目的 旨在探讨多层螺旋CT平 扫及三期动态增强扫描对腹膜后神经鞘 瘤的诊断价值。方法 选取我院2013年1 月-2016年12月收治的腹膜后神经鞘瘤患 者48例，收集48例患者的临床资料、影像 学资料等，分析48例腹膜后神经鞘瘤患者 CT平扫及三期增强扫描的图像表现，并 以病理学检查结果为标准，比较CT平扫 与CT三期增强扫描对腹膜后神经鞘瘤的 检出率及诊断准确率。结果 CT平扫对腹 膜后神经鞘瘤的检出率及准确诊断率分 别为79.16%(38/48)、72.91%(35/48)， CT三期增强对腹膜后神经鞘瘤的检出率 及准确诊断率分别为97.91%(47/48）、 95.83%(46/48)，CT三期增强扫描对腹膜 后神经鞘瘤的检出率及准确诊断明显高于 CT平扫，差异具有统计学意义(P<0.05)； CT平扫病灶外形呈现圆形或类圆形，部分 呈现结节状，病灶以低密度为主，其间可 见小囊状低密度影，其中12例(28.00%) 患者可见邻近椎间孔扩大，骨质压迫 吸收，完全实性者瘤体密度较均；完全 囊性者为囊壁较薄，内外壁均光整；囊 实性者图像可见实性成分出现大片低密 度。增强扫描肿瘤实体部分静脉期平均 CT值(52.5±8.25)HU，动脉期平均CT值 (52.5±8.25)HU，增强扫描中多数患者可 见肿块边缘强化较均匀，内部强化呈云絮 状、蜂窝状强化，静脉期进一步轻度渐进 性强化，矢状位重建可见病灶上下缘低密 度影与肿块相连，形成典型的神经出入征 像。结论 多层螺旋CT三期动态增强扫描 对腹膜后神经鞘瘤检出率及诊断准确率 高，可清晰显示病灶大小、内部结构及与 邻近脏器解剖等具体情况。

Objective To investigate the diagnostic value of multi-slice spiral CT plain scan and three phase dynamic enhanced scan in retroperitoneal schwannoma. Methods A total of 48 patients with retroperitoneal schwannoma treated in our hospital from January 2013 to December 2016 were selected. The clinical data and imaging data of 48 patients were collected, analyze the 48 cases of retroperitoneal schwannoma CT scanning images, and the pathological examination results as the standard, compared with unenhanced CT scanning rate detection and diagnosis of retroperitoneal schwannoma and the accuracy rate of CT three enhanced. Results The detection rate and accurate diagnosis rate of CT scan for retroperitoneal schwannoma were 79.16% (38/48) and 72.91% (35/48), the detection rate and accurate diagnosis rate of retroperitoneal schwannoma with three phase CT enhancement were 97.91% (47/48) and 95.83% (46/48), the detection rate and accurate diagnosis of retroperitoneal schwannoma with CT three phase scan were significantly higher than that of CT plain scan, the difference was statistically significant (P<0.05). CT scan showed round or oval shape, part of the nodular lesion with low density, there were cystic low density, 12 cases (28%) patients with visible adjacent intervertebral foramen, compression bone absorption, completely solid tumor density than all;The cystic wall is thin and the internal and external wall are all smooth; the cystic solid image shows that the solid components appear low density. Enhanced CT scanning average tumor entity region venous phase (52.5+8.25) HU value, the average value of CT arterial phase (52.5+8.25) HU, the majority of patients in the visible mass enhancement scanning edge enhancement is uniform, internal enhancement was cloudy, mild enhancement in venous phase, further mild progressive enhancement, sagittal reconstruction of visible lesions on the edge of the low density and mass connected, forming a typical nerve like syndrome. Conclusion The three slice dynamic enhanced CT scan has a high detection rate and high accuracy in the diagnosis of retroperitoneal schwannoma. It can clearly show the size of the lesion, the internal structure and the anatomy of the adjacent organs.