CT导向下切割活检在纵隔病变诊断中的应用价值

目的 探讨经皮针刺切割活检纵隔病变的临床应用价值.方法 回顾性分析52例纵隔肿瘤CT导向下经皮针刺切割活检术.穿刺针为美国MD公司TRU-CORE 18 G切割针,52例均做切割病理组织学检查,6例加做免疫组化.结果 (1)病变部位前纵隔49例,中纵隔1例,后纵隔2例;(2)43例病理诊断明确,9例病理诊断不确定.穿刺活检正确率为82.7% ,假阴性率为17.3% ,假阳性病例1例;(3)淋巴瘤活检准确性为50%, 辅以免疫组织化学后切割活检的准确性为80%,明显提高了穿刺活检的诊断准确率(χ2 = 3. 96 ,P<0.05);(4) 8 例小病灶穿刺敏感性为50%,44 例大病灶穿刺敏感性为84.1%,穿刺阳性率与病灶大小无关(确切概率法P>0. 05);(5)胸腺类肿瘤、淋巴结转移性癌活检准确性分别为93%、100% ,淋巴瘤活检准确性仅为50%, 胸腺类肿瘤、淋巴结转移性癌活检阳性率显著高于淋巴瘤(P < 0.05)与前2组比较有统计学意义(P < 0.05);(6) 穿刺并发症发生率为9.6%.气胸发生率为5.8%.结论 CT导向下经皮切割活检术是纵隔病变安全而有价值的诊断方法,辅以免疫组织化学技术可以很大提高纵隔病变的诊断正确率.     

CT导向下经皮针刺活检前纵隔肿瘤

目的　探讨经皮针刺活检前纵隔肿瘤的影响穿刺准确性的因素。资料与方法　回顾性分析 80例前纵隔肿瘤CT导向下经皮针刺活检术。结果　 (1)病理学明确诊断 6 7例 ,不能确定诊断 13例 ;(2 )细针抽吸、切割针活检穿刺敏感性分别为 75 %、90 .5 % ;(3) 16例小病灶穿刺敏感性为 6 8.8% ,6 4例大病灶穿刺敏感性为 87.5 % ;(4)胸腺类肿瘤、淋巴结转移性癌活检准确性均为 92 % ,淋巴瘤活检准确性仅为 6 5 % ,与前两组比较有统计学意义(P <0 .0 5 ) ;(5 )穿刺并发症发生率为 7.5 %。结论　切割针活检阳性率高于细针活检 ,活检阳性率大病灶高于小病灶 ,胸腺类肿瘤、淋巴结转移性癌活检阳性率显著高于淋巴瘤 ;CT导向下经皮针刺活检术是前纵隔肿瘤安全、有价值的诊断方法。     

CT导引穿刺活检对纵隔病变的诊断价值

目的 评估CT导引经皮细针穿刺活检对纵隔病变的诊断价值.方法 回顾性研究CT导引经皮穿刺纵隔病变104例.活检部位包括前纵隔73例、中纵隔29例和后纵隔2例.病灶大小2.31 cm×1.11 cm～14.5 cm×10.3 cm,病灶直径＜3.0 cm 16例,3.1～5.0 cm 39例,＞5 cm 49例,使用18～20 G穿刺针作穿刺抽吸活检.结果 穿刺活检成功率100%,穿刺活检诊断为恶性病变67例、良性27例、假阴性8例,假阳性2例.穿刺活检正确率、灵敏度和特异度分别为90%、92%和100%.病变大小和病变良恶性对活检正确率差异无统计学意义(P＞0.05).并发症为轻度气胸(6例)、咯血(2例)和纵隔气肿(1例).结论 CT导引经皮细针穿刺活检纵隔病变是安全可行的诊断方法.     

胸部大血管旁直径≤3cm病灶CT引导穿刺活检技术的应用

目的:评价CT引导经皮穿刺活检术对邻近胸部大血管旁直径≤3cm病灶的临床应用价值。方法:采用CT引导经皮穿刺术对206例邻近胸部大血管的直径≤3cm病灶进行活检,并与手术或临床随访诊断结果进行对比,分析其敏感性、特异性、准确性及并发症情况。结果:本组中该方法对恶性肿瘤的诊断敏感度为82.7%(124/150),阳性预测值100%;对良性病变的诊断特异度为100%,阴性预测值68.3%(56/82);总诊断符合率为87.4%(180/206)。气胸发生率8.3%(17/206),肺内出血发生率9.2%(19/206),均未作特殊处理而自愈;病灶周围有肺气肿是气胸及肺内出血的危险因素(χ2分别为27.56和30.45,P<0.01),而病灶大小及深度与并发症无明显相关性(P>0.05)。结论:CT引导经皮穿刺活检术对邻近胸部大血管旁直径≤3cm病灶的诊断准确性较高且并发症少。     

胸部疑难病灶CT导向经皮穿刺活检

目的 :探讨 CT导向胸部疑难病灶经皮穿刺活检技术及其临床意义。方法 :52例胸部疑难病灶穿刺含肺部 41例 ,纵隔8例 ,胸膜 3例。病例选择标准 :肺 ,胸膜病灶最大径小于 /等于 3 cm,或胸片不能显示或显示不清 ,或近肺门大血管距离小于 /等于 1cm者 ;纵隔病灶。结果 :52例穿刺 ,病灶刺中率 1 0 0 %。其中恶性肿瘤 30例 ,恶性病变诊断敏感性 86.7% ,特异性 1 0 0 % ,准确性 92 .3% ,总的穿刺准确率 88.5%。并发气胸 1 5例 (2 9.9% )。结论 :(1 )精确的定位及穿刺过程是活检成功的关键 ;(2 )除不能合作者外 ,CT导向经胸穿刺技术可用于几乎所有胸部病灶的活检 ;(3)对恶性肿瘤诊断敏感性 ,特异性及准确性高 ,具有重要临床意义     

CT透视引导下的纵隔小病灶穿刺活检的临床价值

目的探讨CT引导下纵隔小病灶穿刺活检技术及诊断价值。方法42例纵隔小病灶(小于3cm)在CT引导下采用自动切割式活检针穿刺活检。结果42例纵隔肿块穿刺活检病灶取材成功率97.65(41/42)。纵隔肿块穿刺活检的诊断准确率92.3%(39/42),对于恶性病变诊断准确率96.3%(26/ 27),良性病变为86.7%(13/15)。并发气胸2例(4.8%),纵隔少量出血1例(2.3%)。结论CT引导下穿刺活检是安全、有效的诊断手段,对于纵隔病变诊断的准确率高,CT引导下纵隔小病灶穿刺活检对纵隔病变的诊断和治疗具有重要意义。     

CT导引下的纵隔病变穿刺活检

目的探讨CT导引纵隔病变穿刺活检技术及其临床意义。方法35例纵隔病变在CT导引下行穿刺活检。结果35例纵隔病变穿刺活检病灶成功率100%。诊断准确率94.2%(33/35),其中恶性病变诊断准确率100%(21/21),良性病变为85.7%(11/14)。并发气胸3例(8.6%),纵隔出血1例(2.9%)。结论CT导引下穿刺活检术对于纵隔病变诊断的正确率高,对纵隔病变的诊治具有很大的帮助。     

CT引导穿刺治疗骨盆病变的临床分析

目的 CT引导下穿刺活检在骨盆病变精准医疗中的诊断价值。方法分析我院CT引导下骨盆穿刺活检病例86例临床资料,对其成功率、准确性及后续诊治情况进行随访。结果 86例穿刺病例中,穿刺成功率为98.8%(85/86),穿刺活检阳性率为96.5%(83/86)。穿刺活检在鉴别病变是否为恶性方面的敏感性、特异性、准确率、阳性预测值、阴性预测值分别为82.80%、100%、90.60%、100%、76.3%;溶骨性骨质破坏59例,成骨性骨质破坏11例,混合性骨质破坏16例,溶骨性病灶与非溶骨性病灶穿刺活检准确率无明显差异(χ~2=2.35,P=0.13);1例非霍其金淋巴瘤患者,术后穿刺针道区域出现少许血肿;45例接受了手术治疗,41例行包括放疗、化疗、抗痨、抗炎等在内的非手术治疗。结论 CT引导下穿刺骨盆病变活检是诊断准确率高、损伤小的微创检查,为临床精准治疗提供可靠依据。     

腮腺病变的CT评价

目的　探讨CT对腮腺疾病的诊断价值。方法　回顾性分析 66例经病理及临床证实的腮腺病变的CT表现。结果　 62例 (94% )表现为腮腺内肿块影 ,4例 (6% )表现为腮腺弥漫性肿大。边缘清楚者 5 0例 (76% ) ,边缘不清者 16例 (2 4% )。CT诊断腮腺肿瘤的敏感性为 96% ,特异性为 5 4% ,准确性为 89% ;阳性预测值为 91% ,阴性预测值为 75 %。以病灶边缘模糊不清作为判断恶性肿瘤的预测指标 ,敏感性为 91% ,特异性为 89% ,准确性为 89% ;阳性预测值为 62 % ,阴性预测值为 98%。结论　CT易于显示腮腺内的病变 ,并能准确地定位。但对于良性肿瘤和非肿瘤性疾病的鉴别有限度 ,病灶边缘模糊不清是诊断恶性肿瘤的一个重要征象     

CT引导下经皮穿刺活检对纵隔占位病变的诊断价值

目的评价CT引导下经皮穿刺活检术在纵隔占位病变中的应用价值和安全性。方法采用弹簧式自动活检枪,在CT精确定位下对纵隔内占位病变行经皮穿刺活检,所获标本送病理组织学检查,并对穿刺准确性、病理确诊率和并发症发生情况进行分析。结果本组33例病灶穿刺成功率100%,病理确诊率85%,无一例发生并发症。结论CT引导下经皮穿刺活检术是一项操作方便,定位精确,穿刺准确率和病理确诊率高,安全可靠的介入放射诊断技术,对纵隔占位病变的定性诊断很有价值,值得临床推广应用。     

CT-guided percutaneous transthoracic biopsy in the diagnosis of mediastinal masses: evaluation of 73 procedures

PURPOSE: This study was performed to evaluate the factors affecting the diagnostic accuracy and rate of complications of CT-guided percutaneous transthoracic needle biopsy of mediastinal masses. MATERIALS AND METHODS: We reviewed 73 consecutive mediastinal biopsies in 70 patients. Final diagnoses were based on a retrospective analysis of surgical outcomes, results of repeat biopsies or findings of imaging and clinical follow-up lasting at least 4 months. Benign and malignant biopsy findings were compared with the final outcomes to determine the diagnostic accuracy of the method. Finally, we analysed the complications. RESULTS: CT-guided percutaneous transthoracic needle biopsy provided adequate samples in 61/73 cases, with a total sample rate of 83.6%. Of these 61 biopsies, 51 yielded a correct diagnosis with specific histological typing, mainly in the case of thymoma and metastasis. Lymphomas were less reliably diagnosed. The overall sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy values were 83.6%, 100%, 100%, 35.3% and 83.6%, respectively. Pneumothorax was the most common complication (5.5%). CONCLUSIONS: CT-guided percutaneous transthoracic needle biopsy is an easy, reliable and safe procedure that obviates the need for exploratory surgery in medically treatable or unresectable cases. It should be the first invasive procedure in the diagnostic workup of mediastinal masses.     

320例胸部病变CT引导经皮穿刺活检总结

目的：评价CT引导经皮胸部穿刺术的诊断价值和并发症。材料和方法：收集资料完整的320例CT引导胸部穿刺活检病例作回顾性分析。肺部病变267例,纵隔病变30例,胸壁和胸膜病变23例。统计敏感性、特异性、准确性和并发症,并分析其影响因素。结果：191例穿刺确诊为恶性肿瘤。穿刺未发现癌细胞者129例,后经手术和随访证实其中属特征性阴性结果者58例,非特征性阴性结果46例,假阴性25例。未见假阳性,阳性预测值为100％（191／191）,敏感性为88．4％（191／216）,特异性为80．6％（104／129）,准确性为92．2％（295／320）,假阴性率为19．4％（25／129）。29例发生气胸,占9．1％（29／320）,但仅1．6％（5／320）需要引流处理。肺出血12例,咯血12例,纵隔血肿8例,均为少量,不需处理。结论：CT引导经皮胸部穿刺是敏感性高和安全的定性诊断方法,降低假阴性是进一步提高准确性的关键。     

CT-guided automated cutting needle biopsy by a combined method for accurate specific diagnosis of focal lung lesions

PURPOSE: The purpose of our study was to evaluate a method of automated cutting needle biopsy (ACNB) that combines the use of a long-throw needle, higher mean number of needle passes, and tandem system, in terms of the accuracy of specific diagnosis of small and large lung lesions and the safety of the procedure. MATERIALS AND METHODS: Fifty-seven ACNBs were performed under computed tomography guidance using a tandem system with a 20-gauge and 18-gauge (through non-aerated lung) automated cutting needle with a throw length of 23 mm. We classified the nodules into 21 small nodules (< or =2 cm) and 36 large nodules (>2 cm). All ACNB diagnoses were divided into three groups: specific, non-specific, and false diagnoses. All of the complications were recorded. RESULTS: The mean number of ACNB specimens obtained was 2.0. Of the 35 ACNB procedures for malignant lesions, 33 yielded a specific malignant diagnosis (33/35, 94%). Of the 22 procedures for benign lesions, 17 gave a specific benign diagnosis (17/22, 77%). The diagnostic accuracy for small nodules was no lower than that for large nodules. Postbiopsy pneumothorax occurred in 18 patients (32%). CONCLUSION: The diagnostic accuracy of the combined method is as high for small lung nodules as for large ones. The procedure has high diagnostic accuracy for the subtypes of lung cancer and an acceptable complication rate.     

A comparative study of 2D and 3D ultrasonography for evaluation of solid breast masses

OBJECTIVE: To compare image quality and diagnostic accuracy of 2D with 3D ultrasonography in solid breast masses. METHODS AND MATERIAL: To rate image quality, two radiologists compared lesion contrast and characterization of 507 solid breast masses in 2D and 3D ultrasonography and then graded the 3D imaging in 3-point scale. To characterize the masses, the same radiologists rated the examination for clarity of margin, posterior acoustic feature, and clustered microcalcifications within a mass. In addition, the masses were assigned BI-RADS categories as proposed by the American College of Radiology, criteria using just ultrasonographic features. In the 202 pathologically confirmed cases, sensitivity, specificity, positive predictive value, negative predictive value, and false negative rate for diagnosis of breast cancer in 2D and 3D ultrasonography were assessed. Image quality and diagnostic accuracy were further evaluated according to the size of the masses. RESULTS: Two observers rated 3D imaging superior to 2D imaging in terms of lesion contrast and characterization of the masses. Especially, superiority of 3D ultrasonography in terms of image quality was increasing in more than 10 mm sized masses. However, diagnostic accuracy including sensitivity, specificity, positive predictive value, negative predictive value, and false negative rate for diagnosis of breast cancer of 3D imaging was not different from 2D imaging. CONCLUSION: In spite of superior image quality on 3D ultrasonography, it does not provide additional benefits to diagnostic accuracy for diagnosis of breast cancer.     

使用切割针行经皮纵隔肿块穿刺活检术

探讨ＣＴ引导下使用切割针行经皮纵隔肿块穿刺活检术的临床价值。材料和方法：对３２例纵隔肿块,使用１６～１９Ｇ切割针在ＣＴ引导下施行穿刺活检术,分别进行细胞学和组织学检查。结果：诊断准确性为９３．８％,假阴性率６．１％。并发症包括气胸（３例）、肺内出血（５例）、纵隔内出血（３例）,其发生与穿刺路径有关;总体发生率为３４．４％（１１／３２）,均无需特殊处理。结论：ＣＴ引导下经眼纵隔肿块切割活检术诊断准确     

Role of diffusion-weighted imaging in the differential diagnosis of benign and malignant lesions of the chest-mediastinum

Purpose

We retrospectively evaluated the role of diffusion-weighted imaging (DWI) with fat and background signal suppression in the differential diagnosis of benign and malignant lesions of the chest-mediastinum by calculating the mean apparent diffusion coefficient (ADC) values.

Materials and methods

Thirty-four patients with lung nodules/mediastinal masses underwent magnetic resonance (MR) imaging of the chest with conventional and DWI sequences. All patients had been previously studied with computed tomography (CT). After magnetic resonance (MR) imaging the patients underwent transthoracic CT-guided biopsy or mediastinoscopy. After the histopathological diagnosis had been obtained, the lesions were retrospectively divided into five groups: adenocarcinomas (n=16), squamous cell carcinomas (n=12), chronic pneumonias (n=2), malignant mediastinal tumours (n=2) and typical carcinoids (n=2). We compared ADC values in the different lesion groups using the Mann-Whitney U test.

Results

There were statistically significant differences (p<0.05) between ADC values of benign and malignant lesions. Using an ADC value of 1.25×10^?3 mm²/s as a threshold, we were able to differentiate malignant from benign lesions with 91% diagnostic accuracy, 90% sensitivity, 100% specificity, 100% positive predictive value and 57% negative predictive value.

Conclusions

Short-tau inversion-recovery echo-planar imaging (STIR-EPI) sequences applied to the chest-mediastinum provided potentially useful images for the differential diagnosis of benign and malignant lesions.     

Accuracy of CT in the demonstration of lymph node metastasis in pulmonary carcinoma

The CT, surgical and histological findings were examined of 350 lymph nodes in a perspective study of 50 patients affected with lung cancer. CT accuracy could thus be evaluated in assessing the size of hilar and mediastinal lymph nodes; the incidence of histologically-proven metastases in nodes more/less than 10 cm in diameter could also be determined, together with CT diagnostic accuracy for nodal metastases. Finally, CT capabilities were also evaluated in distinguishing N0 from N1-N2 patients. CT proved to have high negative predictive value and low positive predictive value, which caused the authors to raise the normal threshold value of CT evaluation of the greatest diameter for hilo-mediastinal nodes from 10 to 20 mm.