22例原发性恶性胸腺生殖细胞瘤的CT及MRI表现

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22例原发性恶性胸腺生殖细胞瘤的CT及MRI表现。
目的：分析恶性胸腺生殖细胞肿瘤（GCTs）的CT和MRI特征，以提高对这些肿瘤的诊断准确性。
材料与方法：回顾性纳入组织病理学证实为恶性胸腺 GCT 的 22 名患者（20名男性，2 名女性；年龄 28 ± 8.64 岁），并分析其 CT 和 MRI 表现。
结果：根据CT表现，恶性胸腺GCT通常表现为胸腺区巨大肿块，通常向中线两侧生长（20/22，90.9%），形状不规则（15/22，68.2%），呈分叶状（12 /22, 50%)、边界不清 (9/22, 40.9%) 、包膜不完整(21/22, 95.5%)。 20例肿块均显示密度不均匀，19例（86.4%）有多灶性坏死或囊性改变。大多数病例（16/18, 88.9%）表现为轻至中度强化，14例（14/18, 77.8%）见瘤内分支样血管。 14例患者的最小表观扩散系数（ADCmin）和平均表观扩散系数（ADCmean）分别为（1.13±0.45）和（1.37±0.49）×10-3 mm2/s。与CT表现相比，所有恶性胸腺GCT患者的MRI图像均出现包膜不完整、信号不均匀、坏死或囊性改变。此外，所有 14 例 (100%) 病例均发现瘤周水肿。
结论：MRI在显示GCTs包膜不全、瘤周水肿、信号不均、坏死或囊性改变方面优于CT。分支样强化和多灶性坏死可能有助于恶性胸腺 GCT 的诊断。

Hu YC, Wang SZ, Xiao G, Liu CX, Wang SM, Kou HL, Cui GB. CT and MRI features in 22 cases of primary malignant thymic germ cell tumours. Clin Radiol. 2022 May;77(5):390-398. doi: 10.1016/j.crad.2022.01.047. Epub 2022 Feb 12. PMID: 35164927.

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Aim: To analyse the computed tomography (CT) and magnetic resonance imaging (MRI) features of malignant thymic germ cell tumours (GCTs), in order to improve the accuracy of diagnosis of these tumours.
Materials and methods: Twenty-two patients (20 men, two women; age, 28 ± 8.64 years) with malignant thymic GCTs confirmed at histopathology were enrolled retrospectively, and their CT and MRI findings were analysed.
Results: According to the CT findings, malignant thymic GCTs usually manifest as a bulky mass that typically grows to both sides of the midline (20/22, 90.9%), with irregular shape (15/22, 68.2%), lobulation (12/22, 50%), ill-defined margin (9/22, 40.9%), and incomplete capsule (21/22, 95.5%). Twenty masses revealed heterogeneous density with multifocal necrosis or cystic change in 19 (86.4%). Most cases (16/18, 88.9%) showed mild to moderate enhancement, and the branch-like vessel was found in 14 (14/18, 77.8%) cases. The minimum apparent diffusion coefficient (ADCmin) and mean apparent diffusion coefficient (ADCmean) values in 14 patients were (1.13 ± 0.45) and (1.37 ± 0.49) × 10-3 mm2/s, respectively. Compared with CT findings, the incidences of an incomplete capsule, heterogeneous signal, and necrotic or cystic change on MRI images occurred in all patients with malignant thymic GCT. In addition, peritumoural oedema was found in all 14 (100%) cases.
Conclusion: MRI is superior to CT in showing incomplete capsule, peritumoural oedema, heterogeneous signal, and necrotic or cystic change of GCTs. Branch-like enhancement and multifocal necrosis may help the diagnosis of malignant thymic GCTs.

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