早期肺癌X线胸片诊断要点分析

目的：着重论述早期肺癌在X线中的征象，以及X线胸片检查对早期肺癌诊断的特殊意义。方法：经临床手术、病理、细胞学检查等证实为肺癌的41例患者(男性32例，女性9例)，均摄取胸部后前位及胸部侧位片。结论：X线胸片检查对早期肺癌具有发现早、表现特殊，辅助诊断鉴别性强等优点。对于40岁以上有长期吸烟史的病人妇胸片中肺门部或纵膈部出现阴影应引起足够重视；对于40岁以上患者，肺野内突然出现的孤立结节影短期内复查；对于临床高度怀疑的患者应多次检查排除；做好肺癌与炎性、良性假瘤、机化性肺炎、肺门淋巴结结核性肿大、结核球等的鉴别：X线胸片检查要紧密结合纤维支气管镜与CT检查，同时，应注重提高X线摄片的质量以避免误、漏诊的发生。     

肺部周围型癌肉瘤二例

例1男，65岁，因感冒、发热拍胸片提示“右上肺阴影”。X线表现：右上肺4.5cm×4.5cm肿块，密度不均匀，分叶及毛刺明显。肺门纵隔未见肿大淋巴结，X线诊断：右上肺癌(图1)。病理：癌肉瘤(腺癌伴横纹肌肉瘤)，Actin(++)。例2男，51岁，右胸痛3个月，胸片示右上肺后段4.5cm×3.5cm肿块，边界清楚，密度欠均匀，形态不规则，肺门纵隔未见肿大淋巴结。X线诊断：右上肺癌(图2)。病理诊断：右上肺癌肉瘤(癌为腺鳞癌，向神经内分泌分化，肉瘤以软骨肉瘤为主)。讨论肺原发癌肉瘤的发生率很低，仅占肺恶性肿瘤的0.6%。国内文献多为案例报道。文献…     

新生儿肺炎早期X线影像与特征

新生儿肺炎是新生儿期最常见疾病之一，及早诊断可明显降低并发症死亡率，并且在早期具有某些特征性。X线表现以两下肺野内带纹理增粗最为明显，尤以左侧为著，且增粗的边缘较模糊。笔者认为肺纹理增粗可作为新生儿肺炎早期的一个最重要的X线征象。两肺野可见到颗粒状小病灶阴影，边缘模糊，以中下野内带最为多见。但此病变区内很少见到支气管充气征。     

支气管肺癌胸片、CT结合纤支镜诊断对照分析

目的 对比分析X线胸片、CT和纤维支气管镜(纤支镜)检查对支气管肺癌的诊断准确率，并评价该三种方法结合应用的意义。方法 164例支气管肺癌患包括术前活检和术后病理证实的162例和术前脑、肾CT扫描证实的2例，于1个月内均依次接受了X线胸片、CT以及纤支镜检查。结果 164例患中被发现有170个癌性病灶，126例为中心型癌灶，44例为周围型癌灶。X线胸片、CT和纤支镜对周围型肺癌的诊断准确率分别为31．82％、52．27％和63．64％，对中心型肺癌的诊断准确率分别为32．54％、60．32％和95．24％。三项检查结合对周围型肺癌的确诊率为81．82％，而纤支镜与CT并用对中心型肺癌的确诊率为98．41％。结论 在支气管肺癌诊断中，纤支镜明显优于X线胸片与CT，而三项技术并用则可显提高其确诊率。     

婴幼儿毛细支气管炎的DDR诊断及分析（附26例报告）

目的：探讨直接数字化X线摄影（DDR）诊断婴幼儿毛细支气管炎的价值。方法：回顾性分析26例经临床确诊为毛细支气管炎患儿DDR胸片的影像学资料。结果：常规DDR胸片26例中有异常表现24例（92．3％），无异常表现2例（7.7％）。病变跨肺叶20例，肺野透亮度增强14例，肺纹理增多6例、纹理增粗19例、纹理紊乱13例、纹理模糊16例、纹理僵直13例，肺野内粟粒状或斑点状阴影6例，絮状阴影19例，肺门增大9例，肺门结构模糊19例。结论：通过分析婴幼儿毛细支气管炎的DDR胸片表现，加强影像学表现综合分析，提高对该疾病早期诊断的准确性。     

肺癌筛查的影像技术进展

肺癌的发病率很高,早期肺癌影像上常表现为小结节,但多无临床症状。普通X线胸片是最简便、常用的肺癌筛查手段,但对肺内小结节的敏感性及特异性不高。数字化断层融合技术空间分辨力较高,辐射剂量较CT低,相对于X线胸片能明显提高肺内小结节的检出率。与常规CT相比低剂量CT可作为早期肺癌筛查的一种首选检查方法。双能减影技术能获得单一软组织像和骨组织像,可提高肺内小结节检出率。基于神经网络学习的骨抑制技术能够在不需要额外增加辐射剂量和机器设备情况下提高早期肺癌的检出率。     

CT导向肺活检标本端粒酶活性检测对肺癌的早期诊断价值

目的 研究肺活检标本端粒酶活性检测对肺癌的早期诊断价值。资料与方法 经X线平片与CT扫描疑诊为早期肺癌52例患者，分别进行纤维支气管镜活检与经皮针刺切割活检，并使用银染端粒酶重复序列扩增法（TRAP）检测活检标本端粒酶活性；而后将早期肺癌（T1NOM0）与非癌病变组对照研究。结果 经手术病理证实为早期肺癌患者22例，肺活检标本端粒酶活性表达率为86．4％（19／22）；经手术或随访2年以上证实为良性病变者24例（肺囊肿3例，结核6例，炎性假瘤5例，肺炎10例），端粒酶活性表达阳性率为4．2％（1／24）。两组有显著性差异（P＜．01）。结论 端粒酶可以作为肺癌定性的一个敏感的肿瘤标志物，结合病理学检查，有可能对肺癌作出早期诊断。     

支气管肺癌的影像诊断

肺癌的主要影像检查方法为X线胸片、CT、MRI等,其中高电压胸片、高分辨CT是早期发现及鉴别诊断的最重要的方法。螺旋CT的影像重建技术和MRI对于肿瘤的分期有重要价值。中央型肺癌的早期X线表现为支气管的阻塞性改变,HRCT显示支气管狭窄、管壁增厚及管腔结节。周围型肺癌的早期X线表现为肺内结节或小斑片阴影,HRCT显示结节有分叶、空泡或细支气管气像、边缘毛糙及胸膜凹陷征。CT或MRI增强扫描显示肿瘤明显强化。经皮肺穿刺活检是诊断肺癌的重要方法。螺旋CT对于病变的多平面重建、三维重建及仿真支气管内镜可从多个角度显示病变的形态,对病变的鉴别诊断起辅助作用。对于肺癌转移的诊断方面,CT及MRI可较准确地判断淋巴结转移,三维CT血管重建（CAT）及MR血管成像（MRA）可准确地诊断肿瘤对血管的侵犯。MRI是确定胸壁转移的可靠方法。中心型肺癌需与肺结核及慢性肺炎鉴别,周围型肺癌应与结核球、慢性炎性结节等肺内孤立结节病变鉴别。在充分发挥X线胸片及HRCT检查的基础上,有目的地选择其他影像方法进行综合影像诊断,可提高肺癌的早期诊断及鉴别诊断水平。     

肾移植术后合并巨细胞病毒肺炎的X线分析

目的：探讨肾移植术后患者合并肺部巨细胞病毒感染的X线征象及其鉴别诊断。方法：对285例肾移植手术后9例感染巨细胞病毒肺炎患者资料进行回顾性分析。结果：9例感染巨细胞病毒患者的肺部X线改变早期为两肺野肺纹理增强，模糊不清，呈磨砂玻璃状密度增高，其中6例胸片早期出现肺部肺纹理增强并有少许结节阴影，36h后复查发现两肺野出现直径2～4mm、边缘模糊的小结节阴影，弥漫分布于两肺野内，可见弥漫性的支气管血管旁阴影。结论：贤移植术后的患者出现上述表现并短时间内变化明显时，鉴别诊断应考虑合并巨细胞病毒感染的可能。     

小儿重症手足口病的胸部X线表现

目的 探讨重症手足口病患儿X线胸片的表现特点.方法 回顾性分析32例重症手足口病患儿的胸部X线表现.结果 13例表现为单侧或双侧肺纹理增粗,8例有局限性肺渗出阴影,6例有肺水肿,4例肺不张,1例有气胸;11例患儿X线胸片动态观察,8例表现为由肺纹理增粗至出现肺部程度不同肺水肿,最终5例恢复,3例死亡;3例患儿胸部X线表现由程度不等的肺水肿至单纯肺纹理增粗,逐渐恢复正常.结论 重症手足口病患儿胸部X线表现以肺水肿为主要表现,伴有肺部其他表现.     

严重急性呼吸综合征X线表现初步分析

目的初步分析严重急性呼吸综合征(SABS)的X线表现，为其早期诊断提供参考。资料与方法回顾分析2003年3月20日-4月28日经临床综合诊断为SABS患者82例的胸部X线表现。结果82例SABS患者，除2例儿童肺部无明显异常外，其余80例均有改变，其表现主要为肺野透亮度减低、大小不一的斑片状、球形阴影的肺实质漫润，以及肺内间质漫润为主的肺纹理异常、索条影、网状影、结节影。结论胸部X线检查为临床诊断和治疗SABS病提供了有力的依据。     

放射性肺损伤的影像学诊断(附70例分析)

目的:探讨放射性肺损伤(Irradiation lung injury ILI)的影像学表现及其诊断价值。方法:分析了70例经临床和影像学证实的ILI的影像学表现与放射剂量、放射方法、放射面积、放射野、放射速度之间的关系。结果:急性期ILI的X线胸片表现为:血管纹理周围模糊阴影或斑片状均匀实变影,可融合为片状,病变范围与照射野相符。CT表现为放射野内出现斑片状或磨玻璃状阴影,与正常组织分界平直而且清楚,内有“含气支气管征”。慢性期或纤维化期ILI的X线胸片表现为放射野内见到条索状阴影,肺体积缩小,病变与正常肺组织间呈锐利直边。CT表现为与放射野一致的条索状阴影,行四野照射的病人可见到“十字征”。结论:高分辨率CT诊断ILI较之X线平片更为敏感且更具特征,可达到早期诊断与及时治疗之目的。     

异常体动脉供应正常左下肺基底段的胸部X线片和螺旋CT表现

目的 总结异常体动脉供应正常左下肺基底段在胸部X线片和螺旋CT上的特征性表现。方法 回顾分析5例异常体动脉供应正常左下肺基底段的胸部X线片和螺旋CT资料。结果 5例异常体动脉供应正常左下肺基底段在胸部X线片上均表现为心后区肿块，左下肺动脉纹理细小，受累左下肺区域无正常肺动脉分支影分布，但有异常增粗纹理。CT上5例均表现为受累肺组织体积轻度缩小，支气管通畅，2例肺实质呈磨玻璃状改变。5例均可见左下肺动脉在背段动脉起始远侧缺如，增粗扭曲的异常体动脉起自降主动脉，其扩张的分支分布于受累肺段。1例血管造影表现与CT相仿。结论 该病在胸部X线片上的表现有一定特征性。增强螺旋CT扫描可明确诊断，以避免创伤性的血管造影和致命的穿刺活检。     

Detection of lung cancer using single-exposure dual-energy subtraction chest radiography

PURPOSE: The aim of this study was to evaluate the detectability of lung cancer by chest radiography with a single-exposure dual-energy subtraction (ES) method. MATERIALS AND METHODS: Five radiologists read two sets of chest radiographs from 77 patients (66.5 +/- 9.6 years old) with histologically proven lung cancer measuring or=50 but <100%; (3) solid: TDR was <50%. RESULTS: Overall, detectability with the ES method was significantly better than that without ES (mean Az value increased from 0.7673 to 0.8265, P < 0.05). In the subgroup analysis of the nonsolid group and the solid group detectability did not change using the ES method, whereas in the partly solid group detectability with the ES method was significantly better than that without ES (mean Az value increased from 0.7162 to 0.8209, P < 0.005). CONCLUSION: The ES method improves the detectability of lung cancer by chest radiography, especially of the partly solid group.     

The role of radiologic screening in lung cancer

The present available data do not support the routine utilization of chest radiography or sputum cytology for the early detection of lung cancer. While on an individual basis, as part of a general health maintenance consideration, some high risk individuals may benefit from radiologic or cytologic screening, there has been no overall decrease in cancer mortality associated with these screening procedures. The early cases picked up by screening while asymptomatic and often detected by sputum cytology have lead-time bias to account for prolonged survival. Furthermore, many of these asymptomatic lesions are so indolent that they may never come to the patient's attention during his or her lifetime and the patient may die of other causes. There are other cancers, which may be of the same histology, that develop in the interval between even closely applied screening examinations. Patients with these cancers are often symptomatic and the biologic behavior of these lung cancers is so aggressive that, regardless of intervention, the prognosis is miserable. The cooperative studies also show a fairly high miss rate for the diagnosis of lung cancer even in patients who are being heavily screened. The miss rate for the early detection of lung cancer with chest radiography is probably on the order of 30% or more. That is, in at least 30% of cases, the tumor can be identified retrospectively on earlier examination. Nevertheless, in spite of the significant miss rate, those tumors with an indolent biologic behavior can be present for 2, 3, or more years and still remain localized, have a high resectability rate, and carry a prolonged survival prognosis.(ABSTRACT TRUNCATED AT 250 WORDS)     

低剂量螺旋CT筛选检查早期肺癌的初步研究

目的 评价低剂量螺旋CT筛选检查（简称筛检）对肺癌高危险人群早期肺癌的检出率。方法 对无症状300例体检者胸片及CT进行前瞻性研究，纳入标准为年龄45岁以上，吸烟10年包（10年以上，每日1包）以上，或既往有慢性阻塞性肺疾病病史，以前无癌症史，身体状况适合手术治疗者，低剂量CT扫描采用Philip SR 7000及GE LightSpeed Plus多层面CT扫描机。图像由2位放射医师在工作站显示器上以电影显示方式观察，存储至影像存储与传输系统（PACS）。结果 低剂量CT共检出56例（19％）非钙化结节（其中恶性4例），胸片检出9例（3％）（其中恶性3例），均为1期病变。低剂量CT检出叶支气管或段支气管病变9例（3％），其中早期中央型肺癌例（1％），胸片均未检出，胸片、CT对肺癌筛检的敏感度分别为43％、100％，特异度分别为89％、80％。结论 初步筛检结果表明低剂量螺旋CT明显提高了对肺内非钙化小结节及支气管细微病变的检出，可检出早期肺癌。     

肺郎格汉斯细胞组织细胞增生症的临床、X线、CT表现(2例报告并文献复习)

目的探讨肺郎格汉斯细胞组织细胞增生症(PLCH)的临床、X线及CT表现,以提高对该病的影像学认识。方法回顾性分析2例病理证实的PLCH患者的临床、X线和CT资料。2例患者均行胸部螺旋CT、高分辨CT(HRCT)扫描及X线胸部平片摄影,1例行头颅CT扫描。结果 2例患者CT及HRCT均为双中上肺野广泛分布的高密度小结节状影、纤维条索影及囊状和蜂窝状影。1例头颅CT示右枕骨局限性骨质破坏;胸部平片示双肺野透光度减低,双肺纹理模糊;另1例胸部平片示双肺纹理紊乱,右肺中野可见多个小囊状低密度区;纵隔影明显增宽。结论 PLCH的X线、CT及HRCT表现有一定的特征性,尤其是HRCT显示病变更加清晰,结合临床资料可提高对此病的诊断,确诊仍需病理学诊断。     

Low-dose CT: new tool for screening lung cancer?

Lung cancer is the leading cause of death from malignant tumours as it is very common and has a poor prognosis at advanced tumour stages. Prognosis could be improved by treatment at early stages. As these stages are usually asymptomatic, a diagnostic test that would allow detection of early tumour stages in a population at risk could potentially reduce mortality from lung cancer. Previous approaches using chest radiography and sputum cytology in smokers have been disappointing. Fluorescent bronchoscopy and molecular markers are not yet applicable in clinical routine. Because of its high sensitivity for small pulmonary nodules, which are the most common manifestation of early lung cancer, CT appears suitable as a screening test. Low-dose examination parameters can and should be used for this purpose. From clinical practice it is well known that chest CT often demonstrates small pulmonary nodules, which do not represent lung cancer. Therefore, non-invasive diagnostic algorithms are required to avoid unnecessary biopsies in benign lesions. In preliminary studies of low-dose CT using algorithms based on size and density of detected nodules a large proportion of asymptomatic lung cancers and a large proportion of early, resectable tumour stages were found with a small proportion of invasive procedures for benign nodules. Before this technology can be recommended for broad application, however, further information is required regarding appropriate inclusion criteria (smoking habits, age groups) and screening intervals. Most importantly, further data are required to clarify whether lung cancer screening using low-dose CT can actually reduce mortality from lung cancer.     

老年肺结核的X线、CT征象（附260例分析）

目的了解老年肺结核的影像特征,进一步提高诊断准确率。方法260例临床及病理证实的老年性肺结核患者均经胸部x线平片检查,其中157例经CT平扫,对所有患者X线、CT表现进行了回顾性分析,对X线与CT诊断肺结核的能力进行了比较,以及观察分析病变的部位、范围、形态、类型。结果本组260例肺结核中,X线平片正确诊断191例（73.5％）,漏诊及不能确诊69例（26.5％）。老年性肺结核的主要X线征象：空洞及纤维性空洞性病变175例,增殖性病变142例,纤维病变及钙化81例,渗出性病变52例。CT正确诊断146例（93％）,漏误诊11例（7％）。肺结核主要CT表现：纤维空洞性病变,片状渗出性病变,增殖性病变,纤维及钙化,淋巴结增大,结核球。本组X线漏诊69例,后经CT明确诊断。被CT漏诊的2例由X线胸片明确诊断。结论CT对老年肺结核的诊断准确率明显高于x线平片。老年肺结核具有临床症状不典型,影像表现多样,典型征象少,病变部位不固定等特点,只有综合分析才能做出正确的诊断。     

The "dirty chest"--correlations between chest radiography, multislice CT and tobacco burden

Objectives

Cigarette smoking-induced airway disease commonly results in an overall increase of non-specific lung markings on chest radiography. This has been described as “dirty chest”. As the morphological substrate of this condition is similar to the anthracosilicosis of coal workers, we hypothesised that it is possible to quantify the radiological changes using the International Labour Organization (ILO) classification of pneumoconiosis. The aims of this study were to evaluate whether there is a correlation between the extent of cigarette smoking and increased lung markings on chest radiography and to correlate the chest radiographic scores with findings on CT studies.

Methods

In a prospective analysis a cohort of 85 smokers was examined. The cigarette consumption was evaluated in pack years (defined as 20 cigarettes per day over 1 year). Film reading was performed by two board-certified radiologists. Chest radiographs were evaluated for the presence of thickening of bronchial walls, the presence of linear or nodular opacities, and emphysema. To correlate the smoking habits with the increase of overall lung markings in chest radiography, the ILO profusion score was converted to numbers ranging from zero to nine. Chest radiographs were rated according to the complete set of standard films of the revised ILO classification.

Results

63/85 (74%) of the smokers showed an increase in overall lung markings on chest radiography; 32 (37%) had an ILO profusion score of <1/1, 29 (34%) had an ILO profusion score of <2/2 and 2 (2%) had an ILO score of ≥2/2. There was a significant positive linear correlation between the increase of overall lung markings on chest radiography and the cigarette consumption quantified as pack years (r=0.68). The majority of the heavy smokers (>40 pack years) showed emphysema; there was no significant difference between the prevalence of emphysema as diagnosed by CT (62%) or chest radiography (71%) (p<0.05).The most common findings in CT were thickening of bronchial walls (64%) and the presence of emphysema (62%) and of intralobular opacities (61%). Ground-glass opacities were seen in only 7% of our patients.

Conclusion

Bronchial wall thickening and intralobular opacities as seen in CT showed a positive linear correlation with the increase of overall lung markings on chest radiography.Tobacco smoke is the most important and well-known causative factor for the development of chronic bronchitis, bronchial cancer and emphysema [1]. Cigarette smoking also results in a focal accumulation of macrophages within the walls of the respiratory bronchioles and adjacent alveoli described as respiratory bronchiolitis-associated interstitial lung disease (RB-ILD) [2-6]. The common finding of “dirty chest”, an overall increase in non-specific lung markings on chest radiography in such patients, is frequently identified in daily routine [7-10]. Remy-Jardin et al [11] found that the morphological substrate of cigarette smoking-induced changes in chest radiography were parenchymal micronodules and intralobular opacities comparable to the findings in anthracosilicosis of coal workers. Therefore, we hypothesised that it might be possible to quantify the smoking-induced changes of the lung using the International Labour Organization (ILO) classification [12].The aims of this study were to evaluate whether there was a correlation between the extent of cigarette smoking and increased lung markings in chest radiography and to correlate chest radiographic scores with findings on CT studies. To the best of our knowledge, an evaluation like this has not been described in the clinical literature so far.