临床症状差异有统计学意义（P < 0.05）。结论 原发性纵隔支气管囊肿、胸腺囊肿及心包囊肿的影像学表现各有特点，但利用CT平扫、CT增强扫描及囊内有无分隔无法区分。囊肿所处位置和囊壁有无钙化可能为临床鉴别纵隔囊肿提供信息。囊肿大小和临床症状之间可能存在相关性，提示肿瘤大小可作为临床干预的指标。

原发性纵隔支气管囊肿、胸腺囊肿与心包囊肿CT影像学特征比较

武俊波¹, 马亮¹, 许楠¹, 张慧生¹, 杜可仆², 乔英³, 赵军¹

1. 山西医科大学附属长治市人民医院肿瘤中心, 山西 长治 046000;
2. 郑州大学第一附属医院放射与核医学科, 郑州 450003;
3. 山西医科大学附属第一医院放射科, 太原 030001

收稿日期:2021-07-20出版日期:2022-02-28发布日期:2022-01-05
通讯作者:赵军E-mail:zhaojun380@163.com
作者简介:武俊波(1983-),男,主治医师,硕士.
基金资助:山西省科技兴医创新计划项目（2020XM39）


关键词: 计算机断层扫描, 纵隔囊肿, 支气管囊肿, 心包囊肿, 胸腺囊肿, 影像学特征
Abstract: Objective This study aimed to compare the CT imaging characteristics of primary mediastinal bronchial, thymic, and pericardial cysts in order to provide evidence for the clinical diagnosis and differential diagnosis of mediastinal cysts. Methods Twenty-eight cases of mediastinal bronchogenic cyst, 21 cases of thymic cyst, and 25 cases of pericardial cyst were collected from Changzhi People's Hospital, the first affiliated hospital of Zhengzhou University. All cases had plain chest CT and enhanced CT imaging. Imaging features, such as location, size, morphology, density, separation, and calcification, of all cysts were observed, and any correlations between cyst size and clinical symptoms were analyzed. Results Comparison of primary bronchial mediastinal cysts, thymic cysts, and pericardial cysts showed that the location of the three cysts in the mediastinum and whether they were combined with cyst wall calcification, were different. Differences that were found were statistically significant (P < 0.05); however, there was no statistically significant difference in sex distribution and whether it was combined with cyst wall separation (P > 0.05). The minimum diameter/maximum diameter ratios of the above three types of cysts were 0.72±0.18, 0.68±0.18, and 0.69±0.22, respectively; the plain chest CT values were 19.67±10.70 Hu, 13.83±8.37 Hu, and 14.67±9.50 Hu, and the enhanced CT values were 21.69±11.92 Hu, 16.88±11.83 Hu, and 15.66±8.94 Hu, respectively. Their difference was not statistically significant (P > 0.05). However, the enhanced CT values of the three types of cysts were seen to be significantly higher than that of the plain chest CT scan (P < 0.01); clinical symptoms were significantly different between cysts of maximum diameter ≥ 5 cm and those<5 cm (P < 0.05). Conclusion The imaging findings of primary bronchial, thymic, and pericardial cysts have their own characteristics. The plain chest CT values and changes after enhancement, considering the presence or absence of separation in the cyst, cannot distinguish the three types of cysts. However, the location and the presence or absence of calcification in the cyst wall may provide more information that may guide clinical work-up and management. There is a possible correlation between size of the cyst and clinical symptoms, suggesting that tumor size may possibly be recognized as an indicator of clinical intervention.
Key words: computed tomography, mediastinal cyst, bronchogenic cyst, pericardial cyst, thymic cyst, imaging characteristics
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