多层螺旋CT在经皮穿刺肺组织活检中的应用价值

目的探讨多层螺旋CT(MSCT)引导下经皮穿刺肺组织活检的技术方法,并评价MSCT在经皮穿刺肺组织活检中的应用价值。资料与方法对42例患者的42个肺部病灶进行MSCT引导下经皮穿刺肺活检。结果42个病灶均成功穿刺(成功率为100%)。肺外周小病灶的一次穿刺成功率为88.2%(15/17),肺门部病灶的一次穿刺成功率为86.7%(13/15)。病理检出40例,诊断成功率和活检准确率均为95.2%。术后并发肺出血2例,发生率为4.8%;气胸2例,发生率为4.8%。结论MSCT引导不仅能提高经皮穿刺肺外周部小病灶和肺门部病灶的技术成功率、诊断成功率和活检准确性,而且能减少并发症的发生。     

CT引导下经皮肺穿刺切割活检的价值及安全性

目的：评价CT引导下经皮肺穿刺活检对肺部疑难疾病的诊断价值及安全性。方法：回顾性分析有手术病理、临床或影像随访结果的CT引导下经皮肺穿刺活检105例,其中97例为肺部局限性病灶（A组）,8例肺部弥漫性病灶（B组）。结果：2组共有101例穿刺物结果与手术病理、临床或影像学随访结果相符：穿刺诊断正确率96．2％。A组穿刺诊断正确率（99．0％）高于B组（62．5％）（P〈0．01）。A组肺癌占79．4％（77／97;B组肺癌占60．0％（3／5）;二组差异无统计学意义（P〉0．05）。两组合计发生气胸24例;出血34例,其中咯血18例。结论：cT引导下经皮肺穿刺切割活检穿刺诊断正确率高,是肺内疑难病变定性诊断的理想方法;使用18G穿刺针,可减少穿刺次数、降低出血的发生。     

同轴凝血退针法在CT引导下经皮肺穿刺活检中的应用

【摘要】 目的 探讨同轴凝血退针法在预防CT引导下经皮肺穿刺活检并发症中的价值及其优缺点。方法 将134例进行CT引导下经皮肺穿刺活检患者分成两组:61例CT引导下经皮肺穿刺活检患者采用常规方法进行穿刺活检为对照组，73例CT引导下经皮肺穿刺活检患者采用同轴凝血退针法进行穿刺活检为研究组。统计并比较两组的术后并发症。 结果 CT引导下经皮肺穿刺活检术中，对照组气胸20例，发生率为32.7%，研究组8例（10.9%），两者差异具有统计学意义（P＜0.05）；对照组15例出血，发生率为24.5%，研究组7例出血，发生率为9.6%，两组差异具有统计学意义（P＜0.05），同轴凝血退针法穿刺并发气胸和出血的概率均低于传统方法。结论 同轴凝血退针法在CT引导下经皮肺穿刺活检应用中优于传统方法，并发症低，具有应用前景，值得推广普及。     

超声引导经皮肺穿刺活检在肺外周型病变诊断中的价值

目的探讨超声引导下经皮肺穿刺活检对肺外周型病变定性诊断的应用价值。方法在超声引导下对80例胸部影像学检查显示的肺周边型肿块需明确诊断者行超声引导下经皮肺穿刺活检术。结果 80例病人均穿刺成功,成功率100%。病理诊断结果:恶性肿瘤64例,其中鳞癌38例,腺癌20例,大细胞癌2例,小细胞癌2例,恶性淋巴瘤1例,恶性间皮瘤1例;良性病变16例,其中良性错构瘤1例,结核8例,炎症7例。并发气胸、咯血各1例,并发症发生率为3%。结论超声引导下经皮肺穿刺活检术具有定位准确、操作简便、安全性好、并发症少及重复性强等优点,可作为肺外周型病变定性诊断的首选诊断方法。     

18F-FDG符合线路SPECT/CT在CT引导下经皮肺穿刺活检中的增益价值

目的 探讨¹⁸F-FDG(氧化脱氧葡萄糖)符合线路SPECT/CT显像在CT引导下经皮肺穿刺活检中的临床增益价值。方法 回顾性分析我院2019年12月至2021年1月期间313例经皮肺穿刺活检的病例,其中研究组为¹⁸F-FDG符合线路SPECT/CT辅助下经皮肺穿刺活检术病例105例,对照组为单纯CT引导下肺穿刺活检病例208例,比较2组穿刺成功率、诊断效能及并发症的发生率。结果 研究组穿刺成功率为98.1%,诊断灵敏度为97.9%,诊断准确度为98.1%。对照组分别为96.2%、91.4%和90.5%。2组穿刺成功率差异无统计学意义(P>0.05),2组灵敏度和准确度差异有统计学意义(P<0.05);研究组不均匀代谢病变诊断的准确性高于对照组。结论 将¹⁸F-FDG符合线路SPECT/CT图像中代谢活性较高的部位作为穿刺靶点,对提高诊断的敏感性及准确性有较高的临床增益价值,尤其是肺内病变较大、多发病灶和(或)合并肺不张、炎症、坏死、纤维化等情况时。     

超声引导下经皮肺穿刺并发症及相关因素分析

【摘要】 目的 分析超声引导下经皮肺穿刺活检术并发症及其影响因素。方法 2017年6月至2020年1月于超声引导下经皮肺穿刺活检的病例193例,统计并分析并发症的发生与患者的性别、年龄、病灶部位、大小、病理结果、穿刺方式及切割次数的关系。结果 193例中出现并发症的患者共42例（21.8%）。其中气胸14例（7.3%）,咯血14例（7.3%）,胸膜反应12例（6.2%）,穿刺部位疼痛5例（2.6%）。并发症相关因素分析可知:并发症的发生与患者的年龄、病灶部位及病灶大小相关（P＜0.05）。结论 患者的年龄、病灶部位、大小会影响超声引导下经皮肺穿刺活检并发症的发生率。     

超细支气管镜结合经皮肺穿技术在肺外周病变诊断中的价值

目的 评价超细支气管镜结合经皮肺穿技术在肺外周病变诊断中的价值.方法 269例肺外周病变患者均先进行超细支气管镜活检并刷检术,对无阳性结果,且病灶位于肺门、内带或中带的89例患者进行X线引导超细支气管镜肺活检并刷检术;对病灶位于中、外带的77例患者,经X线引导进行经皮肺穿刺针吸活检术;对于超细病灶紧贴胸壁的70例患者经B超引导进行经皮肺自动弹性穿刺切割活检术.结果 269例患者行超细支气管镜肺活检并刷检共276例次,获得诊断者82例,阳性率为30.5%(82/269);89例患者行X线引导超细支气管镜肺活检并刷检94例次,获得诊断者66例,阳性率为74.2%(66/89);77例患者行X线引导经皮肺针吸活检85例次,获得诊断者52例,阳性率为67.5%(52/77);70例患者行B超引导经皮肺自动弹性穿刺切割术79例次,获得诊断者49例,阳性率为70.0%(49/70).4种方法结合后的诊断率(92.6%)明显提高.结论 综合超细支气管镜检查结合经皮肺穿等介入诊断技术,可明显提高肺外周病变的阳性率,值得临床推广应用.     

SCT激光引导下自动活检枪经皮肺穿诊断肺球形病灶的临床应用

目的：观察SCT激光引导下经皮肺活检对诊断肺球形病灶的应用价值。方法：98例肺球形病灶全部在SCT激光引导装置下行自动活检枪经皮细针肺活检，对其穿刺、活检结果评估分级，标本行组织细胞学检查，并将病理结果与手术及随访结果进行对照分析。结果：穿刺精确度分级：Ⅰ级42．9％，Ⅱ级37．8％，Ⅲ级18．3％。活检标本质量分级：Ⅰ级49％，Ⅱ级38．8％，Ⅲ级12．2％。84例首次活检即明确诊断（94．4％），包括57例手术者在内共76例患者经过临床随访，其中72例活检标本病理诊断与手术及跟踪随访结果一致，活检诊断符合率为94．7％。结论：SCT激光引导装置和自动活检枪可显著提高肺穿刺活检的准确性、安全性，尤其对缺乏特征性表现的肺球形病灶的定性诊断更有临床价值。     

C臂CT在肺小结节经皮肺穿刺活检中的临床应用

目的 探讨C臂CT在肺小结节(直径≤3 cm)经皮肺穿刺活检中的应用价值.方法 2010年9月-2012年3月在C臂CT引导下行经皮肺穿刺活检的肺小结节55例,病灶直径1.0 ～ 3.0 cm.术前、术中及术后均行C臂CT扫描.结果 C臂CT引导下经皮肺穿刺活检病理诊断灵敏度86.8％(33/38),特异度100％,无假阳性病例,假阴性率13.2％(5/38);气胸11例(20.0％),2例行闭式引流术;咯血2例(3.6％),无需特殊处理而自愈.结论 C臂CT引导肺结节(≤3 cm)经皮肺穿刺活检术定位准确,能提高肺小结节穿刺阳性率,及时发现术后并发症,是值得推广的一种影像新技术.     

CT引导纤支镜对肺周围病灶活检的价值

通过本方法的研究进一步提高对肺周围病灶的诊断正确率。材料和方法：对４３例肺周围部病灶在ＣＴ引导下经纤维支气管镜活检,共采集５８个部位,钳夹组织１２９块,毛刷涂片９７张。结果：ＣＴ引导纤支镜对肺周围病灶活检的准确性为１００％,特异性为９５．２４％。与Ｘ线定位纤支镜活检及纤支镜盲检均存在高度显著性差异（Ｐ＜０．０１）;并与经皮肺活检间存在显著性差异（Ｐ＜０．０５）。结论：ＣＴ引导下经纤支镜对肺周围部病灶内的准确多点活检,能极大地提高诊断正确率     

123I-IMP clearance of the lung with diffuse lung disease

N-isopropyl-I-123-p-iodoamphetamine (123I-IMP) is taken up by the capillary endothelial cells during the first pulmonary pass and is released from the lung. To evaluate the effect of the 123I-IMP retention on diffuse lung disease, we studied prolonged 123I-IMP clearance from lung in 5 non-smoking control volunteers and 15 patients with various diffuse lung diseases. The time-activity curve for 60 min after the injection of 111 MBq of 123I-IMP was described as follows: C(t) = A1e-k1t + A2e-k1t (A1, A2: intercepts; K1, K2: slopes of the exponential components). 123I-IMP clearance was delayed in the patient group and K2 was significantly lower. There was a significant correlation between K2 and Ga-computer activity index on the 67Ga scintigraphy in the patient group. K2 was also correlated with %Dlco on the pulmonary function test. Our study suggests that the delayed clearance and retention of 123I-IMP in the diseased lung are influenced by the pathological activity in the lung lesion.     

Aspergillus infections of the lung

In this article the three different manifestations of pulmonary aspergillosis are compared with each other: bronchopulmonary aspergillosis, aspergilloma and invasive pulmonary aspergillosis, and their different clinical and radiological manifestations. In particular, invasive pulmonary aspergillosis--being a severe complication in immunosuppressed patients whose defenses are weak--often presents diagnostic problems due to its initially mostly unspecific clinical and radiological signs. The late signs of a pulmonary aspergillus infection, such as formation of a cavern or the manifestation of the "air crescent" sign, however, are seen only when the patient is just beginning to convalesce.     

Contrast-enhanced MRI of the lung

The lung has long been neglected by MR imaging. This is due to unique intrinsic difficulties: (1) signal loss due to cardiac pulsation and respiration; (2) susceptibility artifacts caused by multiple air-tissue interfaces; (3) low proton density. There are many MR strategies to overcome these problems. They consist of breath-hold imaging, respiratory and cardiac gating procedures, use of short repetition and echo times, increase of the relaxivity of existing spins by administration of intravenous contrast agents, and enrichment of spin density by hyperpolarized noble gases or oxygen. Improvements in scanner performance and frequent use of contrast media have increased the interest in MR imaging and MR angiography of the lung. They can be used on a routine basis for the following indications: characterization of pulmonary nodules, staging of bronchogenic carcinoma, in particular assessment of chest wall invasion; evaluation of inflammatory activity in interstitial lung disease; acute pulmonary embolism, chronic thromboembolic pulmonary hypertension, vascular involvement in malignant disease; vascular abnormalities. Future perspectives include perfusion imaging using extracellular or intravascular (blood pool) contrast agents and ventilation imaging using inhalation of hyperpolarized noble gases, of paramagnetic oxygen or of aerosolized contrast agents. These techniques represent new approaches to functional lung imaging. The combination of visualization of morphology and functional assessment of ventilation and perfusion is unequalled by any other technique.     

Quantitative CT of the lung

Lung disease is a leading cause of morbidity and mortality. HRCT, currently the best test to assess lung involvement in emphysema and interstitial lung disease, relies on abnormalities being detected when there is sufficient morphologic distortion to result in visually identified changes that, for the most part, correlate poorly with conventional lung function tests and outcome. QIA offers a technique to assess both structure and function on a regional and global basis. With the advent of user-friendly software packages, this approach is finding application in clinical practice and in clinical studies of new treatment alternatives for diffuse lung disease