Radiology imaging of mediastinal pathology

Medijastinum je kompleksni anatomski prostor koji je ishodište brojnih benignih i malignih patoloških procesa. Timomi, neurogeni tumori i benigne ciste čine 60% medijastinalnih tvorbi. Lokacija i radiološke karakteristike tvorbe ključni su u usmjeravanju diferencijalne dijagnoze. Nova shema podjele medijastinuma prema ITMIG-u (International Thymic Malignancy Interest Group) na prevaskularni, visceralni i paravertebralni odjeljak omogućuje precizniju identifikaciju medijastinalnih tvorbi na slojevnim metodama oslikavanja. Prvi korak u procjeni medijastinalne tvorbe je radiografija prsnog koša, no za precizniji prikaz potrebne su dopunske slikovne metode. Zlatni standard u dijagnostici medijastinalnih tvorbi je višeslojna kompjutorizirana tomografija (MSCT) koja daje detaljan uvid u lokaciju i veličinu tumora, odnos s okolnim strukturama i karakteristike tkiva. Kod nejasne dijagnoze magnetska rezonancija (MR) zbog svoje visoke kontrastne rezolucije za meka tkiva osigurava daljnji uvid u karakterizaciju medijastinalnih tvorbi, kao i bolji prikaz invazije u okolna tkiva, patoloških limfnih čvorova i metastaza. Napredne MR tehnike kao što su MR s kemijskim pomakom, difuzijsko oslikavanje i dinamički kontrastni MR mogu se koristiti u određenim slučajevima za dodatnu procjenu medijastinalnih tvorbi.The mediastinum is a complex anatomical space from which a variety of benign and malignant pathological processes arise. Thymomas, neurogenic tumors and benign cysts account for 60% of mediastinal masses. The location and imaging characteristics of the mass are critical to narrowing the differential diagnosis. The new mediastinal division scheme developed by ITMIG (International Thymic Malignancy Interest Group) into prevascular, visceral and paravertebral compartments enables a more precise identification of mediastinal masses using cross-sectional imaging methods. The first step in the assessment of a mediastinal mass is a chest radiograph, however additional imaging methods are required for a more precise characterization. The gold standard in the diagnosis of mediastinal masses is multi-slice computerized tomography (MSCT), which provides detailed insight into the location and size of the tumor, its connection to adjacent structures and tissue characteristics. If the diagnosis is uncertain, magnetic resonance imaging (MRI) provides further insight into the characterization of the mass due to its superior soft tissue contrast resolution, along with better insight into invasion of surrounding tissue, pathological lymph nodes and metastases. Advanced MRI techniques such as chemical-shift MRI, diffusion weighted imaging and dynamic contrast enhanced imaging can be used in certain cases to further evaluate mediastinal masses