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1.
张华  郭坚溪  孔健 《介入放射学杂志》2022,31(12):1216-1221
【摘要】 随着低剂量CT(low-dose computed tomography, LDCT)在肺癌筛查运用中的日益普遍,越来越多的肺结节被检出,鉴别其良恶性显得尤为重要,电视胸腔镜手术(video-assisted thoracoscopic surgery, VATS)由于具有创伤小、恢复快等优势,在临床中应用较为广泛,成为肺小结节诊断及治疗的重要手段。VATS术前对肺小结节进行精确定位是手术成功的关键环节,近年来一系列术前辅助定位技术应运而生,包括CT引导、术中超声引导、近红外成像技术及支气管镜下引导。通过在影像系统引导下注入液体材料或金属材料标记,包括亚甲蓝、医用胶、对比剂、带钩金属丝、弹簧圈及肺结节定位针,以方便外科医生能够在术中精准定位病灶并予以切除。然而最佳的定位技术尚无统一标准,本文综述了近年来肺小结节VATS术前定位的各种技术手段,并对各种方法的优点及不足进行分析及总结。  相似文献   

2.
孤立性肺结节(Solitary pulmonary nodules,SPN)是肺内较常见的病变,及时的检测与诊断SPN的良恶性有利于早期肺癌的发现。CT有良好的密度分辨率,可以很好地显示肺结节特征。本文叙述了计算机辅助诊断在CT诊断肺内孤立结节的研究进展。  相似文献   

3.
计算机辅助诊断在肺结节中的应用进展   总被引:3,自引:0,他引:3  
随着影像学肺癌筛查计划的研究进展,有关计算机辅助诊断(CAD)在肺结节中的应用受到越来越广泛的关注。目前计算机辅助分析系统的应用主要集中在2个方面:即在胸部X线片或CT模式上检测结节和鉴别结节的良恶性。笔者搜集CAD在肺结节中应用的报道,综述如下。  相似文献   

4.
近些年,随着低剂量计算机断层扫描(low-dose computed tomography,LDCT)的广泛应用,肺癌早期检出率大幅提升,如何有效鉴别肺结节良恶性成为肺癌早期诊断的关键问题之一,尤其是直径<10 mm的肺小结节。液体活检以其标本易于获得、可重复检测和非侵入性的特点有望与其它技术成为肺癌早期联合诊断的手段。microRNA作为液体活检的重要成员,在鉴别肺小结节良恶性方面可发挥重要作用。在此,本文对近年来关于microRNA在肺癌早期诊断及预后判断中相关研究进行了综述,以期为进一步研究microRNA参与多层次、多维度肺小结节鉴别诊断提供参考。  相似文献   

5.
【摘要】目的:探讨CT引导下微弹簧圈定位技术在肺磨玻璃结节胸腔镜外科手术中的应用价值。方法:15例肺磨玻璃结节患者采用CT引导下微弹簧圈定位技术辅助胸腔镜外科手术,回顾性分析所有患者的术前定位、手术过程及病理诊断等临床资料。结果:15例患者均于胸腔镜外科手术前行CT引导下行微弹簧圈定位,平均操作时间(16.54±1.84)min,无严重并发症发生;12例患者行肺楔形切除+肺叶切除术,3例行肺叶楔形切除术,平均手术时间(87.46±7.38)min;术后病理结果:14例为肺腺癌,1例为非典型腺瘤样增生。结论:CT引导下微弹簧圈定位技术可实现对肺磨玻璃结节的快速、准确定位。  相似文献   

6.
目的:探讨肺内孤立结节球形状棘突CT征对周围型肺癌的诊断与鉴别诊断价值。方法:47例经临床手术病理和抗炎治疗后证实的孤立型肺结节中,周围型肺癌32例,肺良性病变15例。所有病例从肺尖至肺底扫描,层厚8mm,依病灶大小,加扫薄层4mm,部分病例(35例)经肘静脉注射对比剂对病灶行增强薄层扫描。对棘突CT征与周围肺癌CT表现的病理基础及鉴别诊断进行了讨论。结果:周围型肺癌的棘突CT征发生率为66%(21/32),比其它肺良性病变20%(3/15)高。结论:肺内孤立结节灶棘突CT征对周围型肺癌的诊断与鉴别诊断具有重要价值,是诊断肺癌的一个指征。  相似文献   

7.
支气管肺癌的影像诊断   总被引:19,自引:1,他引:18  
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。  相似文献   

8.
韩仙俊 《放射学实践》2019,34(2):216-219
【摘要】亚实性结节即磨玻璃密度结节(GGN)作为一个非特异性征象,可以出现在非典型腺瘤样增生(AAH)、原位腺癌(AIS)、腺癌和良性病变(如炎症、局部纤维化、局灶性肺出血)等多种病理状态下。GGN的良恶性鉴别诊断主要依靠其生长特性、密度、形态特征和影像组学技术等。计算机辅助诊断(CAD)已初步应用于肺结节良恶性的判别。本文对GGN的相关研究及CAD进展进行综述。  相似文献   

9.
CT三维体积测量技术在孤立性肺结节诊断中的初步应用   总被引:3,自引:0,他引:3  
孤立性肺结节(solitary pulmonary nodule,SPN)的诊断一直是胸部CT最富挑战性的难题。确定孤立性肺结节的良恶性与病人的临床处理紧密相关。CT三维体积测量(three-dimensional volumetric measurement)作为一种计算机辅助诊断(computer-aided diagnosis,CAD)技术,有助于结节的定性诊断,现已初步应用于临床。本文介绍了孤立性肺结节的倍增时间、CT三维体积测量技术及该技术在孤立性肺结节诊断中的初步应用。  相似文献   

10.
肺结节CT影像评价   总被引:73,自引:5,他引:68  
肺结节的鉴别诊断是肺部疾病诊断难点之一,如何有效地显示其特征是准确诊断的前提。用于肺结节检查的CT应用技术有多种,关键是薄层,特别以靶扫描技术最佳。应该主要从三方面显示肺结节的特征:(1)内部特征,包括形态、密度等;(2)结节-肺界面;(3)邻近结构改变。肺结节中以肺癌诊断最重要,肺癌的重要征象有分叶、毛刺和胸膜凹陷征等,动态增强扫描有其特征的时间-密度曲线。其他病变也各有其特点。  相似文献   

11.
笔者报道了1例行18F-氟脱氧葡萄糖(FDG)PET/CT显像的双肺多发结节性淀粉样变病例,分别从临床症状、影像学表现及病理诊断等方面分析了该病的特点,并通过文献复习加深了对肺淀粉样变的认知。结节性肺淀粉样变的发病率低,临床症状不典型,与常见的肺内肿瘤鉴别困难,临床鉴别肺结节时应考虑该病的可能。因此,18F-FDG PET/CT显像对双肺多发结节性淀粉样变病变范围的评估至关重要。  相似文献   

12.
Pulmonary embolism is the most frequent diagnosis for a filling defect in the pulmonary artery, but a tumor in the arteriae pulmonalis should be contained in the differential diagnosis. Primary pulmonary artery myxoma is extremely rare, and only a few cases have been reported. The early diagnosis of this disease is difficult, but it is feasible with modern radiographic methods, which play an important role in the presentation of the origin and extension of the tumor. Here, we review one case with computed tomographic (CT) and pulmonary CT angiographic findings to emphasize the significance of the imaging method in its diagnosis.  相似文献   

13.
CT angiography for diagnosis of pulmonary embolism: state of the art   总被引:46,自引:0,他引:46  
Schoepf UJ  Costello P 《Radiology》2004,230(2):329-337
In daily clinical routine, computed tomography (CT) has practically become the first-line modality for imaging of pulmonary circulation in patients suspected of having pulmonary embolism (PE). However, limitations regarding accurate diagnosis of small peripheral emboli have so far prevented unanimous acceptance of CT as the reference standard for imaging of PE. The development of multi-detector row CT has led to improved visualization of peripheral pulmonary arteries and detection of small emboli. The finding of a small isolated clot at pulmonary CT angiography, however, may be increasingly difficult to correlate with results of other imaging modalities, and the clinical importance of such findings is uncertain. Therefore, the most realistic scenario to measure efficacy of pulmonary CT angiography when PE is suspected may be assessment of patient outcome. Meanwhile, the high negative predictive value of a normal pulmonary CT angiographic study and its association with beneficial patient outcome has been demonstrated. While the introduction of multi-detector row technology has improved CT diagnosis of PE, it has also challenged its users to develop strategies for optimized contrast material delivery, reduction of radiation dose, and management of large-volume data sets created at those examinations.  相似文献   

14.
肺结节的影像学研究进展   总被引:1,自引:0,他引:1  
肺结节是胸部的常见病变,也是近年来研究的热点和难点,随着现代医学影像学技术的发展,大大提高了肺结节的检出及定性诊断率。本文综述了传统X线检查、CT检查、MRI检查及PET成像技术诊断肺结节的优缺点,其中多层螺旋CT具有一定的优势。  相似文献   

15.
目的 探讨 16层螺旋CT与核素肺灌注 /通气显像对急性肺动脉栓塞的诊断价值。方法 回顾 3 2例临床确诊的肺动脉栓塞病人的影像资料 (螺旋CT平扫加增强扫描 ,核素肺灌注 /通气显像扫描 ) ,进行对比分析。结果 螺旋CT增强检查的病变检出率为 90 .6% ,段级肺动脉栓塞受累率为 43 .2 % ,核素肺灌注 /通气显像检查病变检出率为 84.4% ,肺段栓塞受累率为 3 6.8%。结论 螺旋CT增强检查是观察肺动脉栓塞直接征象的理想方法 ,与核素肺显像相结合 ,更能全面分析病情。  相似文献   

16.
纵膈病变是临床常见病变之一,其仅凭影像学诊断很难定性,临床难以确诊,患者得到最佳治疗的可能性降低。影像导引经皮纵膈肿块定位更精确,提高了穿刺诊断技术,有效地减少了损伤和并发症。尽管X线透视引导穿刺方便可行并且得到了广泛的认可,但是利用超声(US)、计算机断层成像(CT)及磁共振成像(MRI)这样的影像导引手段可以明显提高疾病的诊断率,尤其是用于高危患者。磁共振成像的卓越软组织分辨率对人体的深部组织结构行经皮手术非常有用,比如纵膈病变穿刺诊疗技术的开展。  相似文献   

17.
PURPOSE: We investigated the role of Helical Computed Tomography (CT) as primary screening imaging modality in the diagnosis of pulmonary embolic disease. MATERIAL AND METHODS: We retrospectively reviewed the CT examinations, resulted positive for pulmonary embolism, performed in 134 patients (69 men and 65 women, ranging in age 23-83 years) from June 1998 to June 1999. CT was performed with a helical unit (thickness 3 mm, reconstruction interval 2 mm, pitch 1.5) after intravenous contrast agent (120 mL) rapid infusion (4 mL/s, 15s acquisition delay from bolus starting) and using a power injector. The spiral acquisition was performed from the apex of the pulmonary trunk to the diaphragm. Pulmonary embolism was considered as complete when a filling defect was present in a main pulmonary artery, as moderate when a filling defect was observed in an interlobar pulmonary artery and as very small when a filling defect was identified in a segmental pulmonary artery. RESULTS: Helical CT allowed us to identify the presence of a filling defect in the main pulmonary artery in 60.4% of cases (complete pulmonary embolism), in an interlobar pulmonary artery in 27.6% of cases (moderate pulmonary embolism) and in a segmental pulmonary artery in 11.9% of cases (very small pulmonary embolism). At helical CT study, pulmonary embolus was identified as complete filling defect (92.5% of cases), thromboembolic mass floating freely in the lumen (28.3%) and partial filling defect (19.4%). Pleural effusion and pulmonary infarction were associated in 46.2% and 20.1% respectively. DISCUSSION AND CONCLUSIONS: Pulmonary embolic disease continues to be a major cause of morbidity and mortality. The clinical diagnosis of pulmonary embolism remains an important challenge: among the different imaging modalities, contrast-enhanced helical CT can be used as primary screening imaging modality in the diagnosis of pulmonary embolism, allowing us to detect the presence of pulmonary embolus in the main, lobar and segmental artery, as demonstrated in our experience.  相似文献   

18.
Pulmonary artery sarcoma is an uncommon and highly malignant neoplasm that presents a diagnostic challenge to radiologists due to its tendency to mimic the more common condition of pulmonary thromboembolism. Presented in this case report is a patient with pulmonary artery sarcoma who was initially diagnosed with saddle pulmonary embolism based upon computed tomography (CT) findings. The case emphasizes the importance of including pulmonary artery sarcoma in the differential diagnosis of a large filling defect in the pulmonary arteries when specific CT findings are identified in the appropriate clinical setting.  相似文献   

19.
结节病是一种多器官受累的系统性疾病,以肺和胸部淋巴结受累最常见。其临床表现多样,缺乏特异性。病理表现为淋巴细胞、单核-巨噬细胞集聚,以及非干酪样坏死性上皮细胞肉芽肿形成。影像检查方法常为多层螺旋CT及PET/CT。仅依靠临床表现,肺结节病的诊断准确度为33%~42%,如辅以胸部X线检查可以提高至52%~76%,而结合高分辨力CT则能达到78%~80%。结节病诊断十分困难,且易误诊误治,因此明确诊断需要临床、病理及影像方法的结合。  相似文献   

20.
CT imaging in acute pulmonary embolism: diagnostic strategies   总被引:3,自引:0,他引:3  
Computed tomography pulmonary angiography (CTA) has increasingly become accepted as a widely available, safe, cost-effective, and accurate method for a quick and comprehensive diagnosis of acute pulmonary embolism (PE). Pulmonary catheter angiography is still considered the gold standard and final imaging method in many diagnostic algorithms. However, spiral CTA has become established as the first imaging test in clinical routine due to its high negative predictive value for clinically relevant PE. Despite the direct visualization of clot material, depiction of cardiac and pulmonary function in combination with the quantification of pulmonary obstruction helps to grade the severity of PE for further risk stratification and to monitor the effect of thrombolytic therapy. Because PE and deep venous thrombosis are two different aspects of the same disease, additional indirect CT venography may be a valuable addition to the initial diagnostic algorithm—if this was positive for PE—and demonstration of the extent and localization of deep venous thrombosis has an impact on clinical management. Additional and alternate diagnoses add to the usefulness of this method. Using advanced multislice spiral CT technology, some practitioners have advocated CTA as the sole imaging tool for routine clinical assessment in suspected acute PE. This will simplify standards of practice in the near future.  相似文献   

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