外周型小肺癌的临床特点与经纤维支气管镜细胞刷检的应用价值

外周型早期肺癌的定义不同于肺门部早期肺癌。前者是指外周部直径小于2cm,没有胸膜、淋巴结或远处转移的肺癌。迄今尚未见到关于纤支镜对外周型小肺癌诊断价值的专门研究报告。为此,作者对11例经手术证实,直径小于1.5cm 的外周型小肺癌的临床资料作了研究。     

CT重建技术在小肺癌血管集束征的诊断价值

目的探讨16层螺旋CT多向调整多平面重建在周围型小肺癌血管集束征的诊断价值。方法收集就诊于我院,经手术病理证实的周围型小肺癌29例,16层螺旋CT胸部各向同性扫描后行多向调整多平面重建,并与常规横断薄层重建对比分析。结果 16层螺旋CT多向调整多平面重建对周围型小肺癌血管集束征的检出率高于薄层横断面重建,尤其适宜不能行增强扫描者。结论 16层螺旋CT多向调整多平面重建对周围型小肺癌血管集束征的诊断具有重要价值。     

螺旋CT扫描对周围型肺癌的诊断价值

目的 探讨螺旋CT扫描对周围型肺癌的诊断价值.方法 收集经螺旋CT扫描及病理证实的60例周围型肺癌,其中34例行增强CT扫描,对其CT影像学资料进行分析.结果 周围型肺癌的主要CT征象有:结节状、肿块状、斑片状、分叶征、毛刺征、支气管充气征或空泡征、胸膜凹陷征、血管集束征等.增强CT扫描周围型肺癌呈均匀或不均匀强化,CT值增幅约20～60 Hu,CT值增幅小于20 Hu则提示良性病变如结核球,CT值增幅大于60 Hu考虑炎性病变可能性大.结论 螺旋CT及增强CT扫描对周围型肺癌的诊断及鉴别诊断具有重要价值.     

16排螺旋CT扫描并MPR在孤立性肺结节影像诊断中的价值

目的探讨16排螺旋CT扫描并多平面重建(MPR)在孤立性肺结节(SPN)影像诊断中的价值。方法回顾性分析经病理证实的周围型小肺癌21例和良性SPN 29例的CT影像资料,所有患者均行16排螺旋CT容积扫描并MPR。结果 MPR图像比常规横断位扫描更能显示病灶的特殊征象,如胸膜凹陷、血管集束、小钙化、毛刺征、空泡征、棘状突起等。结论 16排螺旋CT扫描并MPR发现SPN的特殊征象更多,对区分SPN的良恶性具有重要价值。     

中央型肺癌的螺旋CT诊断与鉴别诊断

中央型肺癌是指发生在肺段以上支气管粘膜上皮的恶性肿瘤，是临床常见病和多发病，近年发病率有明显上升趋势：早期诊断和治疗对病人的预后甚为重要。螺旋CT的高分辨率CT扫描和三维重建在早期发现病灶、鉴别诊断和肿瘤分期方面有重要价值。本文就中央型肺癌的螺旋CT（SCT）检查方法、CT表现及其鉴别诊断方面进行论述和讨论，旨在提高对本病的认识。     

X线结合CT诊断周围型小肺癌的价值分析

目的探讨X线结合CT诊断周围型小肺癌的临床价值。方法分析19例经术后病理证实为周围型小肺癌患者的临床资料。结果周围型小肺癌X线征象以分叶小的结节阴影多见,病灶边缘轮廓不规则,呈现分叶征和/或毛刺征,伴或不伴胸膜凹陷、胸腔积液、肺门纵隔淋巴结肿大等。CT征象可见分叶征、毛刺征、棘状突起、空泡征或空气支气管征、血管集束征和胸膜凹陷征等。结论 X线结合CT扫描对于普查和确诊周围型小肺癌具有重要临床价值。     

周围型肺癌螺旋CT表现与血清NSE和SCC-Ag的关系

目的探讨周围型肺癌螺旋CT的表现与血清神经元特异性烯醇化酶(NSE)及鳞状上皮细胞癌抗原(SCC-Ag)的关系。方法选择2016年1月至2017年3月海军青岛第二疗养院收治的周围型肺癌患者168例进行肺部螺旋CT检查,同时检测患者血清NSE和SCC-Ag水平,分析肺部螺旋CT表现与血清NSE和SCC-Ag的关系。结果 168例周围型肺癌患者血清NSE水平为(19.23±5.93)ng/ml,SCC-Ag水平为(2.31±0.52)ng/ml。不同病理类型周围型肺癌患者血清NSE和SCC-Ag水平差异有统计学意义(P<0.05),鳞癌、小细胞肺癌患者血清NSE、SCC-Ag水平均高于腺癌患者(P<0.05),鳞癌患者NSE水平低于小细胞肺癌患者,而SCC-Ag水平高于小细胞肺癌患者(P<0.05)。有深分叶征、有空泡征、有毛玻璃征、有毛刺征患者血清NSE、SCC-Ag水平显著高于无深分叶征、无空泡征、无毛玻璃征、无毛刺征患者(P<0.05)。有无空洞、有无钙化、有无纵隔淋巴结肿大、有无胸膜凹陷症、不同瘤体直径、不同肿瘤CT值患者的血清NSE、SCC-Ag水平比较差异无统计学意义(P>0.05)。结论螺旋CT可以清晰显示周围型肺癌的病灶,对于周围型肺癌早期诊断具有重要意义,而CT征象深分叶征、空泡征、毛玻璃征、毛刺征与患者血清NSE、SCC-Ag水平有一定相关性。     

螺旋CT三期增强扫描在周围型肺癌诊断中的应用

周围型肺癌的CT诊断一直是影像诊断学研究的热点和难点，以往学者们多注意研究肿块的形态学特征，如分叶征、毛刺征、胸膜凹陷征等，而对肿块的增强扫描研究报道不多。我们应用螺旋CT采用三期相扫描技术对25例周围型肺癌进行扫描，取得了满意的诊断效果，现总结报道如下。     

MSCT对2 cm以下的周围型肺癌及炎性结节的临床诊断价值分析

目的研究多层螺旋CT(MSCT)对2cm以下的周围型肺癌及炎性结节的临床诊断价值。方法选取2014年12月至2016年12月经病理以及临床检查确诊为2cm以下的周围型肺癌患者86例与炎性结节患者32例。对比不同CT征象表现及CT增强表现。结果 7mm重建征象中肺癌组小泡征、毛刺征、胸膜凹陷征、分叶征、小棘突征、血管集束征占比显著高于炎性结节组(P0.05)。1mm HRCT重建征象中肺癌组的上述征象占比均显著高于炎性结节组(P0.05)。肺癌组CT增强表现为均匀强化,人数占比显著高于炎性结节组,而强化幅度20Hu人数占比显著更低(P0.05)。结论 MSCT对2cm以下的周围型肺癌及炎性结节的临床诊断价值较高,可作为临床上鉴别周围型肺癌及炎性结节的首选检查方案。     

周围型肺癌的CT诊断

目的分析37例早期周围型肺癌（f≤3．0cm）的CT资料，以提高对其CT表现的认识和诊断。方法37例肺癌病例经手术、穿刺活检的病理结果和临床观察证实f≤3．0cm早期周围型肺癌的完整CT资料进行回顾分析。结果37例周围型肺癌的主要CT表现：全部为f≤3．0em的孤立性结节，29例有分叶征；23例有毛刺征；19例有胸膜凹陷征；14例有血管集束征；6例有空气支气管征和空泡征；2例有砂粒样钙化。结论平扫基础上进行增强靶扫描及薄层增强扫描能更好显示病灶内部结构、形态、边缘，对周围型小肺癌的诊断有重要价值。     

A case of active pulmonary tuberculosis in the right lower lung field detected by CT]

Many studies have indicated the pitfalls in detecting abnormalities on chest radiography, although radiography of the chest has been used for the screening of peripheral lung cancer. Recently, mass screening with a spiral computed tomography scanner has been performed for the detection of small peripheral lung cancers, and it has been clarified that spiral CT was superior to chest radiography in the screening and detection of peripheral lung cancer. However, there have been only a few reports on pulmonary tuberculosis that was detected by chest CT. We report a case of active pulmonary tuberculosis detected by chest CT, and invisible on plain chest radiography. 39 year old female consulted our hospital, because chest radiography at mass screening for lung cancer showed an abnormal shadow in the left upper lung field. Chest CT revealed a high density nodule with calcification compatible with old tuberculosis. However, there was another 20 mm x 10 mm sized nodule in right S9b that was invisible on plain chest radiography. The nodule had a clear margin with satellite lesion that characterize active pulmonary tuberculosis. Bronchial lavage was performed by bronchofiberscopy, and Mycobacterium tuberculosis was isolated from lavage fluid. The nodular shadow disappeared after the treatment with isoniazid and rifampicin for 9 months.     

Screening for lung cancer with low-dose spiral computed tomography

Studies suggest that screening with spiral computed tomography can detect lung cancers at a smaller size and earlier stage than chest radiography can. To evaluate low-radiation-dose spiral computed tomography and sputum cytology in screening for lung cancer, we enrolled 1,520 individuals aged 50 yr or older who had smoked 20 pack-years or more in a prospective cohort study. One year after baseline scanning, 2,244 uncalcified lung nodules were identified in 1,000 participants (66%). Twenty-five cases of lung cancer were diagnosed (22 prevalence, 3 incidence). Computed tomography alone detected 23 cases; sputum cytology alone detected 2 cases. Cell types were: squamous cell, 6; adenocarcinoma or bronchioalveolar, 15; large cell, 1; small cell, 3. Twenty-two patients underwent curative surgical resection. Seven benign nodules were resected. The mean size of the non-small cell cancers detected by computed tomography was 17 mm (median, 13 mm). The postsurgical stage was IA, 13; IB, 1; IIA, 5; IIB, 1; IIIA, 2; limited, 3. Twelve (57%) of the 21 non-small cell cancers detected by computed tomography were stage IA at diagnosis. Computed tomography can detect early-stage lung cancers. The rate of benign nodule detection is high.     

Multiple instances of peripheral artery emboli from occult primary small cell lung cancer

Most peripheral artery emboli originate in the heart, and systemic neoplastic emboli are infrequently associated with bronchogenic carcinoma. To our knowledge, there have been no reports of pulmonary vein infiltration by small cell lung cancer.We describe a highly unusual case of multiple instances of peripheral embolism as the first overt sign of occult primary small cell lung cancer. Tumor emboli infiltrated the pulmonary veins of a 62-year-old man who presented first with a transient ischemic attack and then with other ischemic symptoms. The uncommonly wide distribution of tumor emboli over a short time resulted in death.Improvements in diagnostic imaging have led to the early identification of relatively isolated small cell lung cancers. This patient's case underscores the importance of transesophageal echocardiography in detecting cardiac emboli when the cause of cerebral ischemic attack is unknown or if there might be multiple instances of arterial embolism. Computed tomography also has a role in the investigation of possible sources of emboli and unrecognized, asymptomatic embolization.     

Resected peripheral small cell carcinoma of the lung: computed tomographic-histologic correlation

In order to clarify the characteristic computed tomographic findings of peripheral small cell lung cancer, the authors investigated 12 patients with surgically resected and histologically proven peripheral small cell lung cancer. Conventional computed tomography was performed on all, and additional high-resolution computed tomographic images were obtained for nine patients. Marginal, internal, and surrounding features of the tumors were analyzed, and these findings were correlated with histologic findings. All 12 tumors appeared as homogenous masses, and eight had well-defined margins. Lobulation was found in seven, marginal ground-glass opacity in three, fine spiculation in two, and both ground-glass opacity and spiculation in one. Cut specimens showed whitish medullary masses without large areas of necrosis, and microscopic specimens showed small areas of necrosis in 11 patients. Marginal ground-glass opacities corresponded to focal edema and hemorrhage in two patients and to intraalveolar invasion in one. Fine spiculation corresponded to vascular/lymphatic invasion in one patient and to irregular intraalveolar spread in another. The authors concluded that a homogenous mass without necrosis is the most characteristic feature of peripheral small cell carcinoma on computed tomography.     

Pathology of lung cancer

Microscopic examination of stained smears and tissue sections remains the standard method for definitive diagnosis and classification of lung cancer. However, the morphology of lung cancer is complex, and consensus classifications such as those prepared by a panel World Health Organization (WHO) are required for the sake of consistency and clinical relevance. In the most recent (1999) WHO classification, the diagnostic categories of greatest clinical importance, small cell lung carcinoma and non-small cell lung carcinoma, remain fundamentally unchanged. However, application of immunohistochemistry and electron microscopy has revealed expression of neuroendocrine markers in a wide variety of tumors. Expression of these markers is not taken into account in current treatment protocols, and additional correlative studies will be required to determine the clinical relevance of neuroendocrine differentiation in lung carcinoma. In addition to histological classification, microscopic analysis can provide in situ evidence of response to chemotherapy, as well as information on precursor lesions and multistep carcinogenesis in the airways. Finally, it is likely that morphological assessment of lung carcinoma and preneoplastic lesions will continue to be refined as new diagnostic modalities such as spiral computed tomography and fluorescence bronchoscopy provide previously inaccessible specimens for morphological and correlative molecular studies.     

Screening for lung cancer

The National Lung Screening Study has demonstrated that screening with low-dose spiral computed tomography results in fewer deaths from lung cancer compared with screening with chest radiography (CXR). Previous trials of screening with CXR and sputum cytology failed to exhibit fewer deaths compared with no screening intervention. Early computed tomography (CT) studies showed promise for CT to be a more sensitive test, yet were unable to demonstrate sufficient evidence of efficacy. This review examines the problem of early lung cancer detection, the issues presented by screening, and results of past and recent studies of lung cancer screening.     

虚拟支气管镜导航联合经支气管超声导向鞘引导技术与常规支气管镜诊断周围型肺癌的临床研究

目的探讨虚拟支气管镜导航(VBN)联合经支气管超声导向鞘引导(EBUS-GS)探查技术在,诊断周围型肺癌中的价值。方法随机将385例周围型肺癌(高分辨CT诊断,8 mm≤结节直径≤30mm)患者分为3组,一组为VBN联合EBUS-GS组,一组为EBUS-GS组,另一组为常规支气管镜组。在VBN联合EBUS-GS组,支气管镜经VBN引导到达靶支气管,并用超声探头探查;EBUS-GS组只有超声探头探查,无VBN辅助;常规支气管镜组,则既无VBN辅助,亦无超声探查,仅有胸部CT片作为参考。结果可供分析的研究对象为最后诊断为原发性周围型肺癌的294例患者。VBN联合EBUS-GS组与EBUS-GS组在诊断率方面无显著差异(82.5%/81.3%,P0.05)。而与常规支气管镜组相比,诊断率有显著差异(82.5%/81.3%/43.3%,P0.05)。亚组分析显示,影响VBN联合EBUS-GS组和EBUS-GS组诊断率的因素,可能为CT影像显示有支气管直通病变,病变直径大于20 mm,超声探头是否在病变内。结论 VBN联合EBUS-GS或EBUS-GS可提高周围型肺癌的诊断率;提高其诊断率的影响因素可能包括,CT影像显示有支气管直通病变,病变直径大于20 mm,超声探头是否在病变内。     

Early lung cancer detection using spiral computed tomography and positron emission tomography

RATIONALE: Lung cancer screening using computed tomography (CT) is effective in detecting lung cancer in early stages. Concerns regarding false-positive rates and unnecessary invasive procedures have been raised. OBJECTIVE: To study the efficiency of a lung cancer protocol using spiral CT and F-18-fluorodeoxyglucose positron emission tomography (FDG-PET). METHODS: High-risk individuals underwent screening with annual spiral CTs. Follow-up CTs were done for noncalcified nodules of 5 mm or greater, and FDG-PET was done for nodules 10 mm or larger or smaller (> 7 mm), growing nodules. RESULTS: A total of 911 individuals completed a baseline CT study and 424 had at least one annual follow-up study. Of the former, 14% had noncalcified nodules of 5 mm or larger, and 3.6% had nodules of 10 mm or larger. Eleven non-small cell lung cancers (NSCLC) and one small cell lung cancer (SCLC) were diagnosed in the baseline study (prevalence rate, 1.32%), and two NSCLCs in the annual study (incidence rate, 0.47%). All NSCLCs (92% of prevalence cancers) were diagnosed in stage I (12 stage IA, 1 stage IB). FDG-PET was helpful for the correct diagnosis in 19 of 25 indeterminate nodules. The sensitivity, specificity, positive predictive value, and negative predictive value of FDG-PET for the diagnosis of malignancy were 69, 91, 90, and 71%, respectively. However, the sensitivity and negative predictive value of the screening algorithm, which included a 3-month follow-up CT for nodules with a negative FDG-PET, was 100%. CONCLUSION: A protocol for early lung cancer detection using spiral CT and FDG-PET is useful and may minimize unnecessary invasive procedures for benign lesions.     

2型糖尿病合并冠心病患者行双源CT冠状动脉造影的对比研究

目的探讨双源CT冠状动脉造影在2型糖尿病合并冠心病患者诊断中的应用价值。方法选择临床确诊或疑诊冠心病的2型糖尿病患者88例行CT冠状动脉造影检查,并同期行选择性冠状动脉造影。双源CT的原始数据均行容积再现、曲面重组、最大密度投影及横断面重建。结果 352支血管中(直径≥2 mm),双源CT冠状动脉造影显示≥50%狭窄的血管为163支,占46.3%;选择性冠状动脉造影显示≥50%狭窄的血管为155支,占44.0%。与选择性冠状动脉造影对照分析,双源CT冠状动脉造影评价冠状动脉狭窄(≥50%狭窄)的敏感性、特异性、阳性预测值以及阴性预测值分别为92.3%、89.9%、87.7%和93.7%。结论双源CT冠状动脉造影是检测2型糖尿病患者冠状动脉狭窄的可靠方法。     

Spiral CT for pulmonary embolism: the paradigm has shifted

Computed tomography (CT) is rapidly becoming the first-line modality for imaging pulmonary embolism (PE). However, limitations for the accurate diagnosis of small peripheral emboli have prevented the unanimous embrace of CT as the new standard of reference for imaging PE, although the actual significance of isolated peripheral emboli is uncertain. At the same time, the high negative predictive value of CT pulmonary angiography for excluding clinically significant PE has been established. The introduction of multidetector-row spiral CT has greatly improved visualization of peripheral pulmonary arteries and detection of small emboli. Previous concerns regarding the use of spiral CT for the accurate diagnosis of peripheral pulmonary emboli should thus be overcome. Multidetector-row spiral CT has become a widely available and cost-effective technology and appears to have surpassed other imaging modalities for the accurate detection of central and peripheral PE. In this review, the authors assess the current role of spiral CT in the diagnostic algorithm of PE.