胸部闭合性肺实质损伤的X线诊断

胸部闭合性肺实质损伤的Ｘ线诊断陈留斌，毛维轩，陈南平，周成刚，蒋耀光肺实质损伤在临床上尚未出现明显症状之前，Ｘ线即可显示阳性征象。现收集我院１９８５年～１９９２年间闭合性胸部创伤９００例中临床Ｘ线资料完整的肺实质损伤２００例，进行分析讨论。临床资料性...     

肺平滑肌瘤的临床及X线诊断：附11例报告

作者报告了１１例经手术病理证实的肺平滑肌瘤。根据肿瘤生长部位分为：支气管内型（２型），肺实质型（９例）。对肺平滑肌瘤的临床特点、Ｘ线表现及诊断等问题进行了讨论。并阐述了与肺癌、平滑肌肉瘤及肺部其他良性肿瘤的鉴别诊断要点。     

肺实质损伤的X线诊断(附140例分析)

本文报道了肺实质损伤140例。根据本组资料的观察,将其X线表现的形态主要归纳为:肺挫伤、肺撕裂伤、肺血肿3种类型,并就它们的X线表现及其病理基础作了简要的分析。同时指出,对于肺实质损伤的患者,进行连续胸部X线摄片检查的必要性。     

膈肌包虫囊肿

本文报告了２６例膈肌包虫囊肿的Ｘ线表现，均经手术病理证实，其Ｘ线表现分为单纯性包虫囊肿及破裂感染的包虫囊肿两类，单纯包虫囊肿表现为膈肌局限性膨出；带蒂的突向胸腔的卵园形阴影，及合并囊肿钙化。破裂感染的包虫囊肿表现为囊肿内“月牙征”，“水上百合”或“气液平”；合并胸膜及肺内感染或肺包虫囊肿，及类似单纯性胸腔积液。讨论了常规Ｘ线，ＣＴ，超声的影象诊断。并指出多数膈肌包虫囊肿位于右侧膈肌，约８倍于左膈，因此，左膈的一些病变，一般不应考虑包虫囊肿。     

小细胞肺癌的X线诊断（附25例分析）

本文报导了小细胞肺癌２５例，并进行了分析，临床上多为中央型，纵隔易受侵犯。本组中央型２４例，Ｘ线表现为：（１）肺门肿块，常沿支气管走行略呈串珠样改变，肺内阻塞性改变不明显；（２）纵隔型肺癌表现；（３）肺门及纵隔肿块伴肺内阻塞性改变。前二种表现具有特征性。本病对化疗放疗敏感，疗效较好。     

胸部闭合性肺实质损伤的影像学表现(附68例报告)

目的 探讨胸部闭合性肺实质损伤的影像学表现.方法 回顾性分析了68例胸部闭合性肺实质损伤患者的影像学资料.结果 胸部闭合性肺实质损伤的影像学表现主要归纳为:①肺挫伤36例,影像学表现为肺纹理增多增粗,伴有斑点状、斑片状密度增高影;大片状密度增高影;磨玻璃样改变;②肺撕裂伤22例,影像学表现为边缘光滑的空洞样团块影;边缘模糊的团片状密度增高影,其内夹杂密度减低区,囊腔内可见气-液平面;③肺血肿10例:表现为圆形或椭圆形团块影,边缘尚清楚,可有分叶,周围略高于中心.肺外表现:血气胸28例、皮下气肿或纵隔气肿15例、单纯性气胸6例.结论 影像学检查是发现、诊断和动态观察胸部闭合性肺实质损伤的最佳方法,典型的肺实质损伤单凭X线平片、CT、外伤史即可诊断,但CT优于X线平片.     

外周型肺癌诊断一个有用的X线征象──核晕症及其病理基础的探讨

我们分析了经手术和病理证实的外周型肺癌１１７例的Ｘ线表现，见“核晕征”３５例（２２．９％）。４４例单发肺转移癌中见６例（１３．６％）。１６７例肺良性病灶及４例原发性肺肉瘤均无一例见到此征。１４例有核晕征肺癌的Ｘ线与病理对照结果表明１２例癌核心区的癌实质多于间质，另外２例两者相等。反之癌晕环区的癌实质少于间质。对核晕征的动态观察说明此症是癌生长过程中的一个阶段的表现。笔者认为核晕征对外周型肺癌尤以≤３ｃｍ小肺癌的早期诊断是一个非常重要的Ｘ线征象。     

胃类癌的X线诊断(附5例报告)

胃类癌是一种特殊类型的低度恶性肿瘤，非常少见。本文报告了经手术、病理证实的５例胃类癌。Ｘ线征象：（１）孤立壁内性充盈缺损（１例），（２）大溃疡（２例），（３）息肉样腔内肿瘤（１例），（４）胃壁广泛浸润（１例）。作者认为：本病Ｘ线表现虽多种多样，但缺乏特异性。术前诊断非常困难，必须把临床、实验室、纤维胃镜和Ｘ线资料相结合。确诊必须靠手术、病理或尸检。     

X线诊断婴幼儿病毒性肺炎的准确性（附100例分析）

本文通过对１００例婴幼儿病毒性肺炎Ｘ线分析，评价了Ｘ线诊断病毒性肺炎的准确性，确诊率为８２％。Ｘ线表现有以下特征：（１）肺纹异常伴点状密度增高影；（２）肺过度充气征；（３）节段性肺实变、肺不张；（４）肺门旁支气管周围浸润。     

肺腺棘细胞癌的 X 线分析

目的：探讨肺腺棘细胞癌的Ｘ线表现并与肺鳞癌、肺腺癌进行比较。方法：报告的５０例患者均经手术及病理证实，全部有胸部正侧位平片，男４３例，女７例，年龄３５～６８岁（平均５５．７岁）。结果：作者根据Ｘ线表现将其分为二型：（１）周围型（包括肺段型）３７例，肿块直径多大于３ｃｍ（７９．４％）。（２）中心型１３例，其中１例为气管肿瘤，以肺门肿块及肺不张为主要表现。结论：肺腺棘细胞癌以周围型多见，其Ｘ线表现介于周围型肺鳞癌和肺腺癌之间的一些特点。     

支原体肺炎临床X线分析

目的 分析支原体肺炎的临床与X线表现，以便提高对本病的诊断与治疗水平。方法 对100例临床上诊断的支原体肺炎之X线表现进行了回顾性分析。结果 在X线胸片上支原体肺炎为各种各样的表现且缺乏特征性。常见的表现有如下3种类型：a)肺泡实质浸润型，病变常局限于1个或2个肺段，表现为云絮状或片状阴影，肺纹理增重，沿增重的肺纹理出现不规则的点片状阴影；b)肺间质浸润型，病变区肺纹理增重，伴有网状阴影；c)合并胸膜炎。通常，肺部X线表现较重而临床表现较轻可看作是本病的一个特点。结论 支原体肺炎的X线表现没有特征性，与细菌性肺炎不易区分。临床上、血清冷凝集试验阳性，血清特异性IgM抗体反应阳性，以及大环内酯类抗生素如红霉素治疗具有显著疗效有助于本病的确诊。     

肺部弥漫性病变的影像学分析(附80例报告)

目的 探讨肺部弥漫性病变的X线诊断。方法 回顾分析80例肺部弥漫性病变的X线表现。结果 根据X线征象分析为(1)主质病变，包括腺泡结节，小片及大片阴影，支气管充气征；(2)间质病变，包括间质结节，网状及网状结节阴影，支气管血管束的增粗；(3)主间质病变，包括毛玻璃影，多发肿块及蜂窝状改变。同时对肺弥漫性病变做进一步探讨。结论 常规胸片目前仍是诊断肺弥漫性病变的首选方法，而CT则是重要的辅助手段。     

Lung parenchyma changes in ankylosing spondylitis: demonstration with high resolution CT and correlation with disease duration

OBJECTIVE: To analyze the spectrum of the lung parenchyma changes in ankylosing spondylitis (AS) with high resolution computed tomography (HRCT) and correlate the findings with disease duration. MATERIAL AND METHODS: Twenty patients (18 male, 2 female) with the diagnosis of AS according to New York criteria were included in the study. None of the patients had history of tuberculosis, prolonged inorganic dust exposure and hospitalization for pneumonia. Seven of the patients were smokers, three patients were ex-smokers, and 10 patients were nonsmokers. The patients were assigned to three groups depending on disease duration. Group 1: patients with disease duration or=6 years but or=11 years (N: 12 patients). HRCT and pulmonary function tests (PFT) were performed in all patients. RESULTS: HRCT demonstrated pathology in 17 patients (85%). Two patients in group 1, 4 patients in group 2 and 11 patients in group 3 had pulmonary parenchyma changes. Emphysema (9/20), septal thickening (9/20) and pleural thickening (9/20) were the most common changes followed by nodule (8/20) and subpleural band formation (7/20). Three patients had apical fibrosis (AF). Septal and pleural thickening (both 4/10) were the most common changes when only nonsmokers were considered. Among nine patients with emphysema three were nonsmokers. CONCLUSION: There is a wide spectrum in pulmonary parenchyma changes in AS. These changes begin in early stages of the disease and increase with disease duration. Although smoking complicates the spectrum of changes in pulmonary parenchyma, they are predominately in the form of interstitial inflammation.     

CT-guided needle biopsy of the lung: factors affecting risk of complications

PURPOSE: To analyze factors influencing the risk of complications associated with CT-guided percutaneous needle biopsy for lung lesions. MATERIALS AND METHODS: Sixty patients, aged 24-85 years (37 men and 23 women), underwent CT-guided needle biopsy. A definite diagnosis was made in 49 of 60 cases (81.7%), including 38 of 43 malignant lesions (88.4%) and 11 of 17 benign lesions (64.7%). Complications associated with biopsy were observed in 35 patients (58.3%). Major complications included pneumothorax (n = 26) and pulmonary hemorrhage (n = 20). Chest tube placement was needed in 5 (19.2%) of 26 pneumothorax cases (8.3% of all biopsies). RESULTS: The high frequency of pneumothorax (43.3%) in this series had several contributing factors, including the presence of pulmonary emphysema, lesion size, and traversal of aerated lung. Chest tube replacement was necessary more frequently in patients with pulmonary emphysema. The number of pleural passes, location of lesions, and size of needles were not correlated with the incidence of pneumothorax. CONCLUSION: The presence of pulmonary emphysema, lesion size, and traversal of aerated lung are the predominant risk factors for pneumothorax in patients with CT-guided lung biopsy.     

抗黑色素瘤分化相关基因5抗体阳性皮肌炎的临床和胸部CT表现

目的:探讨抗黑色素瘤分化相关基因5（MDA5）抗体阳性皮肌炎患者的临床表现及胸部损害的CT表现。方法:回顾性分析2017年2月至2019年10月在河南科技大学第一附属医院确诊的15例抗MDA5抗体阳性皮肌炎患者的临床表现、实验室检查及胸部CT表现。实验室检查指标主要包括抗MDA5抗体、抗Ro-52抗体、肌酸激酶等。胸部...     

肺淋巴瘤的CT与X线表现

回顾性分析肺淋巴瘤的ＣＴ与Ｘ线表现，以提高对肺淋巴瘤影像学的表现的认识。材料与方法；２１例肺淋巴瘤均经肺或浅表淋巴结穿刺活检或手术证实。常规及薄层ＣＴ扫描法摄胸部Ｘ线正侧位片作对照检查。结果；肺淋巴瘤的影像异常可以分为；肿块有结节型，实变型，肺炎肺泡型，支气管血管淋巴管型，血行播散型，心包及胸膜病变型。     

Relative preservation of peripheral lung function in smoking-related pulmonary emphysema: assessment with 99mTc-MAA perfusion and dynamic 133Xe SPET

In this study the cross-sectional functional differences between the central and peripheral lung in smokers with pulmonary emphysema were evaluated by lung perfusion and dynamic xenon-133 single-photon emission tomography (SPET). The subjects were 81 patients with a long-term smoking history and relatively advanced emphysema, 17 non-smoker patients with non-obstructive lung diseases and six healthy non-smokers. Regional lung functional difference between the peripheral and central lung was assessed in the upper, middle and lower lung zones by technetium-99m macroaggregated albumin SPET and dynamic 133Xe SPET. The distribution of emphysematous changes was assessed by density-mask computed tomography (CT) images which depicted abnormally low attenuation areas (LAAs) of less than -960 Hounsfield units. Two hundred and eighty-eight (59.2%) lung zones of 63 (77.7%) patients with pulmonary emphysema showed relative preservation of lung function in the peripheral lung, with a curvilinear band of normal perfusion (a stripe sign) and a significantly faster 133Xe half-clearance time (T(1/2)) than in central lung (P<0.0001). Of these lung zones, 256 (88.8%) showed central-dominant LAA distributions on density-mask CT images, but the remaining 32 zones did not show any regional preference in LAA distribution. Conversely, 117 (24.0%) lung zones of 19 (23.4%) patients showed periphery-dominant perfusion defects and LAA distributions, with significantly prolonged T(1/2) in the peripheral lung area (P<0.0001). The remaining 81 lung zones of the patients with pulmonary emphysema and all the lung zones of the healthy subjects and patients with non-obstructive lung diseases did not show a stripe sign, and no differences were observed in T(1/2) values and LAA distributions between the central and peripheral lung. Relative preservation of peripheral lung function seems to be a characteristic feature in smoking-related pulmonary emphysema, and may indicate a lower susceptibility of peripheral parenchyma to the development of this disease.     

MR imaging of pulmonary parenchyma with a half-Fourier single-shot turbo spin-echo (HASTE) sequence.

OBJECTIVE: To evaluate the utility of a half-Fourier single-shot turbo spin-echo sequence (HASTE) at depicting lung parenchyma and lung pathology. METHODS AND PATIENTS: A HASTE sequence was applied to five normal volunteers and 20 patients with various pulmonary disorders to depict the lung parenchyma. Images were acquired with ECG-triggering and breath-holding. In three volunteers, signal intensity measurements from lung parenchyma were performed using four sequences: (a) HASTE; (b) conventional spin echo; (c) fast spin echo; and (d) gradient echo. T2 maps were produced using the HASTE acquisition. RESULTS: Minimal respiratory or cardiac motion artifacts were observed. The signal-to-noise ratios from lung parenchyma were 27.8 +/- 5.4, 22.0 +/- 3.0, 15.3 +/- 0.9, and 6.0 +/- 1.9 for HASTE, spin-echo, fast spin-echo, and gradient echo sequences, respectively. The scan time for HASTE was 302 ms for each slice. The T2 values in the right lung and the left lung were 61.2 +/- 4.1 and 79.1 +/- 8.9 ms in systole and 92.6 +/- 5.8 and 97.5 +/- 12.2 ms in diastole, respectively (P < 0.05 diastole versus systole). The HASTE sequence demonstrated clearly various pulmonary disorders, including lung cancer, hilar lymphadenopathy, metastatic pulmonary nodules as small as 3 mm, pulmonary hemorrhage, pulmonary edema and bronchial wall thickening in bronchiectasis. CONCLUSION: Our preliminary results indicate that the HASTE sequence provides a practical means for breath-hold MR imaging of lung parenchyma.     

双源CT双能量肺灌注成像评估COPD研究进展

慢性阻塞性肺疾病(COPD)是以各种原因引起的肺实质和小气道损伤而导致慢性不可逆的气道阻塞、呼吸阻力增加以及肺功能不全为共同特征的肺疾病。目前肺功能检查、肺核素灌注显像和MR灌注成像评估COPD均不能高分辨力显示肺解剖影像。而双源CT双能量肺实质灌注成像能够显示肺的解剖及灌注功能信息,可对肺气肿的部位与灌注缺损区精确配准,虚拟平扫影像可辨别COPD的类型及肺气肿的数量和大小,这对于COPD早期诊断、治疗及预后评估具有重要意义。就双源CT双能量肺灌注成像技术原理及其在COPD中的研究进展予以综述。     

Ultra‐short echo time (UTE) MR imaging of the lung: Comparison between normal and emphysematous lungs in mutant mice

Purpose:

To investigate the utility of ultra‐short echo time (UTE) sequence as pulmonary MRI to detect non‐uniform disruption of lung architecture that is typical of emphysema.

Materials and Methods:

MRI of the lungs was conducted with a three‐dimensional UTE sequence in transgenic mice with severe emphysema and their wild‐type littermates in a 3 Tesla clinical MR system. Measurements of the signal intensity (SI) and transverse relaxation time (T2*) of the lung parenchyma were performed with various echo times (TEs) ranging from 100 μs to 2 ms.

Results:

Much higher SI of the lung parenchyma was observed at an UTE of 100 μs compared with longer TEs. The emphysematous lungs had reduced SIs and T2* than the controls, in particular at end‐expiratory phase. The results suggested that both SI and T2* in lung parenchyma measured with the method represent fractional volume of lung tissue.

Conclusion:

The UTE imaging provided MR signal from the lung parenchyma. Moreover, the UTE sequence was sensitive to emphysematous changes and may provide a direct assessment of lung parenchyma. UTE imaging has the potential to assist detection of localized pathological destruction of lung tissue architecture in emphysema. J. Magn. Reson. Imaging 2010;32:326–333. © 2010 Wiley‐Liss, Inc.