Skip to main content

Advertisement

SpringerLink
Log in

CT-based mediastinal compartment classifications and differential diagnosis of mediastinal tumors

  • Invited Review
  • Published:
Japanese Journal of Radiology Aims and scope Submit manuscript

Abstract

Division of the mediastinum into compartments is used to help narrow down the differential diagnosis of mediastinal tumors, assess tumor growth, and plan biopsies and surgical procedures. There are several traditional mediastinal compartment classification systems based upon anatomical landmarks and lateral chest radiograph. Recently, the Japanese Association of Research of the Thymus (JART) and the International Thymic Malignancy Interest Group (ITMIG) proposed new mediastinal compartment classification systems based on transverse CT images. These CT-based classification systems are useful for more consistent and exact diagnosis of mediastinal tumors. In this article, we review these CT-based mediastinal compartment classifications in relation to the differential diagnosis of mediastinal tumors.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9
Fig. 10
Fig. 11
Fig. 12
Fig. 13
Fig. 14
Fig. 15
Fig. 16
Fig. 17
Fig. 18
Fig. 19
Fig. 20

Similar content being viewed by others

References

  1. Davies DV, Coupland RE. Gray's anatomy: descriptive and applied. London: Longmans, Green, & Company; 1958.

    Google Scholar 

  2. Felson B. Chest roentgenology. Philadelphia: WB Saunders; 1973.

    Google Scholar 

  3. Fraser RG, Para JA. Diagnosis of diseases of the chest. Philadelphia: WB Saunders; 1973.

    Google Scholar 

  4. Heitzman ER. The mediastinum, radiologic correlation with anatomy and pathology. St. Louis: CV Mosby; 1977.

    Google Scholar 

  5. Whitten CR, Khan S, Munneke GJ, Grubnic S. A diagnostic approach to mediastinal abnormalities. Radiographics. 2007;27:657–71.

    Article  PubMed  Google Scholar 

  6. Zylak CJ, Pallie W, Jackson R. Correlative anatomy and computed tomography. A module on the mediastinum. Radiographics. 1982;2:555–92.

    Article  Google Scholar 

  7. Fujimoto K, Hara M, Tomiyama N, Kusumoto M, Sakai F, Fujii Y. Proposal for a new mediastinal compartment classification of transverse plane images according to the Japanese Association for Research on the Thymus (JART) general rules for the study of mediastinal tumors. Oncol Rep. 2014;31:565–72.

    Article  PubMed  Google Scholar 

  8. Carter BW, Tomiyama N, Bhora FY, et al. A modern definition of mediastinal compartments. J Thorac Oncol. 2014;9:S97–101.

    Article  PubMed  Google Scholar 

  9. Sone S, Higashihara T, Morimoto S, et al. Potential spaces of the mediastinum: CT pneumomediastinography. AJR Am J Roentgenol. 1982;138:1051–7.

    Article  CAS  PubMed  Google Scholar 

  10. Strollo DC, Rosado de Christenson ML, Jett JR. Primary mediastinal tumors. Part 1: tumors of the anterior mediastinum. Chest. 1997;112:511–22.

    Article  CAS  PubMed  Google Scholar 

  11. Clark OH. Mediastinal parathyroid tumors. Arch Surg. 1988;123:1096–100.

    Article  CAS  PubMed  Google Scholar 

  12. Travis WD, Brambilla E, Burke AP, Marx A, Nicholson AG. WHO classification of tumours of the lung, pleura, thymus and heart. 4th ed. Lyon: International Agency for Research on Cancer (IARC); 2015.

    Google Scholar 

  13. Sadohara J, Fujimoto K, Müller NL, et al. Thymic epithelial tumors: comparison of CT and MR imaging findings of low-risk thymomas, high-risk thymomas, and thymic carcinomas. Eur J Radiol. 2006;60:70–9.

    Article  PubMed  Google Scholar 

  14. Tomiyama N, Johkoh T, Mihara N, et al. Using the World Health Organization classification of thymic epithelial neoplasms to describe CT findings. AJR Am J Roentgenol. 2002;179:881–6.

    Article  PubMed  Google Scholar 

  15. Kan X, Wang P, Gong Z, Gao F, Zhang Y, Ge Y. Investigation on computed tomography features of primary thymic atypical carcinoid tumors. J Comput Assist Tomogr. 2017;41:990–4.

    Article  PubMed  Google Scholar 

  16. Shimamoto A, Ashizawa K, Kido Y, et al. CT and MRI findings of thymic carcinoid. Br J Radiol. 2017;90:20150341.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Takahashi K, Al-Janabi NJ. Computed tomography and magnetic resonance imaging of mediastinal tumors. J Magn Reson Imaging. 2010;32:1325–39.

    Article  PubMed  Google Scholar 

  18. Inaoka T, Takahashi K, Mineta M, et al. Thymic hyperplasia and thymus gland tumors: differentiation with chemical shift MR imaging. Radiology. 2007;243:869–76.

    Article  PubMed  Google Scholar 

  19. Rosado-de-Christenson ML, Pugatch RD, Moran CA, Galobardes J. Thymolipoma: analysis of 27 cases. Radiology. 1994;193:121–6.

    Article  CAS  PubMed  Google Scholar 

  20. Strollo DC, Rosado-de-Christenson ML, Jett JR. Primary mediastinal tumors: part II. Tumors of the middle and posterior mediastinum. Chest. 1997;112:1344–57.

    Article  CAS  PubMed  Google Scholar 

  21. Tateishi U, Müller NL, Johkoh T, et al. Primary mediastinal lymphoma: characteristic features of the various histological subtypes on CT. J Comput Assist Tomogr. 2004;28:782–9.

    Article  PubMed  Google Scholar 

  22. Kuroki S, Nasu K, Murakami K, et al. Thymic MALT lymphoma: MR imaging findings and their correlation with histopathological findings on four cases. Clin Imaging. 2004;28:274–7.

    Article  PubMed  Google Scholar 

  23. Moeller KH, Rosado-de-Christenson ML, Templeton PA. Mediastinal mature teratoma: imaging features. AJR Am J Roentgenol. 1997;169:985–90.

    Article  CAS  PubMed  Google Scholar 

  24. Sasaka K, Kurihara Y, Nakajima Y, et al. Spontaneous rupture: a complication of benign mature teratomas of the mediastinum. AJR Am J Roentgenol. 1998;170:323–8.

    Article  CAS  PubMed  Google Scholar 

  25. Tian L, Liu LZ, Cui CY, Zhang WD, Kuang YL. CT findings of primary non-teratomatous germ cell tumors of the mediastinum—a report of 15 cases. Eur J Radiol. 2012;81:1057–61.

    Article  PubMed  Google Scholar 

  26. Jeung MY, Gasser B, Gangi A, et al. Imaging of cystic masses of the mediastinum. Radiographics. 2002;22:S79–93.

    Article  PubMed  Google Scholar 

  27. Shaffer K, Rosado-de-Christenson ML, Patz EF Jr, Young S, Farver CF. Thoracic lymphangioma in adults: CT and MR imaging features. AJR Am J Roentgenol. 1994;162:283–9.

    Article  CAS  PubMed  Google Scholar 

  28. Keller AR, Hochholzer L, Castleman B. Hyaline-vascular and plasma-cell types of giant lymph node hyperplasia of the mediastinum and other locations. Cancer. 1972;29:670–83.

    Article  CAS  Google Scholar 

  29. McAdams HP, Rosado-de-Christenson M, Fishback NF, Templeton PA. Castleman disease of the thorax: radiologic features with clinical and histopathologic correlation. Radiology. 1998;209:221–8.

    Article  CAS  PubMed  Google Scholar 

  30. Murayama S, Murakami J, Watanabe H, et al. Signal intensity characteristics of mediastinal cystic masses on T1-weighted MRI. J Comput Assist Tomogr. 1995;19:188–91.

    Article  CAS  PubMed  Google Scholar 

  31. Nakata H, Sato Y, Nakayama T, Yoshimatsu H, Kobayashi T. Bronchogenic cyst with high CT number: analysis of contents. J Comput Assist Tomogr. 1986;10:360.

    Article  CAS  PubMed  Google Scholar 

  32. Shi Q, Pan S, Bao Y, Fan H, Diao Y. Primary mediastinal myelolipoma: a case report and literature review. J Thorac Dis. 2017;9:E219–25.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Abe T, Yachi A, Ishii Y, et al. Thoracic extramedullary hematopoiesis associated with hereditary spherocytosis. Intern Med. 1992;31:1151–4.

    Article  CAS  PubMed  Google Scholar 

  34. Chen F, Bando T, Hanaoka N, et al. Mediastinal thoracic duct cyst. Chest. 1999;115:584–5.

    Article  CAS  PubMed  Google Scholar 

  35. Balcombe J, Torigian DA, Kim W, Miller WT Jr. Cross-sectional imaging of paragangliomas of the aortic body and other thoracic branchiomeric paraganglia. AJR Am J Roentgenol. 2007;188:1054–8.

    Article  PubMed  Google Scholar 

  36. Murphey MD, Smith WS, Smith SE, Kransdorf MJ, Temple HT. From the archives of the AFIP. Imaging of musculoskeletal neurogenic tumors: radiologic-pathologic correlation. Radiographics. 1999;19:1253–80.

    Article  CAS  PubMed  Google Scholar 

  37. Bhargava R, Parham DM, Lasater OE, Chari RS, Chen G, Fletcher BD. MR imaging differentiation of benign and malignant peripheral nerve sheath tumors: use of the target sign. Pediatr Radiol. 1997;27:124–9.

    Article  CAS  PubMed  Google Scholar 

  38. Jee WH, Oh SN, McCauley T, et al. Extraaxial neurofibromas versus neurilemmomas: discrimination with MRI. AJR Am J Roentgenol. 2004;183:629–33.

    Article  PubMed  Google Scholar 

  39. Varma DG, Moulopoulos A, Sara AS, et al. MR imaging of extracranial nerve sheath tumors. J Comput Assist Tomogr. 1992;16:448–53.

    Article  CAS  PubMed  Google Scholar 

  40. Lonergan GJ, Schwab CM, Suarez ES, Carlson CL. Neuroblastoma, ganglioneuroblastoma, and ganglioneuroma: radiologic-pathologic correlation. Radiographics. 2002;22:911–34.

    Article  PubMed  Google Scholar 

  41. Sakai F, Sone S, Kiyono K, et al. Intrathoracic neurogenic tumors: MR-pathologic correlation. AJR Am J Roentgenol. 1992;159:279–83.

    Article  CAS  PubMed  Google Scholar 

  42. Kato M, Hara M, Ozawa Y, Shimizu S, Shibamoto Y. Computed tomography and magnetic resonance imaging features of posterior mediastinal ganglioneuroma. J Thorac Imaging. 2012;27:100–6.

    Article  PubMed  Google Scholar 

  43. Guan YB, Zhang WD, Zeng QS, Chen GQ, He JX. CT and MRI findings of thoracic ganglioneuroma. Br J Radiol. 2012;85:e365–72.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  44. Erickson D, Kudva YC, Ebersold MJ, et al. Benign paragangliomas: clinical presentation and treatment outcomes in 236 patients. J Clin Endocrinol Metab. 2001;86:5210–6.

    Article  CAS  PubMed  Google Scholar 

  45. Lee KY, Oh YW, Noh HJ, et al. Extraadrenal paragangliomas of the body: imaging features. AJR Am J Roentgenol. 2006;187:492–504.

    Article  PubMed  Google Scholar 

  46. Takashima Y, Kamitani T, Kawanami S, et al. Mediastinal paraganglioma. Jpn J Radiol. 2015;33:433–6.

    Article  PubMed  Google Scholar 

  47. Olsen WL, Dillon WP, Kelly WM, Norman D, Brant-Zawadzki M, Newton TH. MR imaging of paragangliomas. AJR Am J Roentgenol. 1987;148:201–4.

    Article  CAS  PubMed  Google Scholar 

Download references

Funding

The authors declare they have no funding.

Author information

Authors and Affiliations

  1. Department of Radiology, Faculty of Medicine, Saga University, Nabeshima 5-1-1, Saga City, Saga, 849-8501, Japan

    Takahiko Nakazono, Ken Yamaguchi, Ryoko Egashira, Junichi Nojiri, Masanobu Mizuguchi & Hiroyuki Irie

  2. Departments of Pathology & Microbiology, Faculty of Medicine, Saga University, Nabeshima 5-1-1, Saga City, Saga, 849-8501, Japan

    Yukari Takase

Authors
  1. Takahiko Nakazono
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ken Yamaguchi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ryoko Egashira
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Yukari Takase
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Junichi Nojiri
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Masanobu Mizuguchi
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Hiroyuki Irie
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Takahiko Nakazono.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical standards

This article does not contain any studies with human participants or animals performed by any of the authors.

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Nakazono, T., Yamaguchi, K., Egashira, R. et al. CT-based mediastinal compartment classifications and differential diagnosis of mediastinal tumors. Jpn J Radiol 37, 117–134 (2019). https://doi.org/10.1007/s11604-018-0777-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11604-018-0777-5

Keywords

Search

Navigation