MR imaging in the assessment of lung cancer patients: primary lung cancer staging, evaluation of therapeutic effect and diagnosis of recurrent tumor

Magnetic resonance imaging and computed tomography were compared in a prospective study of 137 lung cancer patients proved by surgery or autopsy for determining the staging, evaluation of therapeutic effect and diagnosis of recurrent tumor. 1. Lung cancer staging In peripheral lung cancer, T1 and T2 relaxation times of the tumors before operation have some correlation with those of operated specimens. These relaxation times, however, are of limited nodule characterization. Hilar mass and adjacent pulmonary consolidation (obstructive pneumonia or collapse) can be distinguished on T2-weighted image (77%) and Gd-DTPA enhanced image (80%). Therefore these images help in distinguishing tumor from peripheral lung disease. In the diagnosis of tumor invasion to the heart and great vessels, MRI is superior to CT because MRI can be helpful in distinguishing true mass from heart and great vessels. As for the chest wall, MRI is more useful than CT in detecting tumor invasion especially to the thoracic inlet and superior regions. In the diagnosis of mediastinal and hilar lymphadenopathy, MRI is equivalent or slightly inferior to CT, but MRI can easily demonstrate the lymphadenopathy at subcarinal region on coronal image. 2. Evaluation of therapeutic effect in lung cancer patients treated by radiation and chemotherapy MRI patterns of therapeutic effect was divided into 3 types. It is suggested that there is some correlation between these patterns and histologic types. MRI can easily demonstrate necrotic area on T2-weighted and Gd-DTPA enhanced images. 3. Diagnosis of recurrent tumor in treated lung cancer Concerning detecting recurrent tumor after surgery or irradiation, and delineating tumor from radiation pneumonitis, T2-weighted and Gd-DTPA enhanced images are of clinical value.     

T1期肺癌原发灶18F-FDG摄取与转移的关系

目的 探讨T1期肺癌原发灶18F-脱氧葡萄糖(FDG)摄取与病灶大小、淋巴结转移、远处转移、病理类型的关系.方法 对61例治疗前行全身18F-FDG PET/CT扫描的T1期肺癌患者,确定其临床分期以及原发灶大小(最大径)和18F-FDG摄取值[以最大标准摄取值(SUVmax)表示],并分为无转移组、仅淋巴结转移组和有远处转移组.分析各组的18F-FDG摄取与原发灶大小、淋巴结转移、远处转移、病理类型的关系.结果 原发灶大小与SUVmax呈正相关(r=0.466,P＜0.05),各组间大小差异无统计学意义.SUVmax在无转移组(5.05±1.97)与仅淋巴结转移组(7.96±2.98)、远处转移组(8.25±2.93)之间差异均有统计学意义(P值分别为0.003,0.002).而仅淋巴结转移组与远处转移组之间SUVmax差异无统计学意义(P=0.718).肺腺癌、鳞癌的大小(t=1.566,P=0.111)和SUVmax(t:0.478,P=0.623)差异均无统计学意义.结论 T1期肺癌原发灶18F-FDG摄取可能对预测转移有一定的价值.     

血浆循环DNA在肺癌诊断上的应用

 目的研究血浆循环Fhit基因D3S1300位点杂合性缺失(LOH)作为肿瘤标志物在非小细胞肺癌早期诊断中的意义.方法以微卫星技术检测58例非小细胞肺癌(Non small cell lung cancer,NSCLC)患者血浆及肿瘤组织以及40例非肺癌肺科住院患者血浆Fhit基因D3S1300LOH的表达情况.结果58例NSCLC患者中肿瘤组织D3S1300 LOH检出率为41.4%(24/58),在其匹配的血浆中D3S1300 LOH检出率为29.3%(17/58),二者差异有统计学意义(P＜0.05).对照组血浆游离DNA D3S1300 LOH检出率为5%(2/40),与NSCLC组比较差异有统计学意义(P＜0.01).结论血浆循环DNA Fhit基因D3S1300 LOH是一种简单有效的肺癌肿瘤筛选标志物.     

非小细胞肺癌FDG摄取与转移的关系

目的 观察治疗前非小细胞肺癌患者的原发灶18F-脱氧葡萄糖(FDG)摄取与淋巴结和(或)远处转移的关系.方法 回顾性分析山东省肿瘤医院2004年6月至2007年4月治疗前行FDGPET/CT检查的拟诊肺癌患者资料,共收集到病理或细胞学检查明确诊断(除外糖尿病者)的肺腺癌患者94例和鳞癌65例资料.先分析原发灶大小(以CT肺窗的最大径表示)与FDG摄取[以最大标准摄取值(SUVmax)表示]关系,然后分析腺癌、鳞癌不同转移状态组间[分为无转移组和有淋巴结和(或)远处转移组]原发灶FDG摄取值的差异,并进一步采用Logistic回归法分析影响转移的因素.结果 原发灶的大小与FDG摄取呈正相关(腺癌:r=0.610,P<0.01;鳞癌:r=0.587,P<0.01),整体分析表明非小细胞肺癌原发灶FDG摄取值是影响淋巴结和(或)远处转移的因素[优势比(0R)=1.172,P=0.010],而原发灶大小不是影响因素(OR=0.906,P=0.513);分层分析发现肺鳞癌不同转移状态组间的FDG摄取差异无统计学意义(有、无转移组SUVmax分别为11.45±6.04和10.94±4.20,χ2=0.013,P=0.911),而肺腺癌有转移组的FDG;摄取值显著高于无转移组(SUVmax分别为10.28±3.92和6.33±2.89,χ2=15.125,P<0.01),Logistic分析表明肺腺癌原发灶的FDG;摄取值是影响转移的有意义因素(OR=1.403,P=0.002).结论 肺腺癌原发灶FDG摄取与转移有关,高FDG摄取提示可能已经发生转移;而肺鳞癌FDG摄取与转移无关.     

原发性肠系膜肿瘤的CT诊断

目的：讨论原发性肠系膜肿瘤的CT表现,提高该病的CT诊断率。方法：21例经手术病理证实的原发性肠系膜肿瘤,其中良性8例,恶性13例,分析其CT征象。结果：原发性肠系膜肿瘤多单发,体积较大,与肠管关系密切,多被肠管包绕,肿块常推压腹膜后脏器移位,但两者常有脂肪间隙存在,体积较大的肿瘤多密度不均匀,良性肠系膜肿瘤多数边缘光滑、形态规则,恶性肠系膜肿瘤多数边缘不光滑,常伴大片低密度坏死。结论：CT对原发性肠系膜肿瘤的定位具有重要价值,对于良性及恶性肿瘤的鉴别亦有较大帮助,但不易明确其组织学类型。     

16层螺旋CT成像在原发性肺癌中的应用诊断价值分析

随着CT设备及扫描技术和相关计算机软件的不断更新发展,多层螺旋CT(multislice spiral CT,MSCT)应用于原发性肺癌的定量研究是目前的热点之一[1～5].本文探讨了多层螺旋CT成像在原发性肺癌中的应用诊断价值,提供诊断水平.     

Detection and diagnosis of nonpalpable supraclavicular lymph nodes in lung cancer at CT and US.

PURPOSE: To assess frequency and significance of enlarged nonpalpable supraclavicular lymph nodes by using chest computed tomography (CT) and supraclavicular ultrasonography (US) in patients at initial diagnosis of lung cancer. MATERIALS AND METHODS: Fifty-five patients with no prior malignancy who presented with suspected and subsequently proven lung cancer of any stage or a proven but potentially resectable lung cancer were prospectively selected after chest CT. Chest CT and other radiologic findings were reviewed and tabulated. Standardized US technique was used to identify and guide needle biopsy of enlarged supraclavicular lymph nodes (> or =0.5 cm short axis). RESULTS: Twenty-two (40%) of 55 patients had supraclavicular abnormalities detected at CT and/or US. In 18 (82%) of the 22 patients, supraclavicular abnormalities were recognizable at CT. Seventeen of 22 patients had malignant nodes, and five patients had benign nodes (n = 3), a cyst (n = 1), or an indeterminate lesion (n = 1) at US-guided supraclavicular needle sampling. There were no complications. Supraclavicular metastases (31% of patients) were about as common as the combined number of patients with indeterminate (n = 13) and probably or proven malignant (n = 6) adrenal nodules (35% of patients). Supraclavicular metastases were often associated with mediastinal adenopathy or suspected extrapulmonary nonnodal metastases (P <.05). CONCLUSION: In many patients with lung cancer, chest CT that includes the neck base followed by US-guided sampling of enlarged supraclavicular lymph nodes is a simple and safe method for simultaneously establishing a tissue diagnosis and tumor nonresectability.     

Sonographic diagnosis in primary cancer of the liver

The sonographic findings and their contribution to differential diagnosis and tumor staging are described in 34 patients with hepatocellular carcinoma and in 12 cases of cholangiocellular carcinoma. In most cases of hepatocellular carcinoma the liver was diffusely involved at presentation, whilst in cholangiocarcinoma tumor growth was usually limited to a single lobe. Over 60% of the hepatocellular carcinomas were predominantly echogenic. The cholangiocarcinomas all presented with a highly echogenic tumor in combination with uni- or bilaterally dilated intrahepatic bile ducts. In 20 patients estimation of liver size by the ultrasound-measurement of liver span in the right midclavicular line is compared with ultrasound-measured liver volume and its value in assessing response to therapy. Volume changes in response to therapy were demonstrated in five patients with hepatocellular carcinoma. In alpha-fetoprotein positive tumors they corresponded with changes in alpha-fetoprotein levels.     

Effect of temporal subtraction technique on the diagnosis of primary lung cancer with chest radiography

PURPOSE: The purpose of this study was to assess the diagnostic accuracy of the temporal subtraction technique in the detection of primary lung cancers by readers with different levels of experience. METHODS: Previous and current chest radiographs from 40 patients with histologically proven lung cancer and 40 controls were studied. Temporal subtraction images were produced using an automated digital subtraction technique. We evaluated the effect of temporal subtraction images in the diagnosis of lung cancer with chest radiographs via an observer performance study with the use of receiver operating characteristic analysis. Six experienced radiologists and six residents participated as observers. RESULTS: Observer performance for all observers was superior when temporal subtraction images were used (mean Az value increased from 0.764 to 0.836, p=0.0006). Although the average Az value for residents increased significantly, from 0.707 to 0.795 (p=0.0038), the average Az value for experienced radiologists increased only from 0.821 to 0.878 (n.s.). CONCLUSION: In conclusion, the temporal subtraction technique clearly improves diagnostic accuracy for the detection of primary lung cancer. The results indicated that the use of temporal subtraction images was more beneficial for the residents than for the experienced radiologists. This method would compensate to some extent for experience-dependent diagnostic accuracy in the detection of lung cancer.     

99Tcm-PPM及99Tcm-MIBI肺显像诊断原发性肺癌

目的 探讨99Tcm－培普利欧霉素（PPM）及99Tcm-甲氧基异丁基异腈（MIBI）肺显像诊断原发性肺癌的临床价值。方法 对28例临床诊断肺肿瘤患者进行99Tcm-PPM ey 99T0-MIBI肺肿瘤显像并进行比较。结果 肺癌与良性病变对99T -PPMey 99T-MIBI观的摄取差异有显著性（P＜0．01）,以肺癌晚期显像摄取比值（T／NT,X－S）作为判断良恶性阈值,99Tcm-PPM及99Tcm-MIBI对肺癌诊断的灵敏度,准确性分别为90％,89．3％,和80％,82．1％,两者结合显像阳性率为95％,病灶对放射性药物的摄取与肿瘤大小无明显相关（P＞0．05）,结论 99Tcm-PPM ey 99T-MIBI肺显像对肺癌的诊断,鉴别诊断有一定的临床价值。两者联合应用可提高肺癌的阳性检出率,单独使用99Tcm-PPM优于99Tcm-MIBI。     

Analysis of primary tumor metabolic volume during chemoradiotherapy in locally advanced non-small cell lung cancer

Purpose

Positron emission tomography with 2?deoxy-2-[fluorine-18] fluoro-d-glucose integrated with computed tomography (18F-FDG-PET/CT) has an established role in the initial diagnosis and staging of lung cancer. However, a prognostic value of PET/CT during multimodality treatment has not yet been fully clarified. This study evaluated the role of primary tumor metabolic volume (PT-MV) changes on PET/CT before, during, and after chemoradiotherapy (CRT).

Methods

A total of 65 patients with non-small-cell lung cancer (NSCLC) UICC stage IIIA/B (TNM 7th Edition) were treated with definitive chemoradiotherapy (sequential or concurrent setting). PET/CT was acquired before the start, at the end of the third week, and 6 weeks following CRT.

Results

Median overall survival (OS) for the entire cohort was 16 months (95% confidence interval [CI]: 12–20). In all, 60 (92.3%) patients were eligible for pre-treatment (pre-PT-MV), 28 (43%) for mid-treatment (mid-PT-MV), and 53 (81.5%) for post-treatment (post-PT-MV) volume analysis. Patients with pre-PT-MV >63?cm³ had worse OS (p < 0.0001). A reduction from mid-PT-MV to post-PT-MV of >15% improved OS (p = 0.001). In addition, patients with post-PT-MV > 25?cm³ had significantly worse outcome (p = 0.001). On multivariate analysis, performance status (p = 0.002, hazard ratio [HR] 0.007; 95% CI 0.00–0.158), pre-PT-MV1 < 63?cm³ (p = 0.027, HR 3.98; 95% CI 1.17–13.49), post-PT-MV < 25?cm³ (p = 0.013, HR 11.90; 95% CI 1.70–83.27), and a reduction from mid-PT-MV to post-PT-MV > 15% (p = 0.004, HR 0.25; 95% CI 0.02–0.31) correlated with improved OS.

Conclusions

Our results demonstrated that pre- and post-treatment PT-MV, as well as an at least 15% reduction in mid- to post-PT-MV, significantly correlates with OS in patients with inoperable locally advanced NSCLC.

     

基于PET/CT选定阈值与基于4D-CT呼气末时相所勾画非小细胞肺癌原发肿瘤靶区相关性分析

目的 探讨基于PET/CT图像选定阈值与基于4D-CT呼气末时相图像所勾画的非小细胞肺癌(NSCLC)原发肿瘤靶区相关性因素。方法 入组NSCLC患者序贯完成3DCT、4D-CT、¹⁸F-FDG PET/CT胸部定位扫描。基于4D-CT呼气末时相(50%)图像勾画原发肿瘤大体肿瘤体积(GTV_50%)。基于PET图像原发肿瘤标准摄取值(SUV)≥2.0、SUV最大值(SUV_max)的20%勾画内大体肿瘤体积(IGTV)分别命名为IGTV_PET2.0、IGTV_PET20%。分析IGTV_PET2.0、IGTV_PET20%与GTV_50%的体积比(VR_2.0、VR_20%)及适形指数(CI_2.0、CI_20%)与GTV_50%最大横径、GTV_50%体积大小、GTV头脚方向位移、GTV三维运动矢量及SUV_max的相关性。结果 VR_2.0和GTV_50%最大横径、GTV_50%体积大小、GTV头脚方向位移、GTV三维运动矢量及SUV_max均无相关性(P>0.05);VR_20%和GTV_50%体积大小、GTV_50%最大横径及SUV_max呈负相关(r=-0.663、-0.669、-0.752,P<0.05)。CI_2.0和GTV_50%体积大小、GTV_50%最大横径呈正相关(r=0.613、0.483,P<0.05)。结论 3D PET图像是包含了多个呼吸周期的中位图像,未能包含肿瘤的全部运动信息,基于3D PET/CT图像所构建的靶区不能准确地代表NSCLC的IGTV。     

原发性肺透明细胞癌的CT诊断

目的 探讨原发性肺透明细胞癌的CT表现.方法 回顾分析经手术和/或病理证实的7例患者的CT表现和临床病理的特点,并结合文献进行分析.结果 原发性肺透明细胞癌的CT主要表现为肺周围性肿块（5/7）,肿块常较大、形态不规则、密度均匀、有分叶、可见毛刺;1例为空洞性肿块,增强扫描呈中等度强化,无纵隔淋巴结肿大.2例左肺上叶中央型肿块合并肺不张,与其它类型中央型肺癌相似.结论 原发性肺透明细胞癌临床表现无特异性,CT上仅有相对的影像学特征,确诊仍需依赖病理学检查.     

肺炎型肺癌的CT诊断与鉴别诊断

 目的 分析肺炎型肺癌的CT表现,并探讨需要与肺炎型肺癌鉴别的相关疾病。方法 回顾性分析17例经皮穿刺活检、纤维支气管镜、痰脱落细胞学检查及手术证实的肺炎型肺癌的CT表现。结果 17例肺炎型肺癌中腺癌14例,腺鳞癌2例,细支气管肺泡癌1例。CT表现包括磨玻璃密度13例,小结节影15例,实变影17例,支气管充气征16例,枯枝征14例,血管造影征12例,胸膜牵拉增厚或叶间裂膨隆16例,空泡征13例,蜂窝征5例,铺路石征9例,肺门和(或)纵隔淋巴结大13例,骨质破坏4例,胸腔积液11例。12例CT增强扫描的患者中7例呈明显强化(CT值增加大于30 Hu),5例呈轻度强化。结论 当CT表现有磨玻璃征、多发结节、枯枝征、空泡及蜂窝征、铺路石征、临近纵隔胸膜增厚,增强后实变区较明显强化和轻度强化并见血管造影征,呈外周分布,结合临床有刺激性咳嗽、咳大量白色黏液痰、痰中带血,以及肿瘤标志物升高时,高度提示肺炎型肺癌。     

多层螺旋CT诊断孤立性周围型原发肺癌的临床价值

本文收集2010年2月～2012年5月在我院就诊的23例孤立性周围型原发性肺癌患者临床资料,分析多层螺旋CT对孤立性周围型原肺癌的诊断价值[1～3],提高诊断水平. 1材料与方法 本组23例患者,其中男性18例,女性5例,年龄48～82岁,平均66.3岁.主要临床表现为咳嗽、咳血丝等,所有患者均经病理证实为肺癌.其中鳞癌13例,腺癌7例,小细胞肺癌3例.