Anterior mediastinal lesions: CT and MRI features and differential diagnosis
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INVITED REVIEW
Anterior mediastinal lesions: CT and MRI features and differential diagnosis Takahiko Nakazono1 · Ken Yamaguchi1 · Ryoko Egashira1 · Masanobu Mizuguchi1 · Hiroyuki Irie1 Received: 4 July 2020 / Accepted: 11 August 2020 © Japan Radiological Society 2020
Abstract Anterior mediastinum is the most common location of mediastinal tumors, which include various solid and cystic lesions. The lesion location and CT and MRI features are important in the differential diagnosis. Recently, CT-based mediastinal compartment classification systems were proposed and suggested to be useful for accurate evaluation of mediastinal lesions. CT and MRI reflect the pathological findings of mediastinal lesions, and knowledge of the pathological features is important for the differential diagnosis. In this article, we review the CT and MRI features of anterior mediastinal lesions and describe important points in the differential diagnosis. Keywords Mediastinum · Anterior · Computed tomography · Magnetic resonance imaging
Introduction Various solid and cystic lesions occur in the mediastinum. The location and imaging features are important for the differential diagnosis of these lesions. There are several traditional mediastinal compartment classifications based on anatomy [1] and chest radiographs [2]. However, some mediastinal lesions cannot be reliably localized to a specific compartment, since considerable overlap exists among the radiographically imaged compartments. Mediastinal lesions are optimally evaluated with cross-sectional imaging techniques such as computed tomography (CT) and magnetic resonance imaging (MRI). Accordingly, new CT-based mediastinal compartment classification systems were recently proposed and were suggested to be useful for accurate evaluation of location of mediastinal lesions [3, 4]. CT and MRI reflect histopathological features of mediastinal lesions. MRI may provide additional information to the CT findings of mediastinal lesions. In this article, we review CT and MRI features of anterior mediastinal lesions according to the CT-based mediastinal compartment classification systems.
* Takahiko Nakazono [email protected]‑u.ac.jp 1
Department of Radiology, Faculty of Medicine, Saga University, Nabeshima 5‑1‑1, Saga City, Saga 849‑8501, Japan
CT‑based mediastinal compartment classification systems The Japanese Association of Research of the Thymus (JART) proposed a CT-based 4-compartment mediastinal classification system that included the superior portion of the mediastinum, anterior mediastinum (prevascular zone), middle mediastinum (peritracheoesophageal zone), and posterior mediastinum (paravertebral zone) (Fig. 1a) [3]. The inferior boundary of the superior portion of the mediastinum is a horizontal plane at the intersection of the caudal margin of the brachiocephalic vein with the trachea [3]. Classifying the superior portion of the mediastinum has the advantage of making it easy to differentiate an intrathoracic goiter or neurogenic tumor of the thoracic inlet from other mediastinal
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