原发性周围型小肺癌与良性结节影像学鉴别

目的：探讨深分叶征、毛刺征、支气管气相、血管集束征、胸膜凹陷征在周围型小肺癌中的诊断价值。材料与方法：对32例直径≤2cm的周围型原发性肺小结节的影像学形态特征进行统计学分析。结果：深分叶征、钙化在小肺癌与良性结节两组病例间有显著统计学差异，毛刺征、血管集束征、支气管气相、胸膜凹陷征在小肺癌与良性结节两组病例间无显著统计学差异，但毛刺征、边缘模糊、血管集束征在小肺癌中出现率明显高于良性结节，边缘光滑、钙化较多则多为良性结节。结论：深分叶征、毛刺征、血管集束征是诊断小肺癌的重要征象；支气管气相、胸膜凹陷征并非肺癌的特征，边缘光滑、钙化较多则多为良性结节。     

薄层CT上周围型小肺癌支气管气象的意义:与良性肿瘤比较

CT已被公认为发现周围型肺结节内钙化及脂肪的有效方法。薄层CT可显示周围型肺癌的毛刺、分叶、胸膜凹陷及周围脉管聚集等征象。有时在CT上当含气支气管与无气肺组织之间形成良好对比时,亦可使支气管气象得以充分显示。作者选择性研究了40例有肺内结节病变的病人,其中包括20例直径在2cm以下的周围型肺癌(18例腺癌,1例鳞癌及1例大细胞癌)和20例良性小结节(8例错构     

局灶性磨玻璃征-早期周围型肺癌的重要CT征象

目的:探讨局灶性磨玻璃征(Ground Glass Opacity GGO)对早期周围型肺癌的诊断价值。方法:搜集临床、CT资料完整,经手术病理证实的早期周围型肺癌27例(28个),对其CT表现,作一回顾性分析。结果:28个早期周围型肺癌直径均<2.0cm,呈园形或卵园形22个,其中纯GGO或部分GGO密度的有21个,并见有毛刺14个,血管集束征14个,胸膜凹陷13个,分叶征10个和小泡征8个。结论:局限性GGO为早期周围型肺癌重要CT征象之一,若同时具备下列4项中的一项或多项高度提示早期小肺癌:①结节呈圆或卵圆;②内部见实性结节(即部分GGO);③伴有分叶、毛刺、血管集束征、胸膜凹陷征等其它恶性征象;④短期复查未变化。     

周围型肺癌X线动态观察(附14例分析)

目的 分析周围型肺癌不同时期的Ｘ线征象,以提高影像诊断水平。材料与方法 搜集有Ｘ线随访资料的早期周围型肺癌１４例,着重总结其早期征象。结果 其早期征象以肺内孤立结节状病灶为主,平均直径１．６ｃｍ,密度中等偏低,进展期征象以肺内圆或椭圆形肿块为主,平均直径４．６５ｃｍ,密度中等偏高;瘤体内部结构;小泡征见于早期,钙化病灶见于进展期,空８洞征进展期比早期出现率高;瘤体边缘征象;毛刺、分叶及胸膜凹陷征等     

周围型小肺癌形态学表现与CT灌注成像参数及微血管密度的相关性研究

目的:研究周围型小肺癌形态学特征与CT灌注参数及微血管密度(MVD)的相关性。方法:分析44例周围型小肺癌的CT形态学特征(包括分叶、毛刺、血管集束、胸膜凹陷、空泡及细支气管充气征、病灶远端阻塞性改变),分析各征象与CT灌注参数及MVD的相关性。结果:周围型肺癌CT征象的有无与CT灌注参数及MVD有密切的关系。有分叶征、毛刺、血管集束、胸膜凹陷及病灶远端阻塞性改变组的BF、PS及MVD均高于无分叶、毛刺、血管集束、胸膜凹陷组及阻塞性改变组。结论:周围型小肺癌形态学特征与CT灌注参数及MVD有较好的相关性。     

16层螺旋CT在周围型小肺癌诊断中的应用价值

目的探讨16层螺旋CT对周围型小肺癌的诊断价值。方法收集经临床和病理已证实的周围型小肺癌患者32例,对其影像学进行回顾分析。结果周围型小肺癌的主要CT征象有:边缘分叶征22例,边缘毛刺征21例,空泡征14例,胸膜凹陷征13例,血管集束征10例。周围型小肺癌动态增强CT扫描病灶于增强1～2 min其强化峰值最高,于3～4 min后病灶强化缓慢下降,强化值在20～60 Hu,其时间密度曲线呈抛物线状。结论16层螺旋CT平扫及增强扫描对周围型小肺癌具有较大的诊断价值。     

无分叶征的外周型小肺癌的CT诊断

图1小细胞肺癌。右上肺内1.2cm大小结节(箭),无分叶及毛刺,周围未见卫星灶。图2中分化鳞癌。右上叶后段见2cm×1.5cm大小葫芦状结节(箭),密度均匀,边缘光滑。图3细支气管肺泡癌。右中叶外侧段不规则结节影(箭),边缘见长短不一毛刺,内见空气支气管征,与胸膜有细条状粘连。图4低分化腺癌。右上肺多发小结节影(箭),密度不均,多为磨玻璃密度影。近年来,肺癌的发生率持续上升,已居男性恶性肿瘤死亡率的首位。CT对肺癌的定性和分期诊断准确性很高,但对直径<3.0cm并且缺乏分叶征的孤立性外周型肺癌,CT定性困难。本文对CT资料完整的19例无分叶征…     

周围型小肺癌CT诊断--附36例分析

目的　在普通CT机薄层扫描图像中研究小肺癌的CT征象。方法　采用病灶 3mm憋气扫描法 ,对 3 6例得到病理证实的小肺癌进行CT征象分析。结果　周围型小肺癌的CT征象有 :分叶征 ,占 91.6% ;边缘毛刺征 ,占 77.8% ;空泡征 ,占 5 0 % ;胸膜凹陷征 ,占 88.9% ;蜂窝征 ,占 11.1% ;病灶胸膜侧放射影 ,占 11.1% ;空洞 ,占 2 .7% ;血管集束征 ,占 66.7%。结论　在周围型小肺癌的诊断上 ,可将CT征象分为基本CT征象和次要CT征象。其基本CT征象有 :分叶征、边缘毛刺征、空泡征、胸膜凹陷征和血管集束征 ,各不同组织类型的小肺癌具有的CT征象也不完全一致     

周围型小肺癌的CT征象分析

目的　进一步认识周围型小肺癌的CT征象 ,提高CT诊断正确率。方法　收集经手术病理证实直径≤ 3cm周围型小肺癌 63例 ,术前均行螺旋平扫。其中 2 8例加做了高分辨扫描 ,41例做了增强扫描。重点对病灶的形态、边缘征象、内部结构及增强程度进行总结分析。结果　 63例小肺癌中 ,具有深、浅分叶征 57例 ,毛刺征 56例 ,胸膜凹陷征 48例 ,血管束征 36例 ,小泡征 1 5例 ,空气支气管征 6例。 41例增强病例中 34例CT值增幅 >30HU。结论　CT显示有 3种边缘征象以上的肺部外围型结节应高度怀疑周围型肺癌 ;增强扫描对鉴别结节的良恶性很有帮助     

3厘米以下孤立性肺结节胸膜凹陷征的CT评价

本文复习了经手术病理证实的3cm 以下孤立性肺结节的CT 影像40例(周圈性小肺癌30例、肺良性小结节10例)。结果显示胸膜凹陷征阳性率在小肺癌为66.7%,良性结节为70%,两者相近.此征象阳性的结节一胸壁间距平均6.8mm,而无此征象的结节一胸壁间距平均15mm,有胸膜凹陷者的结节一胸壁间距比无此征象者明显小。CT 一病理对照显示肺内小结节纤维组织增生与胸膜凹陷征的形成关系密切.此征象的形成与肺内结节的良、恶性关系不大.作者认为CT 像上单纯的胸膜凹陷征对周围型小肺癌与良性小结节鉴别诊断的价值不大.     

肺内孤立结节的CT诊断：CT,普通X线与病理对照研究

A correlative study of CT, X-ray and pathology was done on 41 cases with pulmonary solitary nodule, including peripheral lung cancer 30 cases, benign lesion 10 and metastatic tumor 1. Results showed that CT was more sensitive than conventional X-ray in depicting the characteristic signs such as spiculate protuberance, minute calcifications, small vacuole sign and retraction of pleura. 2 mm thin slice CT scanning is helpful in differential diagnosis of lesions less than 2 cm in diameter. Correlation of CT findings with pathology indicated that spiculate protuberance was caused by infiltrative growth of tumor, whereas the small vacuole sign represented remnant of air containing cavity or slit. The shaggy border of inflammatory nodule was the result of extension of inflammatory process. A correct diagnosis of pulmonary solitary nodule lies in comprehensive analysis of CT manifestations. There is greater possibility of malignancy with mass greater than 4 cm in diameter, lobulation and spiculation are frequently present. Lung cancer less than 3 cm in diameter often presents as lobulated mass with spicules, small vacuole sign and pleural retraction.     

Rapidly growing small peripheral lung cancers detected by screening CT: correlation between radiological appearance and pathological features

12 peripheral small lung cancers (< 20 mm) of rapid growth (volume doubling time < 150 days), detected by repeated low dose CT screening, were evaluated to examine their CT features and to correlate such features with histopathological findings. Each patient's CT images, including follow-up and thin section CT images, were studied retrospectively to determine tumour growth rate and CT morphological features. Nine of the tumours exhibited a solid tumour growth pattern: seven of these showed a well defined, homogeneous, soft tissue density with spicular or lobulated margin. These seven tumours included small cell lung cancer (n = 3), moderately differentiated adenocarcinoma (n = 2), poorly differentiated adenocarcinoma (n = 1) and squamous cell carcinoma (n = 1). The other two tumours, a moderately differentiated adenocarcinoma and a well differentiated adenocarcinoma, appeared as irregular, soft tissue density nodules with poorly defined margins. The latter exhibited an air bronchogram pattern and a small cavity. The remaining three tumours exhibited a lepidic tumour growth pattern. They showed ground glass opacity or ground glass opacity with a higher density central zone on CT images and were well differentiated adenocarcinomas. In conclusion, most peripheral small lung cancers of rapid growth were adenocarcinomas. They also included small cell lung cancer and squamous cell carcinoma. The majority showed solid tumour growth pattern and lacked an air bronchogram and/or small air spaces in the nodule. Some well differentiated adenocarcinomas with lepidic tumour growth pattern also showed rapid growth.     

局限性机化性肺炎CT表现

目的 分析局限性机化性肺炎(FOP)的影像学征象,探讨FOP的CT诊断价值.方法 回顾性分析57个经手术病理证实的FOP病灶,结节型(长径≤30 mm)40个,肿块型(长径>30 mm)17个,分析FOP分布位置、形态边缘、内部特点及强化特征等CT征象.结果 39个病灶位于右肺,18个病灶位于左肺;51个病灶位于外带肺野,6个病灶位于内中带肺野;FOP在肺叶和肺野分布的差异有统计学意义.FOP常见充气支气管征象(28/57),疏松症(18/57),血管集束征(21/57).49个病灶与胸膜相连,其中34个病灶与胸膜宽基底相连.CT增强扫描54个病灶,动脉期平均增强CT值35 HU,静脉期平均增强CT值45 HU,呈渐进性强化.肿块型FOP多呈不均匀强化(14/17),结节型FOP以均匀强化为主(25/40).肿块型FOP与结节型FOP边缘、形状、磨玻璃影、坏死、空洞、与胸膜相连的差异有统计学意义.结论 FOP的CT表现具有一定的特征性,增强CT扫描结合多平面重组图像有助于鉴别诊断.     

Thin-section computed tomography of intrapulmonary metastases after surgical resection of lung cancer

To evaluate the morphology of small peripheral intrapulmonary metastases of lung cancers, we studied thin-section computed tomography (CT) images of 12 lesions in 5 cases (1 squamous cell carcinoma, and 4 papillary adenocarcinomas). All lesions were resected, and histopathological diagnosis of them was performed in comparison with primary lesions to differentiate multiple primary lung cancers from intrapulmonary metastases. Thin-section CT images showed mildly lobulated nodules in connection with supplying pulmonary vessels, however, indented pleura and vascular convergence were less frequently seen in intrapulmonary metastases in contrast with primary lung cancers. Thin-section CT is helpful for distinguishing multiple primary lung cancers from intrapulmonary metastases in patients with a history of surgical resection for lung cancers.     

Intrapulmonary lymph nodes: thin-section CT features of 19 nodules

PURPOSE: The purpose of this study was to describe the thin-section CT features of intrapulmonary lymph nodes that accompanied primary or metastatic lung tumors. METHOD: A retrospective analysis of thin-section CT features was performed on 19 nodules in 16 patients with pathologically confirmed intrapulmonary lymph nodes that accompanied primary or metastatic lung tumors. RESULTS: Of the 16 patients, 13 had a solitary nodule and 3 had two nodules. All nodules were distributed in the middle lobe, lingula, or lower lobe. On thin-section CT images, the nodule was located abutting the visceral pleura (n = 10) or within 8 mm of the visceral pleura (n = 9). The thin-section CT findings showed that most of the nodules were well circumscribed (n = 18), homogeneous (n = 19), ovoid (n = 10), or round (n = 9) and smaller than 12 mm in maximal diameter. The surrounding lung field was normal (n = 16). CONCLUSION: Intrapulmonary lymph nodes are subpleural in the lower lung field. On thin-section CT, they are well circumscribed, homogeneous, round or ovoid, and smaller than 12 mm in maximal diameter. In the differential diagnosis of subpleural nodules located in the lower lung field, it should be kept in mind that they may be intrapulmonary lymph nodes even though the patient has malignancy.     

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.     

Small peripheral carcinomas of the lung: thin-section CT and pathologic correlation

The aim of this study was to clarify the thin-section CT features of small peripheral carcinomas of the lung on the basis of pathologic findings of tumor growth patterns. Thin-section CT and pathologic correlation was evaluated in 19 patients with surgically verified small peripheral carcinomas of the lung ( < 20 mm in size) that had been detected in a screening trial for lung cancer using spiral CT. Four thin-section CT types of nodules were observed: (a) type L1 (4 of 19, 21 %), a fairly well-defined nodule with ground-glass attenuation, corresponding to tumor lepidic growth without alveolar collapse; (b) type L2 (4 of 19, 21 %), a partly lobulated nodule with a low but inhomogeneous attenuation, corresponding to tumor lepidic growth with scattered foci of alveolar collapse; (c) type L3 (4 of 19, 21 %), an ill-defined nodule with an irregularly shaped higher-density central zone in a ground-glass attenuation peripheral zone, accompanied by convergence of the bronchovascular structures from the surrounding lung parenchyma, which corresponded to desmoplastic response in the central zone and to tumor lepidic growth in the peripheral zone; and (d) type H (7 of 19, 37 %), a well-defined nodule with a solid homogeneous attenuation, corresponding to tumor hilic growth. Thin-section CT features of small peripheral carcinomas of the lung can be classified into four types, based on the density distribution of the tumor, which reflect the histologic findings. Received: 4 September 1998; Revised: 25 November 1998; Accepted: 17 March 1999     

螺旋CT对周围型小细胞肺癌的诊断价值

目的:探讨周围型小细胞肺癌(PSCLC)的CT表现及其诊断价值.方法:回顾性分析53例经皮肺穿刺活检或手术病理证实的PSCLC患者的CT表现.结果:53例中,肺内病灶呈结节状39例,团块状11例,片絮状3例;结节状或团块状病灶表现为边缘清晰的小波浪状或浅分叶状.49例伴有肺门或/和纵隔淋巴结肿大,其中39例肺门或和纵隔肿大淋巴结的大小超过肺内肿瘤,35例肿大的淋巴结融合成块而呈现冰冻纵隔改变.结论:周围型小细胞肺癌的CT表现有一定的特征性,螺旋CT扫描是诊断PSCLC的有效检查方法.     

肺部孤立球形病变的X线、CT对比研究

目的探讨肺部孤立球形病变的X线、CT表现差异,提高对肺部孤立球形病变的正确诊断率。方法手术及病理证实的肺部孤立球形病变51例,其中周围型肺癌26例,炎性假瘤14例,结核球11例,全部病例均摄取胸部正侧位片及CT片。结果（1）征象特点小泡征、胸膜凹陷征、阻塞性肺炎仅见于周围型肺癌;小于3cm薄壁空洞为周围型肺癌的少见征象之一;炎性假瘤、结核球可出现不规则厚壁偏心空洞;棘状突起除周围型肺癌多见外,炎性病变亦可出现;支气管充气征、长毛刺、胸膜尾征炎性假瘤出现率高;钙化、胸膜肥厚结核球多见。（2）X线、CT表现差异肿块密度、分叶、棘状突起、纵隔淋巴结肿大的观察CT优于胸片,病灶形态、边缘的显示胸片较CT优越。（3）CT对周围型肺癌、炎性假瘤、结核球定性诊断的准确性优于X线（Ρ＜0.05）。结论认识肺部孤立球形病变的征象差异并合理选用X线、CT检查,有助于提高肺部孤立球形病变的正确诊断率。     

Presence of local pleural adhesion in CT screening-detected small nodule in the lung periphery suggests noncancerous, inflammatory nature of the lesion

PURPOSE: Differential diagnosis of small nodules in the lung periphery detected by low-dose chest CT screening is important before surgery. The aim of the study was to discriminate between benign and malignant lesions, identified in our preoperative imaging work-up examinations and confirmed during surgery, for nodules detected on CT screening. MATERIALS AND METHODS: This study is based on 106 patients (46 men and 60 women, median age: 61.5 years) with 123 CT screening-detected and histologically confirmed nodules smaller than 30 mm in the lung periphery identified between 2002 and 2005 at Azumi General Hospital, Japan. Lesions were classified into three groups according to histological findings: adenocarcinoma, atypical adenomatous hyperplasia (AAH) and inflammatory focal lesions. We examined the visceral pleura during surgery at a location close to lung nodules. RESULTS: The median diameter of resected lung nodules on high-resolution CT (HRCT) was 9.0 mm. Nodules were nonsolid in 42, partly solid in 51 and solid in 30. Histopathological diagnosis was lung cancer in 69, AAH in 21, other noninflammatory tumours in 6 and inflammatory lesions in 27. Fifty-four lesions were located in the subpleural zone. Eight of 123 nodules showed local pleural adhesions (LPA), while 2 were buried in extensive pleural adhesion. LPA was noted more frequently in inflammatory nodules than in cancer nodules (P<.01). CONCLUSION: The presence of LPA in close proximity to a small nodule is indicative of noncancerous lesion. This feature allows the discrimination of pulmonary peripheral inflammatory lesion from peripheral small cancer on chest low-dose CT screening.