肺黏膜相关淋巴组织淋巴瘤的CT诊断

目的 研究肺黏膜相关淋巴组织(MALT)淋巴瘤的CT表现,提高对该病的认识及鉴别诊断能力.方法 回顾性分析经病理证实的12例MALT淋巴瘤的CT表现,影像观察指标为病灶的数量、分布、形态、密度及伴随征象.结果 12例MALT淋巴瘤中共检出肺实变、肺肿块、肺结节、磨玻璃样病灶32个,病灶单发2例,多发10例;多发病例中单肺多发2例,双肺多发8例.肺实变10例共21个病灶,其内均可见支气管充气征,1例2个病灶内见支气管扩张;肺肿块或结节影3例共5个病灶,3个病灶内可见支气管充气征;磨玻璃样改变2例共6个病灶;1例伴纵隔及肺门淋巴结肿大.结论 MALT淋巴瘤CT上常表现为双肺多发、含有支气管充气征的肺实变、肿块、结节样或磨玻璃样改变;上述影像表现及相对缓慢的病变过程提示MALT淋巴瘤的诊断.     

CT Diagnosis of Pulmonary Mucosa Associated Lymphoid Tissue Lymphoma

目的 探讨肺黏膜相关淋巴组织型(MALT)淋巴瘤的CT影像学表现及特征.资料与方法 回顾性分析15例确诊的肺MALT淋巴瘤的CT影像学表现.结果 CT表现为实变12例(80％),团块9例(60％),结节7例(46.7％),斑片影11例(73.3％),磨玻璃影5例(33.3％),支气管血管束增粗6例(40％),支气管充气征8例(53.3％),均合并分布在实变、团块中,间质纤维化1例(6.7％),胸膜改变14例(93.3％),肺门纵隔淋巴结增大4例(26.7％),团块、实变、斑片影合并存在6例(40％).结论 肺MALT淋巴瘤主要表现为实变、团块、结节、斑片影等,多合并存在,实变团块中多见支气管充气征,团块边缘较模糊.病程较长,病灶可以较长时间没有影像学变化.     

肺黏膜相关淋巴组织型淋巴瘤的CT表现分析

目的 探讨肺黏膜相关淋巴组织型(MALT)淋巴瘤的CT表现,提高对该病的认识及诊断水平.方法 回顾性分析13例经手术及病理证实的肺MALT淋巴瘤CT表现.结果 (1)单发病灶4例,多发病灶9例,其中多发实变5例,多发肿块结节合并间质性改变3例,多发磨玻璃影1例;(2)实变影11个病灶,均见扩张“空气支气管征”,3例跨叶分布;结节共41枚,其中分叶34枚,边缘模糊31枚,胸膜下分布27枚,沿支气管血管束分布11枚,“细支气管征”或“空泡征”28枚;肿块9枚,均为分叶状,边缘模糊7枚,“空气支气管征”7枚.结论 肺MALT淋巴瘤常表现为两肺多发实变、结节和肿块,扩张“空气支气管征”对诊断有提示意义;多发分叶状肿块和跨叶分布的实变,多发的胸膜下或沿支气管血管束分布的伴“细支气管征”或“空泡征”的分叶状结节,应考虑MALT淋巴瘤的可能.     

原发性肺黏膜相关淋巴组织淋巴瘤的18F-FDG PET/CT影像学表现

目的 分析原发性肺黏膜相关淋巴组织（MALT）淋巴瘤的18F-FDG PET/CT影像学表现,提高对原发性肺MALT淋巴瘤的认识及诊断能力。 方法 回顾性分析2006年11月至2017年4月经病理确诊的9例原发性肺MALT淋巴瘤患者（男性6例、女性3例,中位年龄59岁）的临床资料及18F-FDG PET/CT显像资料,记录病灶的部位、数量、密度、大小、形态及最大标准化摄取值（SUV_max）,以及纵隔及肺门淋巴结等情况;分析影像信息并同时进行相关文献复习。 结果 9例原发性肺MALT淋巴瘤患者18F-FDG PET/CT表现分为3型:实变型4例、肿块型3例、弥漫肺炎型2例。实变型表现为大小、受累范围不等的实变影;肿块型表现为单发或多发、边缘毛糙的实性肿块影;弥漫肺炎型表现为肺叶内或双肺弥漫的斑片、团块样软组织密度影。在9例患者中可见支气管充气征8例（部分伴有支气管扩张）、三角型灌注征3例、病灶向中心聚拢4例、钙化2例、胸腔积液2例、肺门及纵隔淋巴结肿大2例。所有病灶18F-FDG 代谢不均匀增高,中位SUV_max为6.0（2.6~8.3）;2例弥漫肺炎型纵隔及肺门淋巴结18F-FDG摄取异常增高,SUV_max分别为13.0、4.7。 结论 原发性肺MALT淋巴瘤的18F-FDG PET/CT表现常为斑片状致密影,多见实变影,内部常见支气管充气征,18F-FDG轻度摄取,结合相对缓慢的病程,可考虑为原发性肺MALT淋巴瘤。     

肺黏膜相关淋巴组织淋巴瘤的CT表现

目的探讨肺黏膜相关淋巴组织(MALT)淋巴瘤的CT表现,以提高对本病的认识。方法回顾性分析21例经手术、穿刺活检病理证实的肺黏膜相关淋巴组织淋巴瘤的CT影像表现。结果 21例MALT中,双侧肺分布14例(66.7%),单侧肺病灶7例(33.3%)。病灶形态呈斑片及实变影16例(76.2%),结节形或肿块样4例(19%),弥漫性间质性改变1例(4.8%)。结节状病灶、实变病灶及斑片状病灶内有较粗大的支气管充气征12例,粗大蜂窝状改变2例,MALT病灶边缘较清晰,不规则15例,伴毛刺样改变的5例,胸膜凹陷的3例,伴胸腔积液的4例。结论肺MALT淋巴瘤CT表现多样,可为单发结节影、斑片状影及实变影,亦可弥漫性间质性改变,病灶内常伴有粗大的支气管充气征,病灶周边不规则,伴毛刺及胸膜凹陷改变,上述影像表现要考虑MALT的诊断。     

肺黏膜相关淋巴组织型淋巴瘤的影像表现

目的 探讨肺黏膜相关淋巴组织型(MALT)淋巴瘤CT或18F-脱氧葡萄糖(FDG)PETCT表现及其诊断价值.方法 回顾性分析14例经手术及病理证实的肺MALT淋巴瘤的CT或18F-FDG PET-CT表现特点.结果 单肺病灶7例,双肺病灶7例,其中单发实变影3例,单发肿块影3例,单发结节影1例,多发结节影1例,肿块影合并结节影、斑片状影1例,实变影合并斑片状影4例,弥漫性间质性病变1例.9例有支气管充气征,5例有CT血管造影征.2例FDG代谢不均匀增高,最大标准摄取值超过2.5.结论 肺MALT淋巴瘤的影像特征性表现主要为单发或多发结节、肿块或实变影,内有支气管充气征,18F-FDG高代谢,确诊主要依靠病理组织学和免疫组织化学.

Abstract：

Objective To assess the value of CT or PET-CT with fluorine-18-labeled fluorodeoxyglucose (FDG) for the diagnosis of pulmonary mucosa-associated lymphoid tissue (MALT) type lymphoma. Methods The CT or FDG PET-CT findings in 14 patients with pathologically proved pulmonary MALT lymphoma were retrospectively analyzed. Results Lung lesions were unilateral in 7 patients and bilateral in 7 patients. Lesions presented as a single mass in 3 patients, as a single consolidation in 3 patients, as a nodule in 1 patient, as multiple nodules in 1 patient, as multiple patchy consolidations in 4 patients, as a mass with multiple nodules and patchy consolidations in 1 patients, as diffuse interstitial change in 1 patients. Air bronchogram was found in 9 patients and CT angiogram sign in 5 patients. On PET-CT, lesions showed heterogeneous FDG uptake in 2 patients, maximum standard uptake value was higher than 2. 5. Conclusion Imaging characteristics of pulmonary MALT lymphoma are single or multiple nodules or consolidations with air bronchogram on CT, and heterogeneous high FDG uptake on PET-CT.     

肺黏膜相关淋巴组织型淋巴瘤的CT表现及诊断价值

目的探讨肺黏膜相关淋巴组织型(MALT)淋巴瘤的CT影像学表现及特征。资料与方法回顾性分析15例确诊的肺MALT淋巴瘤的CT影像学表现。结果 CT表现为实变12例(80%),团块9例(60%),结节7例(46.7%),斑片影11例(73.3%),磨玻璃影5例(33.3%),支气管血管束增粗6例(40%),支气管充气征8例(53.3%),均合并分布在实变、团块中,间质纤维化1例(6.7%),胸膜改变14例(93.3%),肺门纵隔淋巴结增大4例(26.7%),团块、实变、斑片影合并存在6例(40%)。结论肺MALT淋巴瘤主要表现为实变、团块、结节、斑片影等,多合并存在,实变团块中多见支气管充气征,团块边缘较模糊。病程较长,病灶可以较长时间没有影像学变化。     

39例非免疫缺陷病毒患者肺隐球菌病的CT表现

目的:总结非免疫缺陷病毒(AIDS)患者肺隐球菌病(PC)的CT表现,提高对该病的诊断能力.方法:回顺性分析4家医院2003年4月-2013年11月收治经病理学证实的非AIDS患者PC的CT影像资料39例.结果:39例PC患者中肺肿块/结节型占62％(24例),并以单发型最多见(46％,18例);混合型占21％(8例);肺实变型占15％(6例);弥漫型占3％(1例).普通型及周围型分别占46％(18例)及38％(15例).所有患者共检出可评估病灶75个,主要累及下肺区(65％,49个).充气支气管征见于57％的肺肿块/结节(26个),其中Ⅲ型22个,假空洞征7个.磨玻璃影/晕征见于46％的肺肿块/结节(21个)及52％的肺实变(15个).卫星灶见于33％(13例)的患者.结论:非AIDS患者PC的CT表现各异.肺单发/多发性肿块/结节主要位于下肺、胸膜下/接近胸膜下区域、周围磨玻璃影/晕征、Ⅲ型充气支气管征/假空洞征及卫星灶可能对诊断有帮助.     

原发性肺淋巴瘤的CT表现

目的:研究原发性肺淋巴瘤的CT表现,提高CT诊断水平.材料和方法:回顾性分析8例经病理证实的原发性肺淋巴瘤胸部CT表现.结果:CT平扫表现为肺的单发肿块3例,结节4例(其中多发3例),多发片状影1例,5例出现充气支气管征,周围间质浸润5例,6例行增强扫描,病灶增强明显,CT平均值增加42.7Hu.结论:原发性肺淋巴瘤是一种少见病,CT表现缺乏特征性,但充气支气管征及周围间质浸润的出现以及没有肺门、纵隔淋巴结肿大,可提示本病的可能,应积极行穿刺病理明确诊断.     

MSCT在肺黏膜相关淋巴组织淋巴瘤诊断中的应用价值

目的探讨多层螺旋CT(MSCT)在肺黏膜相关淋巴组织(MALT)淋巴瘤诊断中的应用价值。方法回顾性分析我院自2007年6月~2014年11月经手术或穿刺病理证实为肺黏膜相关淋巴组织淋巴瘤的9例患者MS(T资料。所有患者均行CT平扫及增强扫描,CT表现由两名影像科医师共同分析。结果 9例患者中,病变为单发4例,多发为5例。共检出肺实变、结节、磨玻璃影及肿块病灶24个,其中肺实变伴支气管充气征为最常见表现,共计14例。肺结节、磨玻璃影及肿块病灶分别为3个、5个及2个。6例可见"血管漂浮征"。增强扫描呈轻至中度均匀强化,所有患者未见胸腔积液,纵膈及双侧肺门未见肿大淋巴结。结论肺MALT淋巴瘤在CT上多表现为单发或多发实变影伴支气管充气征,亦可见表现为结节、磨玻璃影或肿块,对于以上影像表现并且临床病程发展缓慢,抗炎效果不佳,应该考虑肺MALT淋巴瘤的诊断,MSCT在肺MALT淋巴瘤的临床诊治中具有重要价值。     

Unresolved major pulmonary embolism: Importance of follow-up lung scan in diagnosis

Unresolved major pulmonary embolism (UMPE) is an uncommon condition which causes pulmonary hypertension, cor pulmonale and death. An accurate and prompt diagnosis of UMPE is very important in the management of such patients with pulmonary embolectomy. Follow-up lung scans can lead to earlier diagnosis of UMPE, especially in patients who have a history of acute pulmonary embolism and present with pulmonary hypertension, respiratory insufficiency and cor pulmonale. We report a case of UMPE strongly suggested by follow-up lung scans and subsequently confirmed by pulmonary angiography and postmortem examination.     

经导管血管内栓塞术治疗肺动静脉畸形

目的 评价经皮穿刺经导管栓塞术治疗肺动静脉畸形(PAVMs)的安全性和疗效。资料与方法 对10例PAVMs患者进行了经导管栓塞治疗,男4例,女6例,平均年龄12岁(6个月～28岁),均为先天性。临床表现有紫绀和杵状指／趾7例,劳力性呼吸困难6例,胸部血管杂音4例,咯血2例和心功能不全2例。栓塞时用微型钢丝圈2例,普通钢丝圈8例。结果 PAVMs病灶为多发性7例,单发性3例。10例共做栓塞治疗12次,技术成功率为100％,治疗结束时复查肺动脉造影显示单发病灶完全消失,多发病灶者主要异常血管不再显影。术后血氧饱和度从平均78％增至96％。2例术前存在心功能不全,术后症状消失;胸部血管杂音消失。术后出现轻微胸痛5例,少量胸腔积液3例;1例术后2个月死于栓塞肺叶肺梗死继发化脓性感染。9例随访18个月～9年,一般情况良好,日常生活正常,无神经系统症状和体征,除2例弥漫型动静脉畸形血氧饱和度持续在85％～90％外,其余缺氧症状未再复发。结论 经导管血管内栓塞术是治疗PAVMs的安全、有效方法。     

孤立性周围型原发肺癌的CT诊断(附58例肺癌及20例肺良性肿块的分析)

本文分析了58例孤立性周围型原发肺癌(简称肺癌)和20例肺良性肿块的CT征象,观察了5例肺癌、2例错构瘤、1例结核球的肺叶切除标本。结果为:①等于或大于5.0cm的肺部肿块绝大多数为肺癌(93.9％);②肺癌钙化并不少见(6.9％),中心性弥漫性钙化并非是肺部肿块为良性的可靠指征;③假性空洞是诊断肺癌的一个指征,其病理基础为肿块内残存的小支气管;④引流线仅见于肺癌,其存在表示肺门淋巴结已受累;⑤薄层CT更清晰地显示肿块的边缘特征、内部结构和肿块与周围组织的关系。     

正常成人主肺动脉的HRCT测量及其意义

目的：探讨通过正常成人主肺动脉的ＨＲＣＴ测量诊断肺动脉高压与否的可能性。方法：连续测量２００例正常成人主肺动脉直径（外径）并计算其与同一层面降主动脉直径（外径）的比值,另外采用相同方法测量１１例６０～７８岁一组已经ＣＴ与彩色Ｄｏｐｐｌｅｒ证实的ＣＯＰＤ患者主肺动脉直径及与降主动脉直径的比值并与正常组比较。结果：正常成人不同年龄,不同性别主肺动脉直径不同并有随年龄增长而增大的趋势（Ｐ＜０．０５）,但其比值与年龄有关（Ｐ＜０．０５）与性别无关（Ｐ＞０．０５）,其比值与ＣＯＰＤ患者的比值比较存在显著差异（Ｐ＜０．０１）。结论：正常成人不同年龄组主肺动脉与降主动脉的比值可作为判断肺动脉高压与否的简单、敏感的指标     

三种心血管造影组合对肺动脉闭锁肺动脉发育情况的评价分析

目的评价分析三种心血管造影组合显示肺动脉闭锁合并室间隔缺损的肺动脉发育情况。资料与方法回顾性分析22例肺动脉闭锁合并室间隔缺损患者的临床资料,包括X线平片、心电图、超声心动图和心血管造影。重点分析三种造影组合对显示肺动脉发育情况的优缺点。结果（1）右心室造影＋楔入肺静脉造影共3例,均显示左右肺动脉融合,一侧肺动脉发育细小。（2）右心室造影＋弓降部主动脉和／或升主动脉造影共15例,其中11例主要由未闭动脉导管供血,均见左右肺动脉融合,融合部狭窄3例,一侧或双侧肺动脉发育不良或变细8例,2例可见主肺动脉及盲端;另4例左右不融合。（3）右心室造影＋弓降部主动脉或升主动脉造影＋体肺侧支血管造影共4例,其中1例由细小动脉导管供血,左右肺动脉融合并发育较好;3例均由小体肺侧支和网状细小血管供血,肺动脉发育细小。结论三种心血管造影组合均能有效显示肺动脉发育情况,主动脉造影能全面了解体肺侧支血管分布,选择性侧支血管造影是术前栓塞所必要的;楔入肺静脉造影可极好地显示纵隔内肺动脉的情况。     

功能性肺叶切除动物模型肺小动脉变化的观察

目的 探讨应用平阳霉素-碘化油乳剂（PLE）实现功能性肺叶切除（FPLT） 的可行性及肺小动脉的病理变化,评价其对肺循环的影响. 材料与方法健康犬16只,随机分成两组,A组12只,B组4只.A组行靶肺支气管肺泡灌注PLE并用支气管封堵器堵塞靶肺支气管,B组为对照组.A组分别于术后28天、56天各处死6只取肺组织,B组各处死2只,测定肺纤维化的程度,运用图像分析仪测量肺小动脉中膜厚度占血管外径比值（mMTPA）和相对中膜面积（WA/TA）. 结果 FPLT术后A组动物组织病理学显示靶肺呈纤维化改变,肺小动脉管壁增厚,管腔部分闭塞;非靶肺未见明显纤维化,未出现血管重构现象. 结论 向靶肺支气管肺泡灌注PLE并用支气管封堵器堵塞靶支气管可达到功能性肺叶切除的目的 ,该方法安全、简便,术后对肺循环无明显不良影响.     

Coil embolization of pulmonary arteriovenous malformations

Pulmonary arteriovenous malformations (PAVMs) are uncommon lesions that can be treated by surgery or interventional radiology. Forty-four PAVMs in 11 patients were occluded by transcatheter coil embolization with only one symptomatic complication, deep venous thrombosis, attributable to the procedure. There was a significant improvement in symptoms and a reduction in pulmonary AV shunting in the 9 patients in whom embolization of all visible discrete lesions was successfully completed. Coil embolization is an effective alternative to other methods of treating PAVMs.     

Clinically suspected pulmonary embolism: is it safe to withhold anticoagulation after a negative spiral CT?

The goal of this study was 3-month clinical outcome in non-anticoagulated patients with clinically suspected acute pulmonary embolism (PE) following a negative spiral CT. During a 6-month period 305 patients underwent spiral CT, of whom only 8 also had a lung scintigraphy. In patients with a final CT report read as not positive for acute PE, all hospital records and answers to a patient questionnaire were analyzed for episodes of venous thrombembolism (VTE). Acute PE was diagnosed at spiral CT in 61 patients (20 %). Twenty-six of the remaining 244 patients were excluded from further analysis because of (a) long-term anticoagulation due to symptomatic acute deep venous thrombosis (n = 5), clinically diagnosed acute PE (n = 2), chronic recurrent VTE (n = 4), and cardiac disorders (n = 5); and (b) a normal perfusion scintigram (n = 4) or a negative pulmonary arteriogram (n = 6). Three patients were lost to follow-up. Among the remaining 215 patients only 10 had undergone a negative lower extremity venous study. Sixteen patients (7 %) died during the follow-up period, 6 of whom underwent autopsy. Venous thrombembolism was diagnosed in three of the 215 patients (1.4 %, 95 % confidence limits: 0.5–4.0 %), one causing the patient's death. Two patients had advanced thoracic malignancies and the third severe chronic obstructive pulmonary disease (84 years old). A negative spiral CT may be able to exclude clinically significant acute PE with the same accuracy as a normal lung scintigraphy or a negative pulmonary arteriography. Received: 8 February 2000 Revised: 18 May 2000 Accepted: 22 May 2000     

Comparison of perfusion lung scanning and angiography in the estimation of vascular obstruction in acute pulmonary embolism

To determine the relationships between perfusion scan defect and angiographic severity (Miller index) in acute pulmonary embolism, we analysed examinations obtained before and after thrombolytic therapy in 34 consecutive patients free from underlying cardiopulmonary disease. The overall agreement between the two techniques was excellent (r=0.82; mean absolute difference=2.8%), although when embolic involvement was extensive (greater than 50% angiographic obstruction), the perfusion scan moderately underestimated (4%) the defect seen angiographically. These findings suggest that the pulmonary lung scan is a reliable method of assessing the initial pulmonary vascular obstruction as well as of quantifying any changes induced by or associated with the treatment.French exchange travelling fellow     

单侧肺动脉化疗性栓塞术在转移性肺癌模型中的应用

目的探讨选择性肺动脉化疗性栓塞治疗肺转移瘤的可行性和疗效,并通过碘油示踪阐明微小肺转移瘤的肺动脉供血情况。方法实验采用新西兰大白兔14只,建立血源转移性肺癌模型。分为3组,A组(4只)作为对照组,B组(4只)和C组(6只)为实验组。所有兔均在全麻下分离股静脉,采用3F微导管行选择性左肺动脉灌注治疗:A组灌注生理盐水5ml;B组灌注表阿霉素(2mg/kg)和卡铂(15mg/kg);C组灌注卡铂(15mg/kg),同时将超液态碘油1ml和表阿霉素(2mg/kg)混合配成碘油乳剂透视下缓慢注入行化疗性栓塞术。术后3周全麻下处死所有存活实验兔(12只),剖胸取肺组织,用4%甲醛溶液固定,取材后石蜡包埋,分别测量肿瘤最大直径并计算肿瘤体积,比较各组治疗后体积改变。同时,在C组标本中另外取材,冰冻切片下用苏丹Ⅲ染色监测治疗后肿瘤内部碘油沉积情况。结果A组转移瘤平均体积(130.56±9.41)mm3较经介入治疗后B组(69.47±10.00)mm3、C组(19.73±3.54)mm3左肺转移瘤平均体积明显大,而C组左肺转移瘤体积较B组小,差异具有统计学意义(P<0.05)。2只兔术中死亡,死亡兔肺转移瘤内均见碘油沉积。另外,化疗栓塞后3周C组转移瘤内仍然可见散在碘油沉积,部分碘油已进入肿瘤实质内。结论化疗性栓塞术治疗肺部转移瘤确实可行,有利于控制肺转移瘤。经过碘油脂质染色进一步证实肺动脉参与了转移性肺癌的血供,尤其是参与了早期肺内微小转移结节的供血。随肿瘤结节的不断增大,转移瘤的肺动脉血供也不断增多。