X线、CT对肺癌诊断的评价

目的:评估X线与CT对肺癌的诊断价值。材料与方法:本组收集110例肺癌经X线平片和体层摄影所见及CT表现与手术病理对照分析两者的诊断价值。结果:肿块型(主要为周围型肺癌)在显示分叶和毛刺征像上CT类同X线,但在显示肺内隐蔽部位病灶CT明显优于X线胸片,且CT显示纵隔肺门淋巴结转移较好,其诊断率为72％。但X线胸片及体层摄片在显示肿块整体形态比CT好,特别对中央型肺癌,气管分层能清晰显示受累气管腔内新生物及阻塞面形态。结论:X线平片加体层摄片对肺癌的诊断优于CT,其诊断率96％(CT为93％)。两者互相结合其诊断率达99％。     

原发性气管肿瘤并皮下气肿的影像评价

目的 :探讨计算机X线摄影 (CR)对原发性气管肿瘤 (PTT)并皮下气肿的诊断价值 ;同时讨论了良、恶性肿瘤的表现 ,普通CR体层、CT和MRI在诊断PTT中的优、缺点和选择。方法 :6例病人均行高千伏胸部摄影及纤支镜检查 ,5例病人行坐位气管体层 ;因病人不能平卧均未做CT检查。结果 :CR体层摄影可清楚显示肿瘤的部位、大小及与管壁的关系 ,其中腺瘤 3例 ,鳞癌、腺癌和纤维瘤各 1例。结论 :普通CR体层摄影是气管肿瘤首选检查方法 ,有很高的诊断价值 ;病情允许仍应选择CT检查。     

先天性支气管闭锁的影像学表现

目的分析先天性支气管闭锁（CBA）的影像学表现。资料与方法回顾性分析5例CBA的临床和影像学表现,并结合文献复习。5例均行X线及CT检查,1例行普通X线断层摄影,2例行MRI检查。结果X线胸片示3例肺门区肿块样阴影．1例局部肺野多发结节阴影,1例囊肿周围肺野过度透亮。胸部CT示5例黏液囊肿显示为多发分支状和棍棒状肿块或结节样阴影及周围肺野的过度充气改变。2例显示周围肺野支气管扩张改变。2例胸部MRI示囊肿T1、T2均为高信号。结论黏液囊肿和周围肺野的过度充气是CBA典型表现,CT对CBA的诊断优于其他影像学检查方法。     

中央型肺癌的X线表现与纤支镜对照分析（附病例分析118例）

目的：为评价X线胸部平片、体层摄影和纤支镜对中央型肺癌的诊断作用，对其进行对照分析。方法：男97例，女21例。全部病例摄有平片、体层片，均行纤支镜检查，并取活检和刷洗涂片，部分病例还作其他检查。结果：平片拟诊肺癌85例诊断正确率为72％；体层片诊断支气管肺癌96例，诊断正确率80.1％，显示肺门及纵膈肿块92例，合并淋巴结肿大16例；纤支镜诊断支气管肺癌108例，诊断正确率91．3％。结论：X线胸部平片，体层摄影和纤支镜各有长处，相互结合提高中央型肺癌诊断的正确率。     

分析数字化体层摄影术对胸部X线疑似肺部疾病病人的影像学检查的作用

目的评价数字化体层摄影术(DTS)对胸部X线摄影(CXR)疑似肺部疾病病人的影像学检查的作用。方法 CXR疑似肺部疾病经过DTS检查的病人有339例[男200例,平均(71.19±11.9)岁]。2名研究人员前瞻性分析DTS和CXR影像,并且记录他们的诊断意见:1或者2表示确定的或很可能为良性病变或假性病变,而不需要进一步检查;3表示不确定的;4或者5表示很可能或确定为肺部病变,需要进一步行CT检查。经CT(76例)、CXR(256例)定期复查的影像,或组织学检查(7例)为参考标准。结果 DTS明确了339例病人中256例(76%)CXR不能确定的病灶,而339例中83例(24%)进一步行CT检查。DTS的平均检查时间[(220±40)s]高于CXR的[(110±30)s](P<0.05),但是低于CT的[(600±150)s]。平均有效辐射剂量,CXR为0.06mSv(0.03～0.1mSv),DTS为0.17mSv(0.094～0.12mSv),CT为3mSv(2～4mSv)。结论相对于CXR而言,平均检查时间和有效辐射剂量略有增加的DTS避免了3/4的病人行CT检查。要点①DTS提高了CXR的诊断正确率。②DTS减少了肺部可疑病变对CT的需求。③DTS仅产生了大约2倍于CXR的辐射剂量。④DTS检查时间长于传统胸部X线的检查时间。     

胸部块影X线、CT与纤维支气管镜对照分析

目的确定胸部块影的X线与CT特征及其与纤维支气管镜所见的关系。材料和方法收集25例肺部块影,均行胸部正侧位片及CT平扫和增强检查,采用纤支镜检查对照分析。结果普通胸部X线诊断符合率64．0％,CT诊断符合率84．0％,对胸部疾病的敏感性和特异性CT优于常规胸片。纤支镜检查符合率88．0％,纤支镜检查对肺周围型病变存在一定局限性,可在CT引导下穿刺活检同样能得到准确诊断。结论胸部X线、CT检查对多数疾病可作出准确诊断,肿块阴影、结节阴影和肺门肿块多见于肿瘤,班片状阴影多见于炎症和结核。纤支镜检查对胸部块影的病因和性质能提供可靠依据。     

直接数字曲面体层摄影在涎腺造影中的临床价值

目的评价直接数字曲面体层摄影在涎腺造影中的临床价值。方法选择表现正常的腮腺造影数字化曲面体层影像(58侧)及传统曲面体层照片(44侧),评价主导管、腮腺腺泡及分支导管的显影情况。结果在显示腮腺主导管、第一级分支导管及腮腺腺泡方面,直接数字曲面体层与传统曲面体层胶片摄影无明显差异;数字成像显示细微解剖结构(第二、三级分支导管)的质量则明显优于胶片方式(P<0.01)。结论直接数字曲面体层摄影在涎腺造影中具有重要的临床价值。     

尘肺的CT检查与X线胸片比较研究

目的对比分析胸部CT及X线胸片对尘肺的诊断价值。方法回顾性分析52例尘肺的胸部CT及X线胸片资料,男47例,女5例,平均年龄59岁。结果52例中有28例胸部CT表现有两肺弥漫性小阴影(直径<10mm的阴影),胸部X线发现19例有小阴影。大阴影(直径>10mm的阴影)CT显示13例,X线胸片显示9例。合并症CT显示20例,其中肺炎5例,肺结核3例,肺癌2例,气胸6例,肺气肿4例。X线胸片显示10例,其中肺炎1例,肺结核1例,气胸6例,肺气肿2例。结论在单纯的尘肺诊断中,CT并不优于X线胸片,但对大阴影、胸膜改变及合并症的检出率明显高于X线胸片,并可弥补X线胸片的不足。     

65例大细胞肺癌的MSCT表现

目的探讨大细胞肺癌(largecell lung cancer,LCLC)的MSCT表现特征。资料与方法回顾性分析经手术病理证实的65例LCLC的MSCT表现。所有患者术前均行胸部CT平扫,其中49例行CT平扫+增强扫描。结果所有病变均表现为肺内肿块,61例(61/65,93.8%)为周围型,38例(38/65,58.5%)位于上叶,45例(45/65,69.2%)肿块呈分叶状,肿块最大径1.2～14.2cm[平均(5.2±2.1)cm],53例(53/65,81.5%)肿块边缘光滑或基本光滑,46例(46/65,70.8%)肿块侵犯邻近胸膜,仅2例(2/65,3.1%)伴胸膜凹陷征。肿块平扫CT值17～54HU[平均(36±8.4)HU];49例肿块行CT增强扫描,其中48例(48/49,98.0%)呈不均匀强化,CT值40～99HU[平均(66±12.2)HU],平均净增30HU;27例(27/65,41.5%)伴同侧肺门或纵隔淋巴结转移。结论 LCLC的MSCT表现具有一定的特征性,主要表现为周围型分叶状较大肿块,平扫密度均匀或不均匀,增强后呈不均匀强化,伴坏死液化区,肿块边缘光滑或基本光滑,易侵犯邻近...     

肺癌X线与CT检查比较

目的:比较X线与CT检查对肺癌的诊断价值。材料与方法:100例肺癌经X线平片和断层摄影及CT检查,并与手术病理对照。结果:中心型肺癌48例,其中CT确诊42例(87.5％),而X线确诊34例(70.8％),显然,CT优于X线。就周围型肺癌而言,在显示肿块分叶状与毛刺状方面,CT类似于X线,当调整肺窗与纵膈窗的窗宽与窗位时,CT比X线显示得清晰。经手术病理证实,肺门、纵膈淋巴结转移67例,CT检出其中48例(72％),而X线只检出16例(24％)。然而,在显示肿物整体形态及边缘状况方面,常规X线胸片及病灶体层片却又比CT好些。结论:X线与CT两种检查方法对肺癌诊断各有利弊,要正确合理配合应用来提高肺癌的诊断水平。     

One-shot dual-energy subtraction chest imaging with computed radiography: clinical evaluation of film images

A clinical evaluation of one-shot dual-energy subtraction chest imaging by means of computed radiography (CR) with imaging plates was carried out in a comparison with the original plain CR images. In analyses of chest images of 140 patients, new information, not detected on the original plain CR images, was obtained on subtraction images in 21 patients (15%). Receiver operating characteristic curve studies also verified the superiority of CR subtraction over the original plain CR images for the detection of pulmonary nodules, calcification in a nodule, and rib lesions. Subtraction images complemented the original plain images.     

外围型早期肺癌的X线诊断

笔者对已确诊的46例直径2cm以下的外围型早期肺癌进行了回顾性分析。第一次胸片X线表现,有单个斑点(或颗粒)状影,多个颗粒状影,少量索条状影,索片状影,小片状影,小结节状影与小空洞影等7种基本形态。其中腺癌27例,鳞癌9例,鳞腺癌3例,混合癌(腺、鳞、小细胞未分化癌)1例,小细胞未分化癌2例,肺泡癌1例,未定类型3例。平片与体层均能显示一种或多种恶性征者22例。24例平片无恶性征,但经正或侧位病灶断层表现有恶性征者18例,具有恶性征共占87％(40/46)。笔者认为,除加强对早期外围型肺癌X线征的认识外,只要有优质胸片,包括多体位的电视透视点片及多轴位的体层片,认真查找恶性征象,绝大部分病例是能作出诊断的。另外还分析了漏诊与误诊的原因,讨论了诊断与鉴别诊断问题。     

Review of radiographic findings in COVID-19

The purpose of this study is to review the published literature for the range of radiographic findings present in patients suffering from coronavirus disease 2019 infection. This novel corona virus is currently the cause of a worldwide pandemic. Pulmonary symptoms and signs dominate the clinical picture and radiologists are called upon to evaluate chest radiographs (CXR) and computed tomography (CT) images to assess for infiltrates and to define their extent, distribution and progression. Multiple studies attempt to characterize the disease course by looking at the timing of imaging relative to the onset of symptoms. In general, plain CXR show bilateral disease with a tendency toward the lung periphery and have an appearance most consistent with viral pneumonia. Chest CT images are most notable for showing bilateral and peripheral ground glass and consolidated opacities and are marked by an absence of concomitant pulmonary nodules, cavitation, adenopathy and pleural effusions. Published literature mentioning organ systems aside from pulmonary manifestations are relatively less common, yet present and are addressed in this review. Similarly, publications focusing on imaging modalities aside from CXR and chest CT are sparse in this evolving crisis and are likewise addressed in this review. The role of imaging is examined as it is currently being debated in the medical community, which is not at all surprising considering the highly infectious nature of Severe Acute Respiratory Syndrome coronavirus 2.     

Effect of patient position on interpretation of lung images complicated by chest radiograph opacities

Lung images in which perfusion defects correspond to chest radiograph (CXR) opacities in size and location are generally classified as having an intermediate probability for pulmonary embolism, while those studies in which the perfusion defects are considerably smaller than the CXR opacities are classified as having a low probability for pulmonary embolism. A case is presented in which, by imaging a patient in both the erect and supine positions, the authors were able to change the interpretation of the study from intermediate probability (perfusion defect = CXR opacity) to low probability (perfusion defect less than CXR opacity).     

肺血管性疾病的临床X线特征(附64例分析)

本文报道经证实的64例肺血管性疾病,着重就其X线平片、断层片的特征以及临床病理表现进行分析。就诊断价值而言,作者归纳如下3类征象:1.特异性X线诊断征,如“8”字征等。2.有相对价值的诊断征,如肺动脉段膨凸等。3.非特异性诊断征,如肿块等。     

Usefulness of technetium-99m hexamethylpropylene amine oxime lung scan to detect inhalation lung injury of patients with pulmonary symptoms/signs but negative chest radiograph and pulmonary function test findings after a fire accident—a preliminary report

OBJECTIVE: In this study, we employed technetium-99m hexamethylpropylene amine oxime (99mTc HMPAO) lung scan to detect inhalation lung injury of patients after a fire accident. METHODS: Ten healthy men for controls and 10 male patients with pulmonary symptoms/signs from a fire accident were enrolled in this study for comparison. 99mTc HMPAO lung scan was performed in each control and patient, as well as the degree of pulmonary vascular endothelium damage was represented as lung/liver uptake ratios (L/L ratio). All of the controls and patients had no smoking histories. None of the controls and patients had positive findings of plain chest radiograph (CXR) and pulmonary function test (PFT). RESULTS: The results showed that significantly higher L/L ratio in the 10 patients (0.53 +/- 0.07) than in the 10 controls (0.30 +/- 0.07) (the p value < 0.05). Using a cut-off value of 0.40, all of the 10 patients had abnormally increased L/L ratios. CONCLUSIONS: We conclude that 99mTc HMPAO lung scan has the potential to be a sensitive, objective and noninvasive method to detect inhalation lung injury of patients with pulmonary symptoms/signs but negative CXR and PFT findings after a fire accident.     

家兔肺挫伤早期影像学的变化及其意义

目的探讨单光子发射计算机断层显像(SPECr)、胸部CT以及x线平片对家兔肺挫伤的早期诊断价值。方法建立兔单侧胸部撞击伤动物模型,采用SPECT、胸部CT以及x线平片对兔肺挫伤进行早期诊断,并与病理解剖结果进行对照观察。结果在伤后1、6、24小时,x线诊断肺挫伤的敏感性分别为33．33％(3／9)、55．56％(5／9)、75．00％(6／8),有2只动物未检出肺挫伤病变。在伤后1小时,CT显示双肺均有挫伤100％(2／2),结合动物病理观察,CT与实际伤情非常吻合,而x线低估了肺挫伤的病变范围。结论胸部CT在诊断胸部创伤获得治疗相关信息方面明显优于x线平片。因此,对于严重胸部创伤以及多发伤,急诊检查应采甩CT扫描,以尽快明确诊断。     

Improvement of lung abnormality detection in computed radiography using multi-objective frequency processing: Evaluation by receiver operating characteristics (ROC) analysis

Computed radiography (CR) has been shown to have relatively low sensitivity for detection of pulmonary nodules. This poor sensitivity precludes its use as a screening modality despite the low cost, low dose and wide distribution of devices. The purpose of this study was to apply multi-objective frequency processing (MFP) to CR images and to evaluate its usefulness for diagnosing subtle lung abnormalities. Fifty CR images with simulated subtle lung abnormalities were obtained from 50 volunteers. Each image was processed with MFP. We cut chest images. The chest image was divided into two rights and left. A total of 200 half-chest images (100 MFP-processed images and 100 MFP-unprocessed images) were prepared. Five radiologists participated in this study. ROC analyses demonstrated that the detection rate of simulated subtle lung abnormalities on the CR images was significantly better with MFP (Az=0.8508) than without MFP (Az=0.7925). The CR images processed with MFP could be useful for diagnosing subtle lung abnormalities. In conclusion, MFP appears to be useful for increasing the sensitivity and specificity in the detection of pulmonary nodules, ground-glass opacity (GGO) and reticular shadow.     

Role of the chest radiograph in the preoperative assessment of the pulmonary function in patients with cirrhosis candidates to liver transplant

PURPOSE: To appraise the role of chest radiography (CXR) in the clinical assessment of pulmonary complications occurring as a result of liver disease of any cause, a standardised reading of CXR was compared both with the results of lung function studies and with the severity of liver disease in 60 consecutive patients with cirrhosis candidates to liver transplant. MATERIALS AND METHODS: CXR were scored for signs of cardiomegaly, enlargement of central and or peripheral vessels, hyperkinetic circulatory and/or intravascular volume states, abnormally increased interstitial lung markings, and pleural effusion by three independent observers. RESULTS: The CXR score of this complete vascular-interstitial deficiency showed a high interobserver reproducibility and was significantly increased in those patients with a more decompensated liver cirrhosis. Moreover, a larger number of CXR signs of vascular and interstitial deficiency was present in those patients who had a more severe cirrhosis (Child-Pugh class 3). Functional indices of pulmonary gas exchange and diffusing capacity were worse in patients with end-stage liver cirrhosis, and for some indices the correlation was statistically significant. The comparison between lung function and CXR score showed that on average lung function impairment was significantly less severe in patients with lower CXR scores. CONCLUSIONS: In conclusion, the information derived from a standardised reading of CXR is valuable in the clinical assessment of the pulmonary damage induced by liver cirrhosis as it allows discrimination of classes of severity of liver disease and of lung function impairment. When integrated with physiologic measurements and, if necessary, with high resolution tomographic studies, chest radiography helps to discriminate patients with advanced liver cirrhosis and progressing towards a hepatopulmonary syndrome, who need a proper therapeutic management.     

Accuracy of transthoracic sonography in excluding post-interventional pneumothorax and hydropneumothorax. Comparison to chest radiography

OBJECTIVE: Transthoracic sonography (TS) has evolved as an important imaging technique for diagnosing pleural and pulmonary conditions. However, the value of TS in either excluding or diagnosing pneumothorax is still under debate. This study was conducted to examine whether TS could replace chest radiography for the diagnosis of post-interventional pneumothorax and hydropneumothorax. METHODS: 53 patients (21 females, 32 males; median age 64 years, range 37-94 years), 35 of whom underwent transbronchial biopsy (TBB) and 18 patients who had an ultrasound-guided chest tube placement (U-GCTP) were enrolled in the study. TS was performed three hours after either TBB or removal of a chest tube, followed by postero-anterior chest radiograph (CRX). If any discrepancy between TS, the clinical presentation and the CRX became apparent, either a lateral CRX or a computed tomography (CT) of the thorax was performed. TS was assessed according to the presence of the following criteria: (1) "gliding sign" of the pleural line, (2) comet tail artifacts, (3) reverberation artifacts, (4) air/fluid mirror, (5) hyperechoic reflectors within the pleural effusion and (6) "lung point". RESULTS: In four out of the 53 patients (7.5%) a post-interventional pneumothorax or hydropneumothorax occurred. One out of the 35 patients (2.9%) developed a pneumothorax after TBB, requiring chest tube placement. Three patients (16.7%) developed a hydropneumothorax due to U-GCTP which was detected by sonography but was missed by postero-anterior CRX in one patient. The sensitivity, specificity and accuracy of TS were 100% in excluding post-interventional pneumothorax/hydropneumothorax. CONCLUSION: TS is a cost-effective and safe bed-side-method, allowing for an immediate exclusion or diagnosis of post-interventional pneumothorax/hydropneumothorax in patients who have undergone TBB or U-GCTP. Thus, these preliminary results suggest that CXR may only be required in patients with pneumothorax diagnosed by TS in order to assess its extension or to exclude any discrepancy between the TS-result and the clinical presentation.