肺结节周围血管集中征在小肺癌诊断中的价值

目的：探讨肺结节周围血管集中征的ＣＴ表现及病理机制。材料和方法：对４５例孤立性肺结节进行３ｍｍ以下的薄层ＣＴ扫描，病灶局部放大并采用适当的窗宽、窗位技术。结果：显示肺血管集中征２２例，其中良性结节２例，小肺癌２０例。结论：肺血管集中征对诊断周围型小肺癌具有重要的临床价值，ＣＴ薄层扫描有助于肺内良恶性病灶的诊断与鉴别诊断。     

肺内球形灶棘突CT征与病理对照研究

目的 探讨肺内球形灶棘突CT征的病理基础及诊断价值。资料与方法 选择27例肺内棘突CT征进行病理对照研究，病灶大小为3－6cm。全部病例均经肘静脉注射对比剂后，从肺尖至肺底扫描，层厚10mm，依病灶大小，加扫薄层3－5mm。手术标本按Heitzman法制作。根据CT横断扫描特点，将标本病灶部分进行横断，作0.5-1.0cm厚组织切片，然后对“兴趣区”取材作石蜡切片，HE染色，光镜观察，进行病理对照。结果 27例棘突CT征分为两型：（1）中央型，13例；（2）周围型，14例。其中22例为肺癌，1例为转移性肺癌，4例为良性病变。结论 肺内球形灶棘突CT征对肺恶性肿瘤有重要诊断价值。     

肺血管集聚征在小肺癌CT诊断中的价值

目的 :探讨肺血管集聚征在小肺癌CT诊断中的价值。方法 :对 43例 2cm内的孤立性肺结节行CT薄层扫描 ,病灶局部放大 ,观察肺结节与血管的关系。结果 :43例中显示血管集聚征 2 4例 ,其中良性结节 3例 ,小肺癌 2 1例。结论 :肺血管集聚征在小肺癌CT诊断中具有重要的参考价值 ,CT薄层扫描有助于肺内良恶性病灶的诊断与鉴别     

周围型肺癌与支气管关系的HRCT研究

目的：探讨支气管薄层高分辨率CT(HRCT)扫描的表现对周围型肺癌的诊断和鉴别诊断价值。方法：回顾性分了经临床手术病理证实的37例周围型肺癌与23例其它孤立性良性病变的支气管HRCT表现及其相关因素。结果：周围型肺癌的支气管HRCT表现有一定特征性，与病灶的良恶性程度及病灶大小有关，而与病灶部位无关。结论：孤立性病灶周围支气管HRCT表现，对周围型肺癌的诊断与鉴别诊断有一定帮助。     

CT增强扫描高密度点条征在周围型肺癌诊断中的意义

目的 采用CT增强扫描评价“高密度点条征”在周围型肺癌诊断中的意义。材料与方法 89例经手术或穿刺病理证实的孤立性肺结节（直径1－5cm)中,周围型肺癌63例,良性肺结节26例,分别于注射100ml碘对比剂前后注射后35秒、2分钟及5分钟对病灶进行薄层系列扫描。采用纵隔窗观察病灶的强化特征,并进行CT－病理对照研究。结果 27肺癌出现“高密度点条征”,表现为增强后在肿块内、尤其是在其周边部出现显著高密度的点、条状影、所有良性结节均未见此征象。CT－病理对照证实：该点、条状高密度影响是由于癌肿内较大的血管充盈对比剂所致。结论 CT增强扫描“高密度点条征”在周围型肺癌的诊断中具有非常重要的价值,是诊断肺癌的一个指征。     

孤立性肺结节CT诊断的评价（附54例分析）

目的：探讨孤立性肺结节的CT表现及诊断。方法：对54例3．0cm以下的孤立性肺结节CT表现进行回顾性分析,其中恶性肿瘤30例,良性病变24例。CT常规扫描加病灶薄层扫描28例,常规扫描后行病灶区HRCT26例,增强扫描4例。结果：26例行HRCT扫描者术前显示病灶特征性改变,并作出正确诊断者22例（84．6％）,病灶局部薄层扫描术前诊断正确者15例（57．6％）,3例恶性肿瘤及1例良性肿瘤增强扫描均显示明显强化。结论：HRCT对肺癌及限局性机化性肺炎的鉴别诊断有较高价值,对孤立性肺结节以HRCT结合增强扫描并综合分析CT表现有助于提高定性诊断。     

CT靶扫描在孤立性肺结节诊断中的价值探讨

目的评估CT靶扫描对孤立性肺结节的诊断价值。方法经胸部平片或普通CT平扫发现肺内孤立结节的21例患者，病灶直径最小5mm，最大2.9Cm，平均2．1Cm。采用2mm层厚，2mm层距，骨重建法，以病灶为中心进行CT靶扫描。结果经病理与随访证实，周围型肺癌11例（CT报告10例，良性肿瘤1例），浸润性肺结核5例1例为周围型肺癌，球形肺炎3例（CT报告2例，其中1例误报为良性肺肿瘤）球形肺不张1例。结论CT靶扫描能提高肺内孤立性结节病灶的诊断准确率。     

血管集中征对周围型肺癌的诊断价值

目的探讨血管集中征对周围型肺癌的诊断与鉴别诊断价值。方法 对６９例周围型肺癌和２０例其他孤立肺结节行闭注增强薄层ＣＴ扫描,对血管集中征与周围型肺癌ＣＴ表现的病理基础,不同组织学类型及鉴别诊断进行了讨论。结果 周围型肺癌的血管集中发生率为６７％（４６／６９）比其他孤立肺结节（１０％,２／２０）高。结论 血管集中征对周围型肺癌诊断与鉴别诊断很有帮助。     

毛刺征在CT诊断周围型小肺癌中的价值

目的:探讨周围型小肺癌(SPLC)毛刺的CT表现、诊断价值及多平面重建(MPR)的检出作用。材料和方法:分析经手术或穿刺病理证实的135例SPLC及65例良性孤立性肺结节。统计CT边缘有毛刺征结节的例数,以宽度2mm为界将毛刺分为粗或细毛刺,以长度5mm为界分为长或短毛刺。对22例SPLC及15例良性结节进行MPR,并与横断薄层扫描对比分析。结果:细短毛刺明显多见于SPLC,敏感性为25.9%,特异性为98.5%,准确性为49.5%,阳性预测值(PPV)为97.2%。MPR对毛刺征的检出率高于横断薄层图像。结论:毛刺征对SPLC的诊断和鉴别诊断具有较高价值。     

孤立性肺结节的CT征象(附65例分析)

目的分析孤立性肺结节的CT影像学特征,及早诊断恶性结节。方法搜集经临床治疗后观察证实或病理证实的65例孤立性肺结节,其中恶性结节35例(周围型肺癌);良性结节30例(结核球18例,炎性结节10例,错构瘤2例)。所有病例行常规CT扫描,并对部分结节病灶进行HRCT检查。结果典型结节并具有深分叶征,毛刺征,小泡征,含气支气管征,胸膜凹陷征,血管集束征对恶性结节的诊断具有较高价值。结论CT,特别是HRCT对孤立性肺结节的定性诊断具有十分重要的作用。     

多层螺旋CT对肺动脉栓塞的诊断价值

目的:评价多层螺旋CT对急性肺动脉栓塞的诊断价值。方法:22例临床确诊的肺动脉栓塞患者,先行螺旋CT平扫,后经肘静脉注入碘海醇100 ml,延迟15~20 s和25~30 s行两次扫描。结果:平扫的间接征象:肺纹理稀疏11例,肺梗死灶形成9例,肺动脉高压2例,胸膜肥厚3例,胸腔积液8例。增强后的直接征象:充盈缺损(附壁性32支,部分性30支,完全性92支和中心性即轨道征15支)和动脉面细小14支。结论:螺旋CT肺动脉造影是急性肺动脉栓塞安全、迅速、无创伤的有效诊断方法。     

Thin-section CT features of intrapulmonary lymph nodes

PURPOSE: The objective of this study was to evaluate CT findings of pathologically proven intrapulmonary lymph nodes (IPLNs) and discuss the utility of thin-section CT and contrast-enhanced CT. METHOD: CT findings of 18 nodules in 14 patients with pathologically proven IPLNs were reviewed. CT scanning of the whole lung was performed contiguously with slice thickness of 10 mm. In addition, a helical scan with slice thickness of 2 mm was performed in nine patients, focusing on the nodule. Contrast-enhanced helical CT was performed in four patients, and the utility of thin section CT and contrast-enhanced CT was investigated. RESULTS: One patient had three nodules, 2 patients had two nodules, and the remaining 11 patients had a solitary nodule. All nodules were located below the level of the carina and within 15 mm of the pleura. In one case, conventional CT revealed the nodule 20 mm away from the pleura; however, the nodule attached to the major fissure was clearly revealed on thin-section CT. The size of the nodules was < or =15 mm, and the shape was round (n = 8), oval (n = 9), or lobulated (n = 1) with sharp border. One nodule demonstrated a spiculated border due to a surrounding pulmonary fibrosis on conventional CT; however, thin-section CT showed precisely a sharp border. The lobulated shape of one case histopathologically reflected a hilus of lymph node. On contrast-enhanced helical CT, all four nodules were enhanced and the degree enhancement was 36-85 HU (median 66.6 HU). CONCLUSION: In current times, IPLNs are not uncommon lesions. We should consider IPLN in the differential diagnosis of solitary or multiple pulmonary nodules in the peripheral field and below the level of the carina. Thin-section CT showed precisely the border or relation between IPLNs and the surrounding structure. It was difficult to distinguish between IPLNs and malignant nodules from the degree of enhancement on contrast-enhanced CT. On thin-section and contrast-enhanced CT, the findings of IPLNs are not necessarily specific. Therefore, strict observation on CT is necessary; in certain cases that are increasing in size, video-assisted thoracic surgery should be considered because of their location.     

肺曲菌病的CT影像诊断

目的：探讨肺曲菌病的CT表现和诊断价值。方法：本组病例6例,分别经手术病理和治疗随访证实,男性3例,女性3例,年龄32~60岁。5例有轻重不一的发热、咳嗽、胸痛、铁锈色痰或血丝痰,1例无任何症状和体征。采用SIEMENS SENSATION 16层螺旋CT,6例均行CT平扫。肺窗：WW1500HU,WC-500HU;纵隔窗：WW400HU,WC40HU。4例加行多方位图像重建（MPR）。结果：病灶位于右肺2例,左肺4例。2例表现为孤立性实质性结节,直径10 mm-37 mm,类圆形,边缘可见棘突及＂晕影＂。4例为空洞性结节,直径15 mm~87 mm,其中2例具有＂新月＂征,2例具有＂滚珠＂征。结论：肺曲菌病早期影像表现缺乏特征性,当病变局限形成曲菌球,尤其具备＂新月征＂和＂滚珠征＂时,才是CT诊断的可靠依据。     

周围型小细胞肺癌的CT征象分析

目的 探讨周围型小细胞肺癌(SCLC)的CT征象.方法 回顾分析78例经病理证实的周围型SCLC的CT影像特点.根据有无纵隔淋巴结转移及其大小,将78例周围型SCLC分为2型:Ⅰ型孤立病灶型、Ⅱ型肺内病灶+淋巴结型;又将Ⅱ型分为2个亚型:Ⅱa型,肺门、纵隔淋巴结短径<10 mm;Ⅱb型,肺门、纵隔淋巴结短径≥10 mm.结果 Ⅰ型7例,Ⅱ型71例,其中Ⅱa型8例,Ⅱb型63例.78例SCLC均为实性病变;圆形、类圆形52例,纺锤形、蠕虫状9例,其他形状17例.71例行CT增强扫描,9例呈均匀强化,58例呈不均匀强化,4例病灶内见大面积不强化坏死区.边缘光整65例,毛糙12例,模糊1例.支气管充气征3例,空泡征4例,钙化4例.分叶征46例,毛刺征5例;支气管血管束增粗、结节41例,胸膜凹陷6例,边缘磨玻璃影5例,血管集束征1例;肺气肿42例,阻塞性肺炎4例;支气管与结节边缘截断18例.纵隔淋巴结转移63例,纵隔淋巴结大于肺原发灶42例.少量胸腔积液9例.     

CT morphological features of the reversed halo sign in pulmonary paracoccidioidomycosis

Objective:

The purpose of this study was to identify morphological characteristics of the reversed halo sign (RHS) on chest CT in patients with pulmonary paracoccidioidomycosis (PCM) that may aid the diagnosis of this fungal disease.

Methods:

We retrospectively reviewed chest CT images from 23 patients with proven pulmonary PCM who demonstrated the RHS. Two chest radiologists analysed the morphological characteristics of the lesions and reached decisions by consensus.

Results:

We identified 64 RHSs on CT images from the 23 patients. Multiple lesions were observed in all cases, with middle and lower lung zone predominance occurring in 17 patients (73.9% of cases). 34 (53.1%) RHSs were round and 30 (46.9%) were oval. Outer borders of the RHSs were smooth in 32 (50%) lesions, nodular in 16 (25%) lesions and irregular/spiculated in 16 (25%) lesions. Ground-glass opacity was observed inside 63 (98.4%) lesions.

Conclusion:

Our data suggest that morphological characteristics of the RHS on chest CT, such as the presence of multiple lesions, middle and lower lung zone predominance and a spiculated RHS ring, as well as the association with other parenchymal patterns, should lead radiologists to include PCM in the differential diagnosis of PCM in endemic areas.

Advances in knowledge:

This is the largest series of patients with RHS due to PCM and is also the first study to report RHS lesions with spiculated or irregular walls. The study adds information regarding morphological characteristics of the RHS that may raise suspicion of PCM on chest CT, particularly in endemic areas of the disease.     

Crescent sign in invasive pulmonary aspergillosis: frequency and related CT and clinical factors

PURPOSE: The aim of our study was to evaluate the frequency of the crescent sign on follow-up radiographs in patients with invasive pulmonary aspergillosis, correlated with initial CT and clinical findings. METHOD: Retrospective analysis of serial chest radiographs was performed to see the frequency of the crescent sign in 21 consecutive patients with pathologically proved invasive pulmonary aspergillosis. The appearance of the crescent sign was correlated with the pattern of parenchymal lesions on initial CT scans, the presence and duration of neutropenia, and underlying diseases. RESULTS: The crescent sign was seen in 10 of 21 patients (48%) on follow-up radiographic examinations. It was seen in patients with initially large [consolidation or mass; 9/11 (82%) patients] rather than small [nodule(s); 1/10 (10%) patients] parenchymal lesions (p = 0.002) on CT. The sign appeared in 7 of 17 (41%) patients with neutropenia 1-10 days after recovery from neutropenia. It appeared in three of four patients (75%) without neutropenia 4--8 days after treatment with amphotericin B. The appearance was not related to the duration (32 days in patients with crescent sign and 17 days without sign) of the neutropenic period (p > 0.05). The sign was seen in 8 of 15 (53%) patients with acute myelogenous leukemia and 2 of 6 (33%) patients with other diseases (p > 0.05). CONCLUSION: The crescent sign appears in about half of patients with invasive pulmonary aspergillosis with recovery from neutropenia, especially when the initial lesion is a consolidation or mass on CT scans.     

螺旋CT薄层扫描并MPVR重建对孤立性肺结节的诊断价值

目的:探讨螺旋CT肺薄层扫描并多层面重建对孤立性肺结节的诊断价值。方法:对86例SPN患者进行螺旋CT规范化检查,并使用多层面重建(MPVR)技术重建观察。病灶结节直径选在0.8~3.0cm,病历均经临床手术或肺穿刺活检病理证实。其中恶性59例,均为原发性肺癌,包括腺癌25例、鳞癌17例、细支气管肺泡癌10例、小细胞未分化癌7例;良性病变27例,包括结核灶13例、炎性假瘤9例、错构瘤5例。结果:86例SPN的CT征象中,分叶征和棘突或毛刺征多出现于恶性结节,与病理和随访结果对比,螺旋CT薄层扫描并MPVR重建判断肺小结节良恶性的准确率、灵敏度、特异性、阳性预测值和阴性预测值分别为75.6%、76.3%、74.1%、86.5%、58.8%。结论:SCT肺薄层扫描并MPVR重建能显示更多的SPNCT征象,对SPN的良恶性诊断有较高的诊断价值。     

Diagnosis of pulmonary metastases with turbo-SE MR imaging

The sensitivity of MR imaging for detection of pulmonary metastases was evaluated in 23 patients. The MR imaging was performed with T2-weighted turbo-spin-echo (TSE) sequences at 1.5 T. The MR images were compared with spiral volumetric CT which served as the radiological standard. All MR images were interpreted by two radiologists without knowledge of CT findings. The MR imaging technique initially enabled correct identification of altogether 286 of 340 metastases (84 %) resulting in sensitivities of 36 % (size of nodules < 5 mm), 83 % (size of nodules 5–10 mm), 92 % (size of nodules 10–15 mm), and 100 % (size of nodules > 15 mm). Retrospectively with knowledge of CT findings an additional 39 metastases were visible; 15 remained undetected even retrospectly. The results of this paper suggest that MRI still does not have a role for screening for pulmonary metastases. It proves, however, that the incidental diagnosis of a pulmonary lesion on T2-weighted TSE images is highly reliable in representing a pulmonary nodule also visible on CT. However, thus far the malignant nature especially of small nodules detected by MRI (as by CT) remains uncertain even in patients with known malignant neoplasm. Received 20 May 1996; Revision received 15 November 1996; Accepted 25 February 1997