肺内恶性孤立性小结节的CT征像特征分析与诊断

目的通过对肺内恶性孤立性小结节CT影像特征的分析,不断提高CT对恶性孤立性肺结节的检出率。方法全面、系统地回顾、分析134例肺内孤立性小结节患者的临床资料。结果 134例肺内孤立性小结节患者中,病检恶性80例(59.70%);病检和CT均诊断为恶性者78例,CT与病检符合率为97.5%,病检确诊为恶性而CT征像不支持者2例(2.50%),CT诊断为恶性,而首次病检不支持,再次病检支持者1例(1.25%);81例结节≥2.0 cm者,恶性75例(92.59%);53例结节2 cm者,恶性3例(5.66%);右肺结节恶性率为73.21%,明显高于左肺的43.59%(P0.05);恶性结节CT影像表现中胸膜凹陷征、引流线征、血管集束征、毛刺征、棘突征、分叶征、空泡和细支气管充气征,征像所占比例明显高于良性结节(P0.05);85.90%的恶性结节病例表现为3种以上基本影像征像并存。结论肺内孤立性结节恶性率高,其发病的部位和影像表现均具有其一定的特征性,CT诊断具有较高的检出率,在CT诊断过程中,要紧紧围绕结节的部位和影像征像进行仔细分析鉴别,对一时难以定论的结节要积极开展动态观察,以提高恶性孤立性肺结节的检出率,减少误诊和漏诊。     

孤立性肺结节CT征象表现与病理结果对照分析

目的分析孤立性肺结节CT征象表现与病理结果的对照情况。方法选我院收治的78例孤立性肺结节患者临床资料,78例患者均行螺旋CT扫描,并记录孤立性肺结节直径以及胸膜凹陷、分叶、毛刺、棘突、空泡以及毛玻璃样变化。CT增强扫描时需绘制孤立性肺结节时间与密度曲线,并记录出现CT值峰值的具体时期以及净增值,之后切除患者孤立性肺结节,并进行病理检验,将病理结果与CT征象进行对比,观察各CT征象在良恶性孤立性肺结节中出现的频数、CT灌注成像定量分析以及增强扫描时孤立性肺结节CT值变化。结果术后病理与CT诊断结果比对(P0.05);而恶性结节的血管集束征、毛刺、空泡等征象出现频数高于良性结节,恶性结节的CT灌注参数和良性结节对比存在较大差异,增强扫描时恶性结节CT值大于良性结节,比较差异均具有统计学意义(P0.05)。结论通过分析恶性与良性结节的CT灌注参数以及征象,能准确鉴别疾病性质。     

临床影像酷似肺肿瘤的隐球菌病临床病理分析——附10例报告

目的:探讨肺隐球菌病(PC)的临床病理特征、诊断、鉴别诊断及临床误诊原因。方法:回顾性分析10例PC的病理和临床资料,并复习相关文献。结果:10例肺隐球菌病中男性6例,女性4例,年龄43~67岁,中位年龄56岁。首发症状常为咳嗽、咳痰、胸痛和发热。影像学检查:5例显示团片状影,4例呈孤立性结节影,1例为混合病变,伴毛刺征及晕征等,术前8例考虑为肺癌,2例考虑特殊感染,无1例初诊为PC。后经手术病理证实10例均为肺隐球菌病。大体切面呈灰白色或灰褐色的瘤样肿块,镜下可见8例有多核巨细胞肉芽肿形成伴大量炎细胞浸润,2例病灶内肺泡结构破坏,明显纤维化;特殊染色显示巨噬细胞胞质及肺泡腔中可见具有诊断意义的圆形空泡状隐球菌孢子。结论:PC的临床及影像学表现不特异,病理表现复杂多样,容易误诊为肺癌、结核及结节病等疾病,其诊断主要组织学形态和特殊染色,术前行经皮穿刺肺活检的诊断方法应给予足够重视。     

胃间质瘤的CT诊断:24例分析

背景:胃间质瘤(GST)的术前诊断主要依靠内镜和影像学检查。为提高GST的术前诊断水平,有必要对其CT诊断和术后病理诊断进行比较研究。目的:明确CT对GST的诊断价值。方法:24例于2002年1月～2008年6月在浙江省三门县人民医院确诊的GST患者纳入研究,对其CT和组织病理学表现进行回顾性分析。结果:24例GST均为单发,直径1.3～12.5 cm,5 cm者13例,≥5 cm者11例。4例肿瘤位于胃腔内,14例完全位于胃腔外,6例骑跨胃腔内外。CT平扫肿块密度均匀8例,密度不均16例(其中4例肿块内出现气体影)。CT诊断恶性9例,可疑恶性倾向6例,良性9例;病理诊断恶性10例,交界性5例,良性9例。仅1例患者CT诊断与病理诊断不符。结论:GST的CT表现有一定特点,CT扫描对GST的术前诊断和良恶性判断具有重要价值。     

肺孤立性结节良恶性诊断的临床分析

随着多层螺旋CT的不断普及,肺内孤立性结节的检出率逐渐上升,这些结节大多是良性病变或早期肺癌,所以预后一般较好,但是肺内孤立性结节的影像学诊断评估比较困难.因此,对于肺孤立结节良恶性评估的目的在于提高良恶性病变的早期诊断率,使恶性肿瘤患者能及时接受手术而良性病变患者能避免不必要的开胸探查.本文就评估肺孤立结节良恶性倾向的研究现状及进展作一综述.     

肺隐球菌病的CT影像表现

目的探讨肺隐球菌病(pulmonary cryptococcosis,PC)的CT影像表现,加强对本病认识,提高诊断水平,减少误诊。方法搜集本院2008至2015年间经病理确诊的26例PC患者的CT影像表现进行分析。结果 26例PC患者中,男14例,女12例,年龄31-65岁,中位年龄48岁。CT表现形态多样:(1)孤立结节或肿块型7例;(2)多发结节或肿块型7例;(3)实变型1例;(4)弥漫混合型11例。所有结节或实变均位于肺外带,呈聚集分布,结节或肿块边缘不规则,所有病例未见钙化,有20例病灶内见支气管充气征,11例出现厚壁空洞,11例呈宽基底状紧贴胸膜,4例周边出现"晕征",2例小结节出现"胸膜凹陷征"。增强扫描:3例出现不均一强化,内见散在低密度坏死灶;1例孤立结节呈周边强化,中间密度稍低;2例实性结节呈均一强化。结论 PC的CT表现形态多样,病灶位于肺外带,呈聚集分布,病变内部多见支气管充气征,呈宽基底向外紧贴胸膜,厚壁空洞。     

经皮肺穿刺活检在孤立性肺结节中的临床应用价值

目的:评价CT引导下经皮肺穿刺针吸活检术对肺内直径<3cm的孤立性结节的临床诊断价值。方法:回顾性分析48例经开胸手术细胞学检查确诊的肺部恶性结节患者的临床资料。结果:术前根据临床资料,疑似诊断肺恶性结节者27例(临床疑诊组),检出率56.3%,术前行CT引导下经皮肺穿刺针吸活检涂片细胞学检查(穿刺诊断组),提示肺恶性结节者45例,检出率93.8%,两组比较有显著差异(P<0.05)。48例手术切除结节病灶病理学诊断,腺癌27例,占56.3%,鳞癌18例,占37.5%,小细胞癌3例,6.3%。穿刺诊断组与手术诊断组比较,无显著性差异(P>0.05)。结论:对于直径<3cm肺部结节,在CT定位引导下经皮肺穿刺针吸细胞学检查,准确性高,并发症少,可作为肺内孤立性小结节灶定性诊断的首选方法,具有推广价值。     

CT引导下分离式BARD活检枪对支气管镜阴性孤立性肺结节的诊断价值

目的 探讨CT引导下分离式BARD活检枪对气管镜阴性孤立性肺结节组织活检的诊断价值。方法 回顾性分析南京军区南京总医院呼吸与危重症医学科2008年1月至2014年2月期间行CT引导下经皮肺穿刺活检术并经手术病理、临床治疗或随访证实的105例孤立性肺结节患者的病例,所有患者行经皮肺穿刺术前均行纤维支气管镜检查,并且检查结果为阴性;采用分离式BARD活检枪,18G BARD穿刺针,根据螺旋CT扫描选择最佳穿刺层面及穿刺点。结果 本组105例孤立性肺结节患者均取材成功,诊断结果经手术病理、临床治疗或随访观察证实,恶性病变诊断敏感性95.83%,特异性100%。良性病变敏感性96.97%,特异性95.83%,假阴性4例(3.8%)。腺癌表皮生长因子受体(EGFR)检测合格标本58例(90.63%),阳性22例(37.93%)。并发气胸11例(10.47%),咯血11例(10.47%)。结论 CT引导下分离式BARD活检枪对气管镜阴性的孤立性肺结节具有很好的临床应用价值,能为肺癌分子病理诊断分析提供足够的标本。     

CT导引下肺小结节穿刺活检的临床应用体会

正CT引导下经皮肺穿刺活检术因具有定位准确、成功率高等优点,已成为周围性肺病变广泛应用的诊断方法~([1])。一直以来,肺内孤立性小结节的诊断与鉴别诊断都是临床和影像学医师研究讨论的焦点,随着CT引导下经皮肺穿刺活检术的发展,为该疾病的诊断提供了可靠的技术支撑。本研究对2014年6月至2016年12月贵州航天医院经CT引导下对直径≤2 cm肺部孤立性结节穿刺成功并送病检的78例患     

前言——老年肺内孤立性结节诊治进展

<正>近年来由于胸部CT的广泛应用,临床发现的老年肺内孤立性小结节越来越多。尤其是胸部薄层高分辨CT检查,检出很多直径10mm的微小结节或片状磨玻璃样影(ground-glass opacity,GGO)改变,肺内孤立性小结节具有病变微小、难以确诊、恶性概率高等特点,给临床诊治带来了很大的挑战。怎样应用现有的检查手段做出更准确的诊断,怎样选择手术时机和最佳的手     

18氟-脱氧葡萄糖正电子发射计算机断层摄影诊断胃恶性肿瘤

目的 探讨18氟-脱氧葡萄糖正电子发射计算机断层摄影(18F-FDG PET/CT)判断胃恶性肿瘤的临床应用价值.方法 2007年5至7月对24例临床疑诊胃恶性肿瘤患者进行18F-FDGPET/CT显像检查,根据初次胃镜及病理活检结果将患者分为确诊组(胃镜和病理检查均提示恶性,9例)和未确诊组(胃镜下疑似恶性但病理检查提示良性,15例).确诊组行PET/CT以助术前评估,之后行手术治疗.未确诊组行PET/CT以判断病灶良恶性,之后再行胃镜和活检病理复查,符合手术指征者行手术治疗,无手术指征者临床随访.最终诊断以手术病理或临床随访结果为准.分析18F-FDG PET/CT对胃恶性肿瘤的诊断灵敏度、特异度、阳性预测值、阴性预测值及对腺癌患者l临床分期的作用.结果 18F-FDG PET/CT检出胃恶性肿瘤患者16例(确诊组9例、未确诊组7例),胃部原发灶16处,腔外增殖性病灶1处侵犯肝脏、胰腺及腹膜,肝转移1处,肺转移1处,空回肠病变3处,累及淋巴结13处,均获术后病理确诊.另有1例未确诊组患者PET/CT疑似恶性病变,术后病理确诊为良性间质瘤;1例未确诊组腺癌患者PET/CT漏诊.PET/CT诊断胃恶性肿瘤的灵敏度为16/17,特异度为6/7,阳性预测值16/17,阴性预测值6/7.对Ⅲ、Ⅳ期胃癌患者的分期正确率为6/6.结论 18F-FDG PET/CT为简单易行、安全、无创及有前景的检查方法,对胃恶性肿瘤的检出及良恶性肿瘤的鉴别有较高的临床应用价值,可作为胃镜检查的补充手段和制定手术方案的辅助工具.     

恶性肿瘤患者腹部CT检查偶然发现的肺结节的临床意义

目的分析在恶性肿瘤患者腹部CT检查中偶然发现的肺结节及其临床意义。方法在医院PACS系统以“占位”、“结节”或“肿块”为关键词搜索,对1年内的腹部CT报告进行搜索并评估。排除之前有胸部或腹部CT检查且/或非癌患者。结果9159次腹部CT检查中有1889例报道了肺部的“占位”,“结节”或“肿块”(1889/9159,20.6%),这其中只有252名为初诊患者,在这252名患者中,43名随访了胸部CT、腹部CT或胸腹部CT,且确诊为恶性肿瘤。既往没有接受过胸部或腹部CT,而1324名(1324/1576,84.0%)既往接受过CT检查,既被排除在研究之外。在剩余的252名患者中,有43名患者(43/252,17.1%)诊断为恶性肿瘤且接受了以胸部CT(n=16),腹部CT(n=13)或胸腹部(n=14)形式的随访CT。恶性肿瘤包括:原发性肝癌(n=21,其中肝细胞肝癌19例,肝内胆管细胞癌2例),结、直肠癌(n=8),胰腺癌(n=5),胃癌(n=5),膀胱癌(n=2),子宫颈癌(n=2)。43名患者中有21名(48.9%)患者的肺结节诊断为恶性。转移的肺结节多为类圆形、边界清楚的实性结节,常位于肺外围。结论在恶性肿瘤患者腹部CT上同时观察肺部情况是有必要的。胸部CT肺结节的良恶性特征鉴别可能也适用于恶性肿瘤患者腹部CT上偶然发现的肺结节。     

Outcome and prognosis after pancreatectomy in patients with solid pseudopapillary neoplasms

BackgroundSolid pseudopapillary neoplasms (SPN) are rare and represent approximately 4% of all cystic pancreatic tumors. The prognosis is excellent, although 10–15% of SPN patients show metastasis at the time of surgery or tumor recurrence during follow-up after pancreatectomy. Aim of the study was to analyze surgical management, risk factors for malignancy as well as long-term outcome and prognosis of this distinct tumor entity.MethodAll patients with pancreatic resection for SPN between 10/2001 and 07/2018 in the authors’ institution were identified from a prospective database. Clinicopathologic details, perioperative data and long-term follow-up results were retrospectively analyzed.ResultsFifty-two patients were identified, 44 (85%) of them were female and the median age was 29 years (IQR 9–71). Seven (13%) patients showed a malignant behaviour of SPN with N1 (n = 2) or M1 (n = 1) disease at resection; 5 patients developed tumor recurrence, after a median of 21 months. During follow-up time (median 54 months) all patients were alive, the 5- and 10-year rates for disease-free survival were 89.0% and 81.6%, respectively. Significant risk factors for recurrence were age <18 years (p = 0.0087) and parenchyma-preserving surgical approaches (p = 0.0006). The postoperative long-term outcome showed ECOG = 0–1 in all patients, with resection related exocrine insufficiency in 20 (41%) and diabetes mellitus in 2 (4%) patients.ConclusionsAge < 18 years is a significant risk factor for malignancy in SPN, and parenchyma preserving resections harbor a significant risk for tumor recurrence. As recurrence may occur late, a systematic life-long follow-up should be performed.     

原发性肺肉瘤样癌的CT表现

目的探讨原发性肺肉瘤样癌的CT影像特点,提高对原发性肺肉瘤样癌的认识,增加术前诊断的准确率。 方法回顾性分析2013年11月至2016年9月苏北人民医院收治的12例经病理证实为原发性肺肉瘤样癌的临床资料、CT影像特点及治疗方法。 结果12例患者均为单发,周围型8例,中央型4例,直径为0.7～8.6(4.5±1.9)cm,5例位于左肺,7例位于右肺。CT均表现为肺内肿块(n＝11)或结节(n＝1),病灶呈类圆形伴有钙化(n＝1),棘突征(n＝5),分叶征(n＝5),毛刺征(n＝2),累及胸膜(n＝8),伴纵隔淋巴结肿大(n＝3),肺门淋巴结肿大(n＝3),骨转移(n＝2),左下肢及脾转移(n＝1)。CT平扫均呈不均匀软组织密度肿块,CT值为14～38(21±14)HU,增强扫描肿块呈分层强化(n＝11),增强后边缘CT值为47～60(57.2±14)HU,低密度区CT值为19～29(25.3±6.3)HU。本组病例中发现占位后行手术切除的4例患者中有2例好转后出院,余放弃治疗。 结论肺肉瘤样癌以周围型为主,生长迅速,CT上有相对特征性的表现,平扫可见不均匀软组织密度肿块,增强扫描肿块大多呈分层强化方式,确诊需依靠组织病理学检查。     

Differential diagnosis of cardiac masses using contrast echocardiographic perfusion imaging

OBJECTIVES: We investigated the usefulness of echocardiographic contrast perfusion imaging in differentiating cardiac masses. BACKGROUND: Two-dimensional echocardiography is the primary diagnostic modality for cardiac masses. However, differentiation between the different types of cardiac masses may be difficult at times. We hypothesized that echocardiographic contrast perfusion imaging would differentiate the neo-vascularization of malignancies from the avascularity of thrombi and the sparse vascularity of stromal tumors. METHODS: Sixteen patients with cardiac masses underwent power-modulation imaging after echocardiographic intravenous contrast administration. Pixel intensities in the mass and an adjacent section of myocardium were analyzed visually and by dedicated software. All masses had a pathologic diagnosis or resolved after anticoagulation. In a subset of patients, video-intensity curves of contrast replenishment in the mass and myocardium over time were generated. The post-impulse steady-state pixel intensity (A) and initial rate of contrast replenishment after impulse (beta) were compared with an index of blood vessel area on pathology. RESULTS: In seven of 16 patients, contrast enhancement resulted in greater pixel intensity in the mass than in the adjacent myocardium. All of these masses were classified pathologically as malignant (n = 6) or benign and vascular (n = 1). Nine masses demonstrated decreased pixel intensity, compared with the myocardium, and were diagnosed pathologically as myxomas (n = 2) or thrombi (n = 5), or they resolved with anticoagulation (n = 2). For the subset of patients, beta correlated with the vessel area index (r = 0.60). CONCLUSIONS: Echocardiographic contrast perfusion imaging aids in the differentiation of cardiac masses. Compared with the adjacent myocardium, malignant and vascular tumors hyper-enhanced, whereas stromal tumors and thrombi hypo-enhanced.     

Contrast-enhanced sonography for differential diagnosis of pleurisy and focal pleural lesions of unknown cause

BACKGROUND: Ultrasound enables the visualization of pleural-based lesions with a poor correlation to specific pathology. At this time, there are no data about the diagnostic value of contrast-enhanced sonography (CES) in pleural lesions. METHODS: From August 2004 to January 2005, 25 consecutive patients with clinical symptoms of pleurisy and focal pleural lesions of unknown origin seen on B-mode ultrasonography were prospectively studied by CES. The lesions were diagnosed as pleuropneumonia (n = 12), pulmonary embolism/infarction (n = 7), malignant lymphoma (n = 2), pleural metastasis (n = 2), granuloma (n = 1), and unknown cause (n = 1). The diagnosis of the lesions was confirmed by contrast-enhanced CT scanning (n = 20), scintigraphy (n = 3), and follow-up (n = 2). Time to the enhancement of the contrast agent was determined. The CES patterns were evaluated during the arterial phase (ie, 2 to 30 s) and the parenchymal phase (ie, 1 to 5 min). The extent of the enhancement of pleural lesions was classified using normal liver tissue as an in vivo reference (absent, hypoechoic, isoechoic, hyperrechoic, or mixed echogenicity). RESULTS: In 20 patients, an enhancement of the pleural lesion was seen. All 12 patients with pleuropneumonia had a short time to enhancement (between 1 and 6 s), and a marked enhancement (isoechoic/hyperechoic) during the arterial and parenchymal phase. In the remaining 13 patients with other diagnoses than pleuropneumonia, 5 patients had no enhancement and 8 patients had a delayed time to enhancement (> 6 s). The extent of the enhancement was reduced (hypoechoic/anechoic) in 12 of 13 patients during the arterial and parenchymal phases. CONCLUSION: In patients with pleurisy and pleural lesions of unknown cause that were found sonographically, CES enables the diagnosis or exclusion of pleuropneumonia.     

原发性心脏恶性肿瘤的诊断和外科治疗经验

目的 :探讨原发性心脏恶性肿瘤的诊断与外科治疗经验。　　方法 :1980年 1月至 2 0 0 2年 10月间 ,9例原发性心脏恶性肿瘤患者接受外科治疗。主要症状有心慌、气短、下肢水肿、腹胀、头面部肿胀等 ,术前行彩色多普勒超声心动图检查 ,均显示不同心腔内有肿块。 5例在体外循环下切除肿瘤 ,2例肿瘤侵及上腔和右心房并广泛浸润 ,导致上腔静脉梗阻 ,仅行无名静脉与肺动脉人造血管架桥术 ,2例因肿瘤广泛转移仅做心包引流和病理活检。　　结果 :术后早期 8例生存 ,1例因急性肝、肾功能衰竭死亡。随访 2～ 12个月 ,1例完整切除肿瘤患者 ,在术后 6个月出现全身骨转移 ,后因呼吸道出血死亡 ;2例无名静脉与肺动脉架桥术及 2例因肿瘤广泛转移仅做心包引流患者 ,其中 3例术后接受局部放疗 ,但均在术后 1年内死亡。另外 3例术后 2个月、 6个月和 9个月随访时情况良好 ,复查彩色多普勒超声心动图检查无肿瘤复发。　　结论 :早期及时准确诊断、及时手术、尽可能完整切除肿瘤和术后加强监护等围手术期处理可延长生存期。     

18F-FDG PET/CT诊断肺部病变的误诊分析

目的 通过探讨18F-氟代脱氧葡萄糖(18F-FDG)正电子发射断层扫描/电子计算机体层成像(PET/CT)误诊肺部占位性病变的原因.方法 分析新疆自治区人民医院6年中924例肺部占位性病变患者行18F-FDG PET/CT检查诊断为肿瘤或者良性病变,其中有28例患者通过组织学或者病理学等检查后发现均为误诊病例.结果 在28例患者中有6例为18F-FDG PET/CT误诊为阴性,通过活检病理确诊为恶性肿瘤;22例18F-FDG PET/CT误诊为阳性,通过活检病理或者细菌学检查确诊为良性病变,并在随访后得到证实.结论 随18F-FDG PET/CT检查的流行,在临床上对于该检查的假阳性率及假阴性率也逐渐被认识,如果联合血肿瘤标记物的检查及对病例病史特点的详细分析可减少误诊率.     

肺孤立性结节CT灌注成像与病理特点的相关性研究

目的探讨肺孤立性结节（SPN）的CT灌注特点与病理基础的相关性。方法对43例SPN患者行CT灌注扫描,记录时间一密度曲线（TDC）、净强化值（PH）。采用免疫组化测定微血管密度（MVD）及VEGF表达。结果恶性结节的TDC多为速升缓降型,炎性结节的TDC多为速升速降型;良性结节的TDC多为低平缓型;恶性结节和炎性结节较良性结节有更高的强化峰值。恶性结节和炎性结节的MVD计数较良性结节MVD计数明显增多,恶性结节VEGF表达为阳性,炎性及良性结节多为阴性。结论 SPN的MVD和VEGF表达是CT灌注成像不同表现的病理基础,它们间具有良好的相关性