中央型小细胞肺癌与肺鳞癌CT征象分析

目的 分析中央型小细胞肺癌(small cell lung cancer,SCLC)及肺鳞癌(squamous carcinoma,SC)的CT表现,探讨各自影像学特点及鉴别诊断价值.方法 选取2019年1月～2019年12月在我院经病理证实的SCLC及SC患者的临床及影像学资料,分为SCLC组30例,SC组31例,对...     

周围型小细胞肺癌和非小细胞肺癌CT表现对比分析

目的 探讨周围型小细胞肺癌CT表现特征.方法 应用配比病例对照研究的方法 ,回顾性分析经病理证实的、原发灶≤3 cm的周围型小细胞肺癌和非小细胞肺癌各30例的临床资料和CT表现.结果 30例周围型小细胞肺癌CT表现为分叶征(23/30)、边缘光滑锐利(22/30)、毛刺或棘突征(8/30)、胸膜凹陷征(7/30)、血管连接征(2/30)等.30例周围型非小细胞肺癌CT表现为分叶征(16/30)、边缘光滑锐利(6/30)、毛刺或棘突征(24/30)、胸膜凹陷征(24/30)、血管连接征(8/30)、空泡或空洞或支气管征(13/30)等.经卡方检验发现小细胞肺癌和非小细胞肺癌中的分叶征发生频率差异无统计学意义(χ2=3.5897,P=0.0581),其它征象的差异有统计学意义.30例周围型小细胞肺癌发现肺门和纵隔淋巴结肿大22例(73.3%),30例周围型非小细胞肺癌发现肺门和纵隔淋巴结肿大5例(16.7%),经统计学分析差异有统计学意义(χ2=19.4613,P<0.001).结论 原发灶≤3 cm的周围型小细胞肺癌主要CT表现为边缘光滑锐利的密实结节.原发灶较小时即可伴有明显的肺门、纵隔淋巴结肿大(转移).     

MSCT对中央型小细胞肺癌与肺鳞癌支气管改变的比较研究

目的 对比分析中央型小细胞肺癌和肺鳞癌对支气管改变的特征性CT表现.方法 回顾性分析89例中央型肺癌患者的胸部CT图像,根据病理分为两组:小细胞肺癌组(43例)、鳞癌组(46例).根据受累支气管在肿块中阻断点的情况分为三型:Ⅰ型,阻断点深入肿块不到1/3;Ⅱ型,阻断点深入肿块1/3至2/3处;Ⅲ型,阻断点深入肿块的2/...     

64层螺旋CT对周围型肺小腺癌的诊断价值

目的:探讨64层螺旋CT对周围型肺小腺癌基本征象的显示及价值。方法:经病理证实的周围型肺小腺癌26例,分析薄层重建、多平面重建(MPR)及容积显示(VR)技术对周围型肺小腺癌的基本征象的显示及价值,并与常规横断面对比分析。结果:①64层CT薄层重建、MPR及VR在显示肺小腺癌的分叶征、毛刺征、胸膜凹陷征及支气管血管集束征方面优于常规横断面;②MPR及VR对于空泡征、支气管气相和支气管血管集束征的判别有优势。结论:64层CT通过薄层重建配合MPR、VR能够克服横断扫描限制,更加细微、准确、立体、完整地显示肺小腺癌的基本征象,为周围型肺小腺癌的诊断提供更多信息。     

周围型小肺癌的CT分析

目的探讨小肺癌CT表现方法对34例经病理证实的小肺癌(首次检查≤2.0cm)行HRCT追踪扫描并回顾性分析CT表现男19例,女15例,年龄38～82岁结果腺癌25例,肺泡癌5例,鳞癌4例;混合磨玻璃密度11例,实性23例结节分叶征25例,毛刺征27例,胸膜凹陷征20例,血管集束征20例,空泡征7例,支气管气相4例7例出现淋巴结转移,8例出现骨或脑转移13例复查1次以上,2例出现密度或大小改变,其中1例实性7年内由0.7cm增大至2.8cm结论肺癌以腺癌最多,部分小肺癌生长缓慢HRCT可以提高显示小肺癌的CT征象     

外围型小细胞肺癌的CT表现及分型

目的分析15例外围型小细胞肺癌(P-SCLC)的临床表现及CT征象,以提高对该病的认识和诊断能力。方法收集经手术或肺穿活检证实的15例P-SCLC的临床资料,回顾性总结分析其CT影像特征。结果根据原发灶及转移范围的CT表现分为4型:Ⅰ型,孤立结节不伴转移,2例;Ⅱ型,原发灶伴转移未超过同侧肺门及纵隔淋巴结,7例;Ⅲ型,原发灶伴转移达两肺或有肺外转移,4例;Ⅳ型,原发灶伴癌性淋巴管炎累及1个以上肺叶,2例。结论CT能清楚显示P-SCLC原发灶的特征及转移范围,CT分型能为临床分期及制订治疗方案提供重要依据。     

基于临床及CT影像组学特征构建周围型小细胞肺癌与肺腺癌诊断模型的研究

目的 基于临床及CT影像组学特征建立周围型小细胞肺癌(SCLC)与肺腺癌(ADC)诊断模型,并评估其诊断价值。方法 回顾性搜集周围型肺癌患者临床及CT影像资料,选取治疗前2周内有薄层CT影像的病例分为SCLC组和ADC组,以SCLC组为实验组,采用倾向性评分匹配按1∶2匹配ADC对照组,两组按照7∶3比例随机分为训练集和验证集。依据训练集病例资料采用多因素Logistic回归分析筛选有意义的变量,建立临床、影像组学及临床组学联合预测周围型SCLC诊断模型。采用受试者工作特征(ROC)曲线评价模型诊断效能,建立个体化诊断列线图。结果 周围型SCLC和ADC两组间NSE和13个组学特征有显著性差异。训练集和验证集ROC曲线下面积,临床诊断模型分别为0.793和0.750,影像组学模型分别为0.857和0.838,联合模型分别为0.905和0.882。结论 基于临床及CT影像组学特征建立周围型SCLC与ADC诊断模型可鉴别诊断周围型SCLC及ADC。     

CT引导肺穿刺活检诊断周围型肺鳞癌的价值

目的:探讨应用CT引导肺穿刺活检术诊断周围型肺鳞癌的价值。方法:对CT引导肺部病变穿刺活检术的31例病例进行回顾性分析。结果:本组病例中,周围型肺鳞癌CT表现为病灶周边强化伴其内不同程度坏死27例,空洞型病灶4例。CT引导肺部病变穿刺活检病理诊断鳞癌16例,中分化鳞癌14例,发现癌变鳞状上皮1例。结论:研究表明应用CT引导肺穿刺活检术对周围型肺鳞癌病例有重要的诊断价值。     

小细胞肺癌的CT表现与诊断途径

目的探讨小细胞肺癌（SCLC）的CT表现、分型及诊断途径。方法对220例SCLC进行X线CT回顾性分析,并与54例病理观察相对照,讨论SCLC的CT表现与病理基础。结果肺内肿块、肺门与纵隔广泛性淋巴结肿大,而肺不张少见,是SCLC的CT表现特点,CT诊断的可能性达80.5%,结合经皮针刺活检阳性率可达91.1%。结论CT平扫结合CT导向经皮针刺活检是SCLC确诊的主要途径。     

肺部周围型空洞性鳞癌与腺癌的CT对比研究

目的对比分析肺部空洞形成的周围型鳞癌及腺癌的CT征象。方法回顾性分析43例肺部空洞形成并经病理证实的周围型肺鳞癌(21例)及腺癌(22例)的临床一般资料、肿瘤T分期及CT征象,两组间采用t检验,χ^2检验或Fisher确切概率法进行统计学分析。结果肺鳞癌空洞组在有吸烟史比例、T分期高于腺癌组(P<0.05),而两组在性别构成、发病年龄、肿瘤肺叶分布上无明显统计学差异(P>0.05)。鳞癌组肿瘤最大径(57.93±16.43)mm vs(35.55±12.59)mm、空洞最大径(35.52±15.04)mm vs(20.73±11.15)mm及洞壁厚度(21.65±6.72)mm vs(15.36±5.98)mm均高于腺癌组,差异有统计学意义(P<0.05)。腺癌组空洞内血管及间隔、边缘磨玻璃密度出现的比例高于鳞癌组,差异有统计学意义(P<0.05)。结论肺部空洞形成的周围型鳞癌及腺癌在吸烟史、T分期及空洞内征象有差异,有助于两者之间的鉴别诊断。     

Comparison of thin-section CT and pathological findings in small solid-density type pulmonary adenocarcinoma: Prognostic factors from CT findings

Objective

We divided pulmonary adenocarcinoma of ≤20 mm into air-containing and solid-density types based on a percentage reduction of the maximum tumor diameter in the mediastinal window image compared to the area in the lung window image on thin-section (TS) CT of ≥50% (air-containing type) and <50% (solid-density type). No relapse occurred in patients with air-containing type. The prognosis of solid-density type may be poor even when the tumor size is 20 mm or smaller. We investigated whether CT findings for these tumors could serve as prognostic factors.

Methods

The subjects were 105 patients with solid-density type pulmonary adenocarcinoma that was identified on TSCT and found to have a diameter of 20 mm or smaller after surgical resection during the period from April 1997 to November 2004. Notches, air bronchogram, pleural retraction, spiculation, venous involvement, and ground glass opacity were examined on TSCT, and their associations with pathological findings (i.e., pleural invasion, lymphatic permeation, vascular invasion, lymph node metastasis, and Noguchi's classification) and relapse were investigated using chi-square test and Cox proportional hazards model.

Results

The incidence of relapse was significantly higher in cases with notches. The incidence of notches increased with tumor growth and notches were frequent in Noguchi type D tumors, reflecting poorly differentiated adenocarcinoma. Lymphatic permeation and type D cases were independent factors associated with a poor prognosis using Cox proportional hazards model.

Conclusions

TSCT findings may be useful for prediction of the prognosis of solid-density type pulmonary adenocarcinoma.     

周围型肺腺癌的CT表现(附36例分析)

目的 研究周围型肺腺癌的CT表现。方法 回顾性分析36例经手术病理证实的周围型肺腺癌CT表现。结果 CT扫描直接显示，36例周围型肺腺癌主要CT征象是空气支气管征、空泡征、深分叶征、血管切迹征、胸膜凹陷征、纵隔淋巴结肿大，以及远处器官转移。结论 只要对周围型肺腺癌的CT征象进行全面分析，通常可以做出正确诊断。     

High-resolution computed tomographic findings of small peripherally located squamous cell carcinoma

With the spread of high-resolution computed tomography (HRCT) screening for lung cancer, we are increasingly faced with the need to determine whether certain small lesions are benign or malignant. The features of small adenocarcinomas have been clarified but not those of squamous cell carcinoma. The objective of our study was therefore to clarify the HRCT findings of peripherally located squamous cell carcinomas less than 2 cm in maximum dimension. Subjects consisted of 27 consecutive pathologically proven cases of peripherally located squamous cell carcinoma that were less than 2 cm in maximum dimension. HRCT findings of all 27 cases were analyzed retrospectively and independently by three radiologists who were unaware of the pathological diagnosis, and decisions were reached by consensus with special attention to 10 review points. Internal characteristic features included calcification, cavity formation, and air bronchogram. Tumor margin features included spiculation, notching, irregularity, and ground-glass opacity. Surrounding structural features consisted of pleural indentation, pulmonary emphysema, and satellite lesions. The presence of irregularity (70.4%), surrounding pulmonary emphysema (70.4%), and pleural indentation (51.9%) was observed frequently. No mass was accompanied by calcification. HRCT images of peripherally located squamous cell carcinoma suggested that the demonstration of irregularity, surrounding pulmonary emphysema, pleural indentation, and absence of calcification may contribute to the accurate CT diagnosis of small peripheral squamous cell carcinoma.     

周围型肺腺癌和鳞癌CT、病理表现与c-erbB-2蛋白异常表达的相关性研究

目的 :研究周围型肺腺癌和鳞癌的CT征象、病理分级与c erbB 2蛋白异常表达的关系。方法 :6 2例经手术、病理证实的周围型肺腺癌、鳞癌术前CT扫描 ,并运用免疫组织化学技术ABC法对手术切除标本进行c erbB 2蛋白检测。将检测结果与肿瘤的CT征象、病理分级进行比较 ,对统计数字进行卡方检验。结果 :①腺癌c erbB 2蛋白的过度表达高于鳞癌 (P <0 .0 5 )。②分化程度低、有肺门和 /或纵隔淋巴结转移者c erbB 2蛋白的过度表达率明显增高 (P <0 .0 5 ,P <0 0 1)。③具有棘突征、血管连接征的周围型肺腺癌和鳞癌c erbB 2蛋白过度表达率明显高于无以上征象者 ;而瘤体最大直径 >3cm的腺癌高于瘤体最大直径≤ 3cm的腺癌。④肿瘤强化明显者 ,其c erbB 2蛋白过度表达率增高 (P <0 .0 5 )。结论 :周围型肺癌c erbB 2蛋白的过度表达与组织学类型及CT表现有关 ,某些CT征象可用来判断肿瘤的生物学行为     

原发性肺肉瘤样癌的病理亚型及其CT表现

目的 探讨原发性肺肉瘤样癌各亚型的临床病理特征及CT表现,以提高对本病的认识.方法 回顾性分析14例经手术病理证实为原发性肺肉瘤样癌患者的临床病理资料及CT表现.所有病例术前均行CT检查,其中10例行CT增强扫描.结果 14例中周围型13例,中央型1例,肿瘤直径2.5～9.5 cm,病变位于右肺上叶5例、中叶2例、下叶4例,左肺上叶3例.14例表现为肺内实质性肿块,3例肿瘤内可见偏心性不规则空洞,肿块边界光整6例、模糊2例、分叶4例、毛刺3例,另1例因中央型肿块伴阻塞性肺炎致边界不清.10例CT增强扫描患者均显示肿块周边厚薄不均的环形强化,肿块中央强化不明显或不均匀强化.7例侵及胸膜或胸壁组织,4例可见肺门和(或)纵隔淋巴结肿大,2例有远处转移.手术病理诊断为多形性癌7例,梭形细胞癌2例,巨细胞癌3例,肺母细胞瘤2例.结论 原发性肺肉瘤样癌的CT表现有一定特征,最终诊断有赖于组织病理及免疫组织化学检查.     

外周型微小肺癌的CT表现

目的:探讨直径≤1.5cm的周围型微小肺癌的CT表现。方法:对CT、临床资料完整,经病理证实的17例微小肺癌的CT表现,作一回顾性分析。结果:在17个结节的分析中,见分叶征11,小泡征7,空气支气管征4,毛刺9,血管集束征8,胸膜凹陷9,磨砂玻璃影7。12个结节具有2种以上CT征象。在40天的CT随访观察中,结节的大小均无改变。结论:周围型肺小结节如存在上述2种以上CT征象、磨砂玻璃征、40天内CT复查结节无吸收缩小者,应高度怀疑肺癌的可能性。     

18F-FDG-PET/CT findings in primary pulmonary mixed squamous cell and glandular papilloma

A 55-year-old female had an abnormal shadow on chest radiograph. Computed tomography (CT) revealed a 26-mm tumor mass in the left upper lobe. No malignant findings were obtained by bronchoscopic cytology or histopathological diagnostics, but on positron emission tomography with 18F-fluorodeoxyglucose (FDG-PET) examination the maximum SUV was 9.01 in accordance with the tumor mass shadow on CT. Video-assisted thoracoscopic surgery was performed as clinically suspected of lung cancer, and the diagnosis was pulmonary mixed squamous cell and glandular papilloma (PMSGP). Primary PMSGP is extremely rare, and this is the first to describe the PET findings of this disease.