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. 2018 May 25:83:e234-e242.
doi: 10.5114/pjr.2018.76709. eCollection 2018.

Diagnostic accuracy of multidetector computed tomography scan in mediastinal masses assuming histopathological findings as gold standard

Somshankar Pandey  1 , Usha Jaipal  1 , Nima Mannan  1 , Rajkumar Yadav  1
Affiliations

Diagnostic accuracy of multidetector computed tomography scan in mediastinal masses assuming histopathological findings as gold standard

Somshankar Pandey et al. Pol J Radiol. .

Abstract

Purpose: Aim of the study was to: 1) present MDCT characteristics of different mediastinal mass lesions, 2) estimate proportion of benign and malignant mediastinal mass lesions based on MDCT findings, and 3) find out the diagnostic accuracy with sensitivity, specificity, positive predictive value, and negative predictive value of MDCT in mediastinal mass lesions assuming histopathology as gold standard.

Material and methods: This study was an analysis of 60 patients who underwent MDCT scan for characterisation of mediastinal mass lesion, and subsequently imaging findings were verified with pathological diagnosis.

Results: Out of 60 patients 65% were malignant and 35% were benign. Metastatic carcinoma was the leading diagnosis. Sensitivity of MDCT in this study came out to be 94%, specificity is 90%, with a positive predictive value of 94% and negative predictive value of 90% with diagnostic accuracy of 93%.

Conclusions: Mediastinal mass lesion can be accurately diagnosed with MDCT which is a non-invasive and easily available modality requiring clinical data for accurate diagnosis and management. Co-relation of MDCT findings with other imaging findings is complex and requires adequate clinical data for optimum diagnostic confidence.

Keywords: ITMIG; MDCT; histopathology; mediastinum.

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Figures

Figure 1
Figure 1
International Thymic Malignancy Interest Group (ITMIG) scheme. Pink area represents prevascular space, yellow area denotes visceral space, and line drawn 1 cm behind anterior border of vertebral body, i.e. area with sky blue colour, represents paravertebral space
Figure 2
Figure 2
A) Mediastinal window – axial non-contrast images showing heterogeneous lobulated mass lesion with necrotic area and egg-shell calcification in prevascular space, which is isodense to muscle. B) Post-contrast axial images show heterogeneous enhancement of the mass lesion, which was seen abutting the major mediastinal vessels. C) Sections show a tumour composed of lobules separated by fibrous septa. Tumour is made up of mixture of epithelial cells and lymphoid cells. The epithelial cells have vesicular oval to round nuclei. Significant atypia or mitotic activity is not seen. The features are suggestive of thymoma type B2
Figure 3
Figure 3
A) Post-contrast image shows lobulated soft tissue mildly enhancing mass with central calcific foci. Also showing rib remodelling. B) Bone window showing widening of neural foramina of upper thoracic vertebra. C) Image showing Verocay bodies of schwannoma
Figure 4
Figure 4
Post-contrast computed tomography showing intensely enhancing soft tissue mass lesion in paravertebral space. Lesion also shows aneurysmal dilatation of vessel inside mass. On histopathology it correlated well and was diagnosed as paraganglioma
See this image and copyright information in PMC

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