低剂量CT在肺癌筛查中的应用研究

目的 探讨肺部结节随访时低剂量CT较常规CT在肺癌筛查中的价值。方法 21名测试者分别行低剂量CT和常规CT检查,所有测试者的检测图像分别由5名专业医师进行独立评估。结果 低剂量CT和常规CT对肺癌的筛查无显著差异。结节病变检出率一致性接近82%（P<0.001）,病变确诊率一致性超过96%（P<0.001）。低剂量CT的肺部辐射剂量范围为1.5~3.6 mSv,仅为常规CT肺部辐射剂量的1/6左右。结论 在肺部结节随访中,低剂量CT能够作为常规CT的有效替代方式,并可减少诊疗过程中的辐射剂量。     

低剂量螺旋CT对35686例健康体检者的肺癌筛查分析

目的了解采用低剂量螺旋CT进行健康体检人群肺癌筛查的特点。方法对解放军总医院国际医学中心2009年10月~2013年6月、已排除既往有恶性肿瘤病史的35 686例健康体检人员采用低剂量螺旋CT进行肺癌筛查,根据筛查结果,分别按性别、年龄段等进行分组,比较肺癌检出率、病理分型及临床分期。结果筛检并经病理确诊肺癌51例(1.429‰),其中男性27例、女性24例,腺癌、鳞癌、小细胞癌分别为36、11、4例,1、2、3、4期肺癌分别为31、0、4、16例。肺癌总检出率、腺癌构成比、腺癌检出率及1期肺癌检出率女性均高于男性,肺癌平均分期及鳞癌、小细胞癌构成比女性均低于男性。腺癌、鳞癌、各期肺癌及男女肺癌检出率随年龄增长均呈上升的趋势。结论采用低剂量螺旋CT进行肺癌筛查有助于肺癌的早期发现并提高肺癌检出率,在健康体检人群中应积极开展。     

16层螺旋CT低剂量肺部体检的临床应用价值

目的：探讨16层螺旋CT小毫安低剂量肺部体检的临床应用价值。方法：运用16层螺旋CT扫描速度快．覆盖面积广，可设小毫安低剂量肺部普查的有利条件，对114例受检者行肺部扫描，扫描条件为120kV，20-50mA，并进行标准（std）与肺模式（1ung）2种方式重建。结果：114例受检者中，发现病变41例。结论：16层螺旋CT小毫安低剂量肺部普查值得推广。     

螺旋CT低剂量扫描对肺结核病情监测的应用价值

目的 探讨64排128层螺旋CT低剂量扫描技术对于肺结核患者病情监测的应用价值。方法 对我院120例经临床确诊的成人活动性继发性肺结核患者（痰涂片结核杆菌阳性）行64排CT检查,在其他扫描条件一致情况下分别采用常规120 mA及15~40 mA低剂量扫描,采用盲法阅片,记录每次扫描的CT容积剂量指数（CTDI_vol）以及剂量长度乘积（DLP）,根据有效剂量转换因子（K=0.014）估算每次CT检查所致有效剂量（ED）,对比低剂量和常规剂量扫描和薄层重建的特殊影像表现,进行定量测量及差异分析。结果 两种扫描方式对于实变、支气管扩张、空洞、磨玻璃密度影、钙化灶、树芽征、结节、胸膜肥厚、胸水等结核基本征象显示无明显差异,低剂量扫描受检者所受的X射线辐射剂量显著下降。结论 飞利浦64排螺旋CT低剂量扫描技术和常规剂量相比,在保障检测效果的情况下,辐射剂量大幅度下降,可应用于肺结核的临床诊断及随访。     

Three cases of intralobar pulmonary sequestration--demonstration of an aberrant artery by contrast CT

Three cases of intralobar pulmonary sequestration, whose aberrant arteries could be demonstrated by contrast CT were reported. We confirmed these aberrant arteries both by selective angiography and/or surgical resection. We conclude that contrast CT may be of great use and benefit in the radiological workup of suspected cases of pulmonary sequestration proceeding to angiography.     

螺旋CT低剂量扫描在肺部疾病诊断中的应用进展

随着螺旋CT在临床上应用的日益广泛,受检人群的辐射危害应得到更多关注。CT低剂量扫描技术的研究及临床应用显得格外关键和迫切。多层螺旋CT低剂量成像技术通过调节扫描参数或修改扫描方案,在满足图像诊断要求的前提下大大降低了辐射剂量,因此越来越受到人们的广泛关注。而肺部本身具有良好的天然对比,同时CT扫描与X射线平片相比具有较高的密度分辨率且无组织重叠的关系,因此螺旋CT扫描被广泛应用于肺部病变的诊断及复查。本文从低剂量成像的必要性及降低辐射剂量的方法出发,就其在肺部不同疾病中的应用研究及未来方向进行综述。     

Feasibility of a patient decision aid about lung cancer screening with low-dose computed tomography

ObjectiveNew clinical guidelines endorse the use of low-dose computed tomography (LDCT) for lung cancer screening among selected heavy smokers while recommending patients be counseled about the potential benefits and harms. We developed and field tested a brief, video-based patient decision aid about lung cancer screening.MethodsSmokers in a cancer center tobacco treatment program aged 45 to 75 years viewed the video online between November 2011 and September 2012. Acceptability, knowledge, and clarity of values related to the decision were assessed.ResultsFifty-two patients completed the study (mean age = 58.5 years; mean duration smoking = 34.8 years). Acceptability of the aid was high. Most patients (78.8%) indicated greater interest in screening after viewing the aid. Knowledge about lung cancer screening increased significantly as a result of viewing the aid (25.5% of questions answered correctly before the aid, and 74.8% after; P < .01) although understanding of screening eligibility remained poor. Patients reported being clear about which benefits and harms of screening mattered most to them (94.1% and 86.5%, respectively).ConclusionsPatients have high information needs related to lung cancer screening. A video-based decision aid may be helpful in promoting informed decision-making, but its impact on lung cancer screening decisions needs to be explored.     

Evaluating the survival of cancer cases detected by screening

Early detection of cancer by screening advances the date of diagnosis, but may or may not affect survival. To assess the survival benefit associated with early detection, one must estimate the distribution of time survived post lead-time, that is, after the unknown date when clinical diagnosis would have occurred in the absence of screening. One can then compare the adjusted survival of screen-detected cancer cases to other groups of cases not diagnosed by screening. This paper describes a model for the survival of screen-detected cases, with a hazard function that depends on an individual's lead time, the duration of preclinical disease, and the time since diagnosis. The model is fitted to the ten year survival data from the 132 screen-detected cases of breast cancer in the well-known HIP (Health Insurance Plan of Greater New York) study. Comparison with the survival of several groups of cancer cases not detected by screening (interval cases arising clinically in persons previously screened, cases among persons who refuse screening, and cases among randomized controls not offered screening) yields various estimates of benefit. Use of the interval cases for comparison gives an estimate of about 21 breast cancer deaths prevented among 20,166 women screened in the HIP study; use of the data from the randomized controls gives an estimate of about 25 prevented deaths. The former estimate derives from the screened group of women only, and so the same method of evaluation may also be applied to community screening programmes and other situations that do not entail randomization.     

Nutrient intake and nutrient patterns and risk of lung cancer among heavy smokers: results from the COSMOS screening study with annual low-dose CT

The role of nutrients in lung cancer aetiology remains controversial and has never been evaluated in the context of screening. Our aim was to investigate the role of single nutrients and nutrient patterns in the aetiology of lung cancer in heavy smokers. Asymptomatic heavy smokers (≥20 pack-years) were invited to undergo annual low-dose computed tomography. We assessed diet using a self-administered food frequency questionnaire and collected information on multivitamin supplement use. We performed principal component analysis identifying four nutrient patterns and used Cox proportional Hazards regression to assess the association between nutrients and nutrients patterns and lung cancer risk. During a mean follow-up of 5.7 years, 178 of 4,336 participants were diagnosed with lung cancer by screening. We found a significant risk reduction of lung cancer with increasing vegetable fat consumption (HR for highest vs. lowest quartile = 0.50, 95 % CI = 0.31–0.80; P-trend = 0.02). Participants classified in the high “vitamins and fiber” pattern score had a significant risk reduction of lung cancer (HR = 0.57; 95 % CI = 0.36–0.90, P-trend = 0.01). Among heavy smokers enrolled in a screening trial, high vegetable fat intake and adherence to the “vitamin and fiber” nutrient pattern were associated with reduced lung cancer incidence.     

河南省城市地区低剂量螺旋CT肺癌筛查依从性及其影响因素分析

目的 评价2013-2017年河南省城市地区肺癌高危人群的低剂量螺旋CT（LDCT）筛查依从性并探索可能的影响因素。方法 采取整群抽样的方法,选取河南省40～74岁城市户籍居民进行癌症危险因素调查和肺癌风险评估,并对评估出的肺癌高危人群进行LDCT检查。采用χ²检验比较不同特征人群的LDCT筛查参与率差异,并采用Cochran-Armitage趋势检验对筛查参与率的时间趋势进行检验;采用多因素logistic回归模型分析LDCT筛查参与率的影响因素。结果 共纳入符合研究要求的肺癌高危人群35 672例,其中13 383例接受了LDCT检查,总体参与率为37.52%。LDCT筛查的参与率存在显著的地区和时间差异：最高和最低城市的参与率分别为38.47%和26.73%;2013-2014年的总体筛查参与率最低,为29.22%,2014-2015年最高,为43.30%（P<0.05）,且随着筛查年份增加,筛查参与率逐渐增加（P<0.001）。多因素logistic回归分析显示,女性、45～69岁、具有初/高中文化程度、既往吸烟、正在饮酒或既往饮酒、不经常体育锻炼、有肺结核史、有慢性支气管炎史、有肺气肿史、有哮喘支气管扩张史和有肺癌家族史的人群更愿意接受LDCT检查（均P<0.05）。结论 河南省城市肺癌高危人群的LDCT筛查参与率仍不高。针对本研究识别出的特定高危人群采取相应的干预措施可能会在将来的肺癌筛查中提升LDCT检查的总体依从性。     

Screening for lung cancer in the Netherlands: the role of spiral CT scan

The very poor prognosis of lung cancer has barely changed in the last two decades despite all efforts. However, prognosis is better when the disease is detected earlier, so that curative surgery or radiotherapy can be applied. Lung cancer screening in the past by chest X-ray did not lead to a decrease in lung cancer mortality, because the chest X-ray has low sensitivity for early invasive stages. With the advent of the low-dose spiral CT scan it has become feasible to detect early invasive stage I lung cancer in 80-90%. Modern screening for lung cancer by spiral CT scan could possibly decrease lung cancer mortality. Despite the first favourable results of screening the question remains whether lung cancer screening will be cost-effective. These questions can only be resolved in a randomised controlled trial with lung cancer mortality as unbiased end-point. Such a study should be initiated in the Netherlands, a country with large experience in screening trials and a good health care system. Only after lung cancer screening has proven to be cost-effective can appropriate implementation be recommended to prevent uncontrolled and opportunistic diffusion of this new screening technique into clinical practice in the near future.     

腰椎椎间盘多层螺旋CT低剂量扫描方式的改进

目的：探讨多层螺旋CT低剂量扫描在腰椎中的应用及其适宜的低剂量扫描条件。方法：选择60例30-65岁腰椎椎间盘退行性病变患者,随机分成A、B、C、D、E、F 6组,每组10例,采用不同的多层螺旋CT扫描参数进行扫描,并记录随机的容积CT剂量指数（volume CT dose index,CTDIvol）及剂量长度乘积（dose-length product,DLP）。采用自定标准盲式评估方法,对6组获得容积再现（volume rendering,VR）重组及Batch重组图像进行图像质量评分,由2位高年资主治医师依据空间分辨率、噪声、伪影及辐射剂量将图像分为好、中、差3级。结果：通过改变管电流（m A）、螺距及机架旋转速度,各组CTDIvol值、DLP值均存在明显统计学差异（P〈0.05）。相对于A组,B组CTDIvol值下降了14.29%,DLP值下降了12.64%;C组CTDIvol值下降了67.87%,DLP值下降了65%;D组CTDIvol值下降了62.49%,DLP值下降了58.45%;E组CTDIvol值下降了50%,DLP值下降了48%;F组CTDIvol值增加了24.86%,DLP值增加了29.7%。结论：正确调节管电流、螺距,可以在确保图像质量的同时,降低受检者所受辐射剂量。采用管电流350 m A、管电压120 k V、螺距1.375∶1,可降低58.45%的辐射剂量。     

Brilliance 64排螺旋CT故障案例分析

通过分析Brilliance 64排螺旋CT的工作原理、正常工作干扰因素及常见故障案例,为排除CT设备在工作中遇到的故障提供解决方案.明确CT设备工作原理与各种干扰因素和故障排除方法后,使CT机得到有效保养与维护,及时排除运行中发生的故障,为设备正常工作提供有效保障.     

肺部霉菌球的多排螺旋CT表现

目的 探讨肺部霉菌球的多排螺旋CT（multi-slice CT,MSCT）表现,以期进一步提高对该病的认识.方法 回顾性分析经临床证实的肺部霉菌球病例的多排螺旋CT表现,观察霉菌球在肺部的分布部位、大小、形态、强化表现以及霉菌球周围肺组织的CT表现.结果 共发现霉菌球23例,发生在右肺上叶7例,左肺上叶10例,右肺下叶4例,左肺下叶2例.15例呈典型的空气新月征,1例呈晕征改变.结论 多排螺旋CT能够显示肺部霉菌球的大小、形态、分布位置以及病变周围肺组织的改变,对霉菌球的诊断与鉴别诊断有很大价值.     

64排螺旋CT薄层加动态增强扫描在周围型小肺癌的诊断价值

目的:探论64排螺旋CT薄层扫描加动态增强扫描在周围型小肺癌的诊断价值。方法:对CT室近2年来诊断的31例周围型小肺癌(SPLC)患者进行回顾,并统计分析。结果:对数据进行分析统计,薄层扫描加动态增强扫描在分叶征(x2=6.331,P=0.012)、细支气管气相(x2=4.048,P=0.044)、血管集束征(x2=4.865,P=0.027)、短毛刺征(x2=16.452,P=0.000)显示率明显高于平扫,有统计学意义(P<0.05),而胸膜凹陷征(x2=0.706,P=0.401)、棘突征(x2=1.038,P=0.308)、空泡征(x2=0.540,P=0.463)显示率较高,但无统计学意义(P>0.05)。结论:64排螺旋CT薄层扫描加动态增强扫描在周围型小肺癌的诊断中具有极高的应用价值。