Abstract
BackgroundTo evaluate the depictability of pericardiacophrenic veins (PCPV) as landmarks for the location of the phrenic nerves on multi-detector-row computed tomography (MDCT), and to investigate the usefulness of depicting the PCPV to aid differential diagnosis of anterior mediastinal lesions.MethodsFifty-six patients with anterior mediastinal lesions (Fifty lesions originated from the thymus, six were of non-thymic origin) were evaluated. Contrast-enhanced CT scans of the chest were performed in all cases before diagnosis, and 22 of these scans were performed with electrocardiographic (ECG) gating. Two chest radiologists assessed the depictability of the PCPV and the positional relationship between the center of each anterior mediastinal lesion and the ipsilateral PCPV.ResultsThe use of ECG gating increased the PCPV depiction rate in the lower left part of the mediastinum. The depiction rate of the left PCPV was significantly higher than that of the right PCPV. All 50 tumors of thymic origin and 3 of the 6 tumors of non-thymic origin were located on the medial side of the ipsilateral PCPV. The 3 lesions located on the lateral side of the ipsilateral PCPV were of non-thymic origin (p = 0.0007).ConclusionThe use of ECG gating during MDCT may improve the depictability of the PCPV in the lower left section of the anterior mediastinum. Solitary anterior mediastinal lesions located on the lateral side of the ipsilateral PCPV are likely to be of non-thymic origin.
Highlights
To evaluate the depictability of pericardiacophrenic veins (PCPV) as landmarks for the location of the phrenic nerves on multi-detector-row computed tomography (MDCT), and to investigate the usefulness of depicting the PCPV to aid differential diagnosis of anterior mediastinal lesions
When a depiction rate score of 3 or more on both the right and left sides was defined as indicating overall good depiction of the PCPV, 20/56 (36%) on the right side and 28/ 56 (50%) on the left side were judged as good depiction by observer 1, and 17/56 (30%) and 28/56 (50%), respectively, by observer 2
During the evaluations performed by observer 2, the PCPV depiction rate for the lower left section of the mediastinum tended to increase during ECG gating (p = 0.069)
Summary
To evaluate the depictability of pericardiacophrenic veins (PCPV) as landmarks for the location of the phrenic nerves on multi-detector-row computed tomography (MDCT), and to investigate the usefulness of depicting the PCPV to aid differential diagnosis of anterior mediastinal lesions. The phrenic nerves are small and difficult to detect on computed tomography (CT), and no previous studies have examined the positional relationship between anterior mediastinal tumors and the phrenic nerves, or the clinical significance of identifying the phrenic nerves in such cases. Anterior mediastinal tumors, such as thymic epithelial tumors, mediastinal lymphomas, and germ cell tumors, mainly arise from the thymus [1]. The purpose of this study was: 1) to evaluate PCPV depictability as landmarks to locate the phrenic nerves on multi-detector-row CT (MDCT) with or without ECG gating; and 2) to investigate the usefulness of identifying the PCPV to aid the differential diagnosis of anterior mediastinal lesions
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