数字化胸片计算机辅助检测在肺结节早期检出中的应用

[目的]评价计算机辅助检测系统(CAD)对肺结节早期检出的临床价值和局限性。[方法]从影像传输与存储系统(PACS)数据库中抽取30例直径7mm～30mm大小肺部结节的病例作为受检组。另抽取30例年龄、性别构成与受检组相仿的正常胸片作为对照组,两组病例均经螺旋CT肺部扫描检查,并由放射诊断专家诊断证实,所有胸片均为直接数字化影像(direct digital radiograph,DR)。由高年资和低年资放射诊断医生各3位分别对不用和用CAD输出分析结果的数字化胸片进行诊断,诊断结论用受试者操作特性曲线(ROC curve)分析来评价。[结果]平均ROC曲线下面积(Az)从不用CAD输出的0.872增加到用CAD输出的0.933(P<0.05)。在使用CAD时,低年资放射诊断医生比高年资放射诊断医生的平均曲线下面积增加得更多。[结论]在直接数字化胸片诊断中应用CAD系统能提高肺小结节的检出率。     

孤立性肺结节的CT研究进展

孤立性肺结节是胸部的常见病变,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率及定性诊断率。全文综述了孤立性肺结节的CT研究现状,同时展望能谱CT在诊断孤立性肺结节方面的应用前景。     

低剂量螺旋CT肺癌筛查检出肺结节的处理及进展

低剂量螺旋CT(LDCT)肺癌筛查可以显著提高肺癌患者的生存率,降低患者的死亡率.目前全球已开展多个著名的肺癌筛查研究项目,国内外多个组织及机构也有相关肺癌筛查指南或指导意见发布,本文主要对CT筛查检出的肺结节处理及进展予以综述.     

螺旋CT靶扫描诊断孤立性肺结节

目的 探讨靶扫描在孤立性肺结节诊断中的价值.方法 常规扫描采用层厚10mm,扫描视野36 cm左右,标准算法重建,靶扫描采用小扫描视野（16～20 cm）,层厚2～5 mm,P=1-2,重建时重叠50%,用标准算法及骨算法两种重建.对同时具有两种扫描方法并经手术切除,经皮肺穿刺活检病理证实及经抗感染治疗后复查的60例病例进行回顾性分析,比较常规扫描与靶扫描在显示孤立性肺结节征象与诊断准确性上的差异.结果 60例靶扫描显示小结节征、空泡征、钙化、增强后高密度点条征、棘突征、毛刺征、分叶征、胸膜凹陷征、模糊绒毛征,高于常规扫描.靶扫描定性诊断准确率为93.3%,也高于常规扫描的81.7%.结论 靶扫描能提高孤立性肺结节征象的显示率,有助于诊断及鉴别诊断,是肺部结节有效的检查方法.     

低剂量螺旋CT肺癌筛查及肺结节的研究现状

肺癌已经成为对人类生命威胁最大的恶性肿瘤之一,其发病和死亡均居恶性肿瘤首位,因此对肺癌的筛查显得尤为重要。随着低剂量螺旋CT的广泛应用,肺结节的检出率在不断增加,对其研究也在不断深入。本文就肺癌筛查的现况、肺结节良恶性影响因素做一阐述,以期为肺癌和肺结节的防治提供依据。     

低剂量CT扫描引导下经皮肺穿刺活检诊断周围型肺癌的应用研究

[目的]探讨低剂量螺旋CT扫描引导下经皮肺穿刺活检术在诊断周围型肺癌中的应用价值。[方法]把60例CT引导下经皮肺穿刺活检患者随机分成两组,低剂量组30例行低剂量（130kV,30mA）CT扫描,常规剂量组30例行常规剂量（130kV,100mA）CT扫描,分别记录容积CT剂量指数（CTDIvol）,并计算剂量长度积（DLP）;统计两组相关指标：扫描范围、图像质量、活检阳性率、肺内针道出血发生率、咯血及气胸发生率,进行统计学分析。[结果]低剂量组CTDIvo1和DLP明显低于常规剂量组,差异有统计学意义（P〈0.05）。两组的扫描范围、图像质量、活检阳性率、肺内针道出血、咯血及气胸发生率无显著性差异。[结论]低剂量（130kV、30mA）螺旋CT扫描引导下经皮肺穿刺活检既能保证穿刺成功和穿刺安全,又能显著减少患者的辐射剂量,是诊断周围型肺癌一种可行的方法。     

多层螺旋CT 激光定位同轴穿刺活检对孤立性肺结节定性诊断的价值

[目的] 探讨多层螺旋 CT(MSCT)激光定位导引同轴穿刺活检在孤立性肺结节定性诊断的临床价值.[方法] 回顾分析经 MSCT激光定位导引同轴穿刺活检直径0.6～3.0cm的孤立性肺结节76例.[结果] 孤立性肺结节靶点刺中率100.0％,穿刺活检诊断准确率为97.3％.其中恶性肿瘤54例占71.1％,良性病变22例占28.9％,术后并发少量气胸(肺压缩＜10％)者9例,占11.8％,并发肺内穿刺针道出血11例,占14.5％.[结论] MSCT激光定位导引同轴穿刺活检可显著提高穿刺精确度,是对孤立性肺结节的定性诊断快捷有效的重要手段.     

同轴技术在CT引导下肺内小结节穿刺活检中的应用108例分析

[目的]评价同轴技术在CT引导下经皮肺内小结节穿刺活检中的应用价值。[方法]CT引导下应用同轴技术经皮肺内小结节穿刺活检108例，导向针用18G带针芯的千叶针，取材针用20G全自动活检切割针。[结果]108例CT引导下肺内小结节穿刺活检．取材针均到达病灶．取得满意标本．无一例穿刺失败。导向针在肺内时．未出现气胸、出血并发症；导向针拔除后出现13例气胸、3例胸壁血肿．无其它严重并发症。形态恢复率100％，组织学和细胞学总阳性率为95％。[结论]同轴技术在CT引导下经皮肺内小结节穿刺活检中的应用，可避免重复穿刺及气胸引起的穿刺失败，提高穿刺阳性率。     

低剂量螺旋CT检出肺内结节的价值

目的：探讨低剂量螺旋CT检出肺内结节的临床价值。方法：对30例患者进行胸部低剂量（33mA）和常规剂量（200mA）的扫描参数重复扫描，检出肺内结节的数量、CT值、及图像噪声等进行统计学分析。结果：低剂量与常规剂量螺旋CT扫描发现肺内结节方面有相同的能力，其检出肺内结节数无显著差异，对诊断的敏感性和特异性影响不大。结论：低剂量螺旋CT可成为肺内结节普查的最佳方法。     

低剂量螺旋CT检出肺内结节的价值

目的:探讨低剂量螺旋CT检出肺内结节的临床价值.方法:对30例患者进行胸部低剂量(33mA)和常规剂量(200mA)的扫描参数重复扫描,检出肺内结节的数量、CT值、及图像噪声等进行统计学分析.结果:低剂量与常规剂量螺旋CT扫描发现肺内结节方面有相同的能力,其检出肺内结节数无显著差异,对诊断的敏感性和特异性影响不大.结论:低剂量螺旋CT可成为肺内结节普查的最佳方法.     

低剂量螺旋CT对7496名社区肺癌高危人群的筛查研究

摘 要：［目的］ 探讨低剂量螺旋CT（LDCT）对社区肺癌高危人群的筛查效果。 ［方法］ 在社区招募7496名肺癌高危人群进行LDCT筛查。肺癌高危人群定义为年龄40岁以上,并且具有下列任何一项者：20包年以上的吸烟史、肺癌家族史、肺部既往病史（慢性阻塞性肺病、肺结核）、职业接触史（石棉、氡、砷、铬、镍接触史）。以发现至少一个≥4 mm非钙化结节为LDCT筛查的阳性结果。［结果］ 7496名肺癌高危人群进行LDCT肺癌筛查,非钙化结节≥4 mm 者共1057名（14.1%）。年龄≥55岁的高危人群结节阳性率显著高于年龄<55岁者（14.9% vs 9.7%;χ2=22.27,P<0.001）。筛查出肺癌33例,占结节阳性者的3.1%,肺癌检出率为0.44%。共确诊21例非小细胞肺癌,其中0~Ⅰ期11例,早期诊断率为52.4%。［结论］ LDCT肺癌筛查有助于提高肺癌的早期诊断率和非钙化结节的检出率,尤以55岁以上人群值得推广。     

血清自身抗体联合低剂量螺旋CT在肺癌早期筛查中的价值

目的 探讨血清自身抗体检测联合低剂量螺旋CT（LDCT）在肺癌早期筛查中的可行性。方法 收集武汉大学人民医院体检中心体检人群12 568例体检资料,男7 453例、女5 115例,筛选出肺癌高危人群1 324例纳入本研究,该人群均进行胸部X线检查。随机选取443例患者采用低剂量螺旋CT检测;488例患者采用血清自身抗体进行检测;393例患者采用血清自身抗体联合低剂量螺旋CT检测。均随访一年,比较不同筛查方法对肺结节初筛阳性率及肺癌确诊率,早期肺癌筛查的敏感度及特异性。结果 血清自身抗体联合低剂量螺旋CT检测对于发现肺结节的初筛率、肺癌的确诊率及不同直径肺结节的检出率均明显高于低剂量螺旋CT组及血清自身抗体检测组（P<0.001）。血清自身抗体联合低剂量螺旋CT检测的特异性为89.1%,敏感度为88.4%,AUC为0.863。结论 血清自身抗体检测联合低剂量螺旋CT可明显提高高危人群早期肺癌筛查的确诊率,为寻找肺癌筛查路径提供理论依据。     

Low-Dose Computed Tomography (LDCT) Lung Cancer Screening in Asian Female Never-Smokers Is as Efficacious in Detecting Lung Cancer as in Asian Male Ever-Smokers: A Systematic Review and Meta-Analysis

IntroductionLung cancer in never-smokers is the major cancer cause of death globally. We compared the efficacy of low-dose computed tomography (LDCT) lung cancer screening among never-smokers versus ever-smokers using systematic review and meta-analysis.MethodsLDCT lung cancer screening studies that simultaneously included both ever-smoker and never-smoker participants published by April 30, 2021, were searched through PubMed and Scopus. Primary outcome measure was relative risk (RR) of lung cancer diagnosed among never-smokers versus ever-smokers.ResultsA total of 14 studies (13 from Asia) were included (141,396 ever-smokers, 109,251 never-smokers, 1961 lung cancer cases diagnosed). RR of lung cancer diagnosed between ever-smokers versus never-smokers overall was 1.21 (95% confidence interval [CI]: 0.89–1.65), 1.37 (95% CI: 1.08–1.75) among males, and 0.88 (95% CI: 0.59–1.31) among females. RR was 1.78 (95% CI: 1.41–2.24) and 1.22 (95% CI: 0.89–1.68) for Asian female never-smokers versus male never-smokers and versus male ever-smokers, respectively, and 0.99 (95% CI: 0.65–1.50) versus high-risk ever-smokers (≥30 pack-years). Proportional meta-analysis revealed significantly more lung cancers diagnosed at first scan (95.4% [95% CI: 84.9–100.0] versus 70.9% [95% CI: 54.6–84.9], p = 0.010) and at stage 1 (88.5% [95% CI: 79.3–95.4] versus 79.7% [95% CI: 71.1–87.4], p = 0.071) among never-smokers versus ever-smokers, respectively. RR of lung cancer death and 5-year all-cause mortality in never-smokers versus ever-smokers was 0.27 (95% CI: 0.1–0.55, p < 0.001) and 0.13 (95% CI: 0.05–0.33, p < 0.001), respectively.ConclusionsThe RR of lung cancer detected by LDCT screening among female never-smokers and male ever-smokers in Asia was statistically similar. Overall and lung cancer specific mortality from the lung cancer diagnosed from LDCT screening was significantly reduced among never-smokers compared to ever-smokers.     

International Association for the Study of Lung Cancer Computed Tomography Screening Workshop 2011 report

The International Association for the Study of Lung Cancer (IASLC) Board of Directors convened a computed tomography (CT) Screening Task Force to develop an IASLC position statement, after the National Cancer Institute press statement from the National Lung Screening Trial showed that lung cancer deaths fell by 20%. The Task Force's Position Statement outlined a number of the major opportunities to further improve the CT screening in lung cancer approach, based on experience with cancer screening from other organ sites.The IASLC CT Screening Workshop 2011 further developed these discussions, which are summarized in this report. The recommendation from the workshop, and supported by the IASLC Board of Directors, was to set up the Strategic CT Screening Advisory Committee (IASLC-SSAC). The Strategic CT Screening Advisory Committee is currently engaging professional societies and organizations who are stakeholders in lung cancer CT screening implementation across the globe, to focus on delivering guidelines and recommendations in six specific areas: (i) identification of high-risk individuals for lung cancer CT screening programs; (ii) develop radiological guidelines for use in developing national screening programs; (iii) develop guidelines for the clinical work-up of "indeterminate nodules" resulting from CT screening programmers; (iv) guidelines for pathology reporting of nodules from lung cancer CT screening programs; (v) recommendations for surgical and therapeutic interventions of suspicious nodules identified through lung cancer CT screening programs; and (vi) integration of smoking cessation practices into future national lung cancer CT screening programs.     

Estimating the Cost-Effectiveness of Lung Cancer Screening with Low-Dose Computed Tomography for High-Risk Smokers in Australia

Introduction

Health economic evaluations of lung cancer screening with low-dose computed tomography (LDCT) that are underpinned by clinical outcomes are relatively few.