小儿纵隔肿块的X线与CT诊断

目的：分析17例小儿纵隔肿瘤的X线与CT检查结果，重点讨论胸部平片与CT检查的价值。材料和方法：17例患儿的年龄为11个月～14岁，全部做了胸部X线平片及CT扫描检查，并均经临床检查／手术病理证实。结果：X线胸部平片对纵隔肿瘤的检出率为14／17，其中定性诊断的符合率为57．1％；CT检查的检出率为17／17，定性诊断符合率达82．4％。结论：胸部X线平片作为初步筛选的常规检查是必要的，能够显示大多数纵隔肿瘤的形态、大小和位置，但对显示隐藏于纵隔内的较小肿瘤以及肿瘤的内部结构受到一定的限制。而CT检查对显示病灶细节及肿瘤周围结构更具优势。因此，X线平片发现纵隔肿块需进一步做CT检查，以尽可能地做出定性诊断，对具有临床表现、B超或胸部检查可疑的患者，也应作CT扫描，以提高检出率，防止漏诊。     

多层螺旋CT与X线检查在肺癌临床诊断中的应用

目的探讨多层螺旋CT与X线检查在肺癌诊断中的效果。方法肺癌患者56例作为研究对象,对所有患者在病理确诊前均行多层螺旋CT和胸部X线检查,将两种检查方法诊断结果分别与临床病理组织学检查结果进行对比研究,比较多层螺旋CT和胸部X线诊断肺癌的的敏感度、特异度和准确性。结果 56例患者经病理学检查确诊为肺癌(阳性)38例,其中中央型肺癌20例,周围型肺癌18例;阴性18例,其中肺结核6例,肺部感染4例,肺部纤维瘤4例,纵膈恶性淋巴瘤4例。以手术病理诊断结果为金标准,螺旋CT检查诊断肺癌的敏感度、特异度和准确性分别为94.74%,77.78%,89.29%。结论多层螺旋CT观察肺癌病灶诊断肺癌具有十分重要的临床价值,X线平片可先作为早期筛查首选影像学检查方法。     

中央型肺癌的X线与CT诊断(附21例分析)

目的 分析中央型肺癌的X线与CT表现并比较这两种方法的诊断能力。方法 21例经纤维支气管镜或病理证实的中央型肺癌患者均经胸部X线与CT检查。对全部病例的X线与CT表现进行了回顾性分析。结果 在胸部X线与CT像上，中央型肺癌均表现为肺门肿块合并阻塞性肺炎和肺不张。此外，CT还显示了X线胸片未看到的支气管壁增厚和管腔变窄，以及纵隔淋巴结肿大等。结论 X线与CT是诊断中央型肺癌的主要方法，而CT的诊断能力明显优于X线平片。     

术前CT诊断NSCIC纵膈淋巴结转移的研究

目的：探讨术前CT检查对非小细胞肺癌（non-small cell lung cancer NSCLC）患者肺门纵隔淋巴结转移的诊断价值。方法：分析我院52例行手术治疗的NSCLC患者,均有术前CT肺门纵隔淋巴结描述以及术后病理检查淋巴结转移的结果。结果：CT检查对NSCLC肺门纵隔淋巴结转移诊断的灵敏性为67.4%、特异性为84.4%和诊断符合率为80.8%。结论：CT是评价NSCLC患者肺门纵隔淋巴结转移的重要检查手段,根据淋巴结直径大小能够提供有效的纵隔淋巴结转移信息。     

肺癌肺门、纵隔淋巴结转移及纵隔胸壁直接侵犯的 CT 评价——附55例 CT 与手术病理对照

本文分析了55例肺癌的术前胸部CT 检查,并与术后病理对照,着重探讨了肺癌的肺门及纵隔淋巴结转移、纵隔及胸壁直接侵犯的CT 诊断的准确性。指出CT 诊断纵隔淋巴结转移是可靠的;对肺门淋巴结,由于肺门大血管的影响,有时会造成误诊,而对于直径小于1.0cm 的淋巴结转移.CT 无法诊断;对纵隔及胸壁的侵犯,典型的诊断可靠,不典型时诊断困难.     

非小细胞肺癌术前CT检查对比术后纵膈淋巴结转移的研究

目的:探讨术前CT检查对非小细胞肺癌(non-small cell lung cancer NSCLC)患者肺门纵隔淋巴结转移的诊断价值。方法:分析我院52例行手术治疗的NSCLC患者,全部患者均有术前CT肺门纵隔淋巴结描述以及术后病理检查淋巴结转移的结果。结果:CT检查对NSCLC肺门纵隔淋巴结转移诊断的灵敏性为67.4%、特异性为84.4%和诊断符合率为80.8%。结论:CT是评价NSCLC患者肺门纵隔淋巴结转移的重要检查手段,根据淋巴结直径大小能够提供有效的纵隔淋巴结转移信息。     

胸部CT对肺癌术前应用的评价——附20例分析

自1985年以来,对20例支气管肺癌病人术前除常规胸片外增加肺部CT检查。手术后对胸片、CT片及病理标本作对照分析。CT对病变定位优于常规胸片,但定性仍不理想。对纵隔淋巴结转移诊断准确性为65％(13/20),特异性85.7％(12/14),敏感性42.9％(3/7),阳性预测率40％(2/5),阴性预测率71.4％(10/14)。文中就胸部CT对肿瘤的定位、定性及临床应用价值方面进行讨论,并提出术前应用胸部CT检查的指征。     

多层螺旋CT和X线平片检查周围型肺癌对比分析

目的探讨螺旋CT和X线平片在周围型肺癌临床诊断中的应用价值。方法对经手术病理确诊的周围型肺癌62例患者分别采用胸部X线和CT进行检查,比较两种检查方法的各种征象检出情况及检查准确率。结果不同病理类型的病灶的发病部位比较不存在显著差异(X~2=1.25,P0.05)。说明不同病理类型病灶在各肺叶发生情况无差异。不同组织病理类型的病灶大小比较发现无显著差异。CT检查在毛刺征、厚壁空洞、胸膜凹陷征、空泡征与支气管气象征、肺门与纵膈淋巴结肿大等征象的检出率方面均明显高于胸部X线检查,且差异具有统计学意义。而两种检查方法对分叶征和胸水两种征象的检出率则无明显差异。CT检查对周围型肺癌的诊断准确率为95.16%(59/62),胸部X线对周围型肺癌的诊断准确率为80.65%;经统计学分析发现CT检查的准确率明显高于胸部X线,有统计学意义。结论CT检查在周围型肺癌中诊断价值高于胸部X线检查。     

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％。     

胸部CT与纤维支气管镜对肺癌的临床诊断分析

目的探讨胸部CT与纤维支气管镜对肺癌的诊断价值。方法回顾性分析2015年2月~2016年3月在我院接受检查和治疗的肺癌患者的临床资料,所有患者均接受了胸部CT和纤维支气管镜检查。观察两种检查方法的诊断准确性和灵敏度。比较不同临床病理特征肺癌患者诊断准确性的差异,分析影响诊断准确性的因素。结果纤维支气管镜对肺癌诊断的准确性为92.86%,明显高于胸部CT(X~2值=10.957,P=0.001);纤维支气管镜对肺癌诊断的灵敏度和特异度分别为52.28、60.13,高于胸部CT;TNM分期为Ⅲ+Ⅳ、有淋巴结转移、低分化,肿瘤直径≥3cm的肺癌患者诊断准确性较高,而不同年龄、性别和组织学分型患者的诊断准确性无差别;患者的淋巴转移和肿瘤大小是影响患者检查结果准确性的因素,OR值分别为5.356、6.012。结论胸部CT和纤维支气管镜对肺癌均有较好的诊断效果,且纤维支气管镜检查效果较好,是否有淋巴结转移和肿瘤大小是影响肺癌患者检查准确性的因素。     

Usefulness of 201Tl SPECT in the predication of mediastinal lymph nodes metastasis in patients with non small cell lung carcinoma (NSCLC)

Predictivity of mediastinal lymph nodes metastasis of 201Tl SPECT were examined before operation in 113 patients with non-small cell lung cancer (69 adenocarcinoma, 31 squamous cell carcinoma, 10 large cell carcinoma, 2 bronchiolo-alveolar carcinoma, 1 neuroendocrine cell carcinoma). Patients were classified into two groups, with or without lymph nodes metastasis according to the pathological diagnosis. We calculated parameters of 201Tl SPECT early ratio, delayed ratio, retention index (RI) and maximal diameters. In addition, we calculated optimal cut-off value of RI to estimate the mediastinal lymph nodes metastasis. Mediastinal lymph nodes metastasis was confirmed pathologically in 62 patients. ER and DR did not show any statistical significance between two groups. Maximal diameters of primary tumor were also comparable between two groups. RI was significantly higher in mediastinal lymph node metastasis positive group compared to that in mediastinal lymph node metastasis negative group. The sensitivity (Sen), specificity (Spe), positive predictive value (PPV), negative predictive value (NPV) and accuracy (Acc) of 201Tl SPECT were 82.2%, 82.3%, 85.0%, 79.2% and 82.3%. These parameters were similar of higher than 72.6%, 82.4%, 83.3%, 71.2% and 77.0% of chest CT. The RI of 201Tl SPECT was useful tool for predicting lymph nodes metastasis in non-small cell lung cancer. The optimum cut-off value of RI in the prediction of mediastinal lymph nodes metastasis was 35%. We should take into account of upstaging in cases with higher RI (>35%).     

The role of CT in staging radiographic T1N0M0 lung cancer

Thirty-one patients with non-small-cell bronchogenic carcinoma and standard chest radiographs showing T1N0M0 tumors underwent preoperative chest and upper abdominal computed tomography (CT) with subsequent thorough surgical-pathologic correlation of their disease status. Eight patients (25.8%) had tissue-proven mediastinal or distant metastasis at presentation. In five (62.5%) of these eight patients the presence of unresectable disease was detected by CT and an unnecessary thoracotomy was avoided. These five patients comprised three with mediastinal lymph-node metastasis, one with adrenal metastasis, and one with a coexistent contralateral, proximal endobronchial tumor. Three patients with unresectable disease not detected by CT (CT false negatives) had metastasis to normal-sized mediastinal lymph nodes. There were two CT false-positive diagnoses of adrenal metastasis in patients proven by CT-guided aspiration to have benign adrenal masses, and these patients subsequently underwent curative lung resection. Although the data base is relatively small, the authors conclude that preoperative CT may be useful in evaluating patients with radiographic T1N0M0 lung cancer.     

串珠征在周围型小细胞肺癌中的诊断价值

目的：探讨串珠征的形成机制,评价其在周围型小细胞肺癌(SCLC)、周围型肺腺癌及周围型肺鳞癌中的鉴别诊断意义。方法收集病理证实的周围型 SCLC 78例、周围型肺腺癌69例、周围型肺鳞癌33例,分别统计串珠征的阳性率、纵隔淋巴结的转移率及纵隔淋巴结大于肺原发灶的比例,对相关数据进行统计分析。结果78例周围型 SCLC中10例串珠征阳性(12.8%),且纵隔淋巴结均大于肺原发灶;78例中63例纵隔淋巴结转移(80.8%),42例纵隔淋巴结大于肺原发灶(53.8%)。69例周围型实性肺腺癌中,无1例出现串珠征,25例纵隔淋巴结转移(36.2%),2例纵隔淋巴结大于原发灶(2.9%)。33例周围型肺鳞癌中1例串珠征阳性(2.8%),该例肺门淋巴结明显小于肺原发灶,33例中13例纵隔淋巴结转移(39.4%),6例纵隔淋巴结大于原发灶(16.7%)。经统计分析,串珠征在周围型 SCLC与周围型肺鳞癌中差异无统计学意义,周围型 SCLC与周围型肺腺癌、肺鳞癌在纵隔淋巴结转移率及纵隔淋巴结大于肺原发灶的阳性率差异均有统计学意义。结论串珠征在一定程度上反映 SCLC 的生物学特性,在周围型SCLC与周围型肺腺癌、肺鳞癌的鉴别诊断中有重要价值,应结合纵隔淋巴结大小。     

低剂量CT灌注联合影像组学评估非小细胞肺癌的纵隔淋巴转移

目的:探究基于低放射剂量CT灌注影像提取CT灌注参数以及影像组学参数联合评估非小细胞肺癌(NSCLC)纵隔淋巴转移的效能.方法:纳入2017年3月-2020年5月经病理证实为纵隔淋巴转移的NSCLC患者以及非纵隔淋巴转移的NSCLC患者,所有患者于术前行低剂量CT灌注扫描.术中系统性清扫患者N1及N2站淋巴结,并取肿瘤...     

18F-FDG PET-CT显像在预测肺癌淋巴结分期中的价值

目的:探究18F-FDG PET-CT显像在肺癌患者淋巴结分期中的预测价值。方法:以35例经手术病理证实为肺癌患者的PET-CT资料及临床资料为研究对象。在PET-CT原发灶及纵隔淋巴结各区最浓聚的部位勾画感兴趣区,得出SUVmax.以淋巴结转移进行分组,采用t检验、Wilcoxon rank-sum检验及四格表资料的Fisher确切概率法分析组间淋巴结SUVmax、淋巴结与原发灶SUVmax的比值(SUVratio)及临床特征的差异。用ROC曲线对PET/CT的预测价值进行分析。结果:患者年龄、性别、吸烟史、组织类型与肺门、纵隔淋巴结转移无显著相关(P>0.05)。转移淋巴结的SUVmax较非转移淋巴结显著升高,差异有统计学意义(P<0.05),而淋巴结的SUVratio与淋巴结转移无明显相关(P>0.05)。取淋巴结SUVmax的最佳阈值,假阴性患者中的肺癌原发灶SUVmax偏低,假阳性患者比假阴性患者中的吸烟率高,但不具有显著统计学意义(P>0.05)。结论:淋巴结SUVmax可以为临床判断淋巴结转移提供定量指标。结合患者的临床病理特征判断淋巴结的转移可能从--定程度上减少假阳性率及假阴性率。     

CT evaluation of mediastinal lymph nodes in lung cancer: influence of the lobar site of the primary neoplasm

Previous reports have shown differences in the ability of CT to detect mediastinal lymph nodes, depending on the precise mediastinal location of the nodes. Poorest correlation between findings on CT and findings at autopsy has been described for left-sided lymph nodes, particularly those in the left peribronchial region (American Thoracic Society node station 10L), suggesting that cancers of the left lung might be less well staged by CT than cancers of the right lung. The relationship between the accuracy of mediastinal lymph node staging and the location of the primary lung cancer was examined in a retrospective study. In 103 patients with non-small-cell bronchogenic carcinoma who had preoperative CT evaluation of the mediastinum, the accuracy of preoperative staging was 81% for tumors of the right lung (70 patients) and 97% for tumors of the left lung (33 patients). The conclusion is that cancers of the left lung are staged at least as accurately as cancers of the right lung, despite the fact that left-sided mediastinal nodes are depicted more poorly on CT. Subcarinal and crossover (contralateral) nodal metastases and a low prevalence of metastasis involving only region 10L were the most important factors minimizing staging differences based on the site of the primary tumor.     

Enlarged mediastinal lymph nodes in the fibrosing alveolitis of systemic sclerosis.

The aim of this study was to determine the prevalence of enlarged mediastinal lymph nodes in systemic sclerosis (SSc) and relate this to the extent of pulmonary disease and disease activity as judged by high resolution computed tomography (HRCT). The HRCT scans of 78 patients with SSc were reviewed. The extent of lung disease and HRCT pattern were analysed and CT scans examined on soft tissue window settings for evidence of mediastinal lymph node enlargement. Sixty six (85%) patients had evidence of lung involvement on CT. Enlarged mediastinal lymph nodes were present in 21 (32%) patients with lung involvement but in only 1 (8%) patient without. The prevalence of enlarged mediastinal nodes increased with more extensive lung involvement on CT (p < 0.025), but correlated poorly with the type of CT appearance and concurrent erythrocyte sedimentation rate. Mediastinal lymph node enlargement occurs frequently in patients with SSc, particularly if lung involvement is extensive.     

Computed tomography for preoperative evaluations of lung cancer

Computed tomography was evaluated for its accuracy in diagnosing mediastinal node metastases, direct chest wall invasion, and direct mediastinal invasion by lung cancer among 61 patients who subsequently underwent surgery. Using 15-mm diameter or larger mediastinal lymph nodes as the criterion for metastasis, the sensitivity was 36% (8/22); the specificity was 92% (34/37). The accuracy for direct chest wall invasion was relatively high, with a sensitivity of 100% (7/7) and a specificity of 92% (22/24). Direct mediastinal invasion had a sensitivity of 67% (4/6) and a specificity of 91% (10/11). These results suggest that the ability of computed tomography to diagnose mediastinal lymph node metastasis when such nodal size is used as a criterion is limited.     

What is the value of the lateral chest radiograph in the follow-up thoracic lymphoma?

Lateral chest radiography in the investigation of thoracic lymphoma remains a feature of the current literature. This study assessed what information the lateral chest radiograph (CXR) adds in the follow-up of such patients. Eighty-eight patients with known lymphoma who had a CXR and thoracic CT within the same 4-week period were assessed. Five radiologists scored eight mediastinal and hilar nodal groups and eight extramediastinal regions on the frontal CXR as normal, equivocal or definitely abnormal (denoted 0, 1 and 2, respectively). This was repeated 1 week later with a combination of frontal and lateral films. Results were compared with the findings on CT which were scored similarly using accepted criteria for the presence of lymphadenopathy. Where the lateral CXR caused a change in score at any site, this change was compared with CT to determine the effect on diagnostic accuracy. For four of the five observers, the lateral film made no significant difference in diagnostic accuracy in the assessment of mediastinal lymph nodes. A fifth observer derived a small benefit from the addition of the lateral film, although almost 30 % of this was accounted for by changing from a wrong to an equivocal diagnosis. The lateral film did cause a small increase in the detection of pleuro-parenchymal lung lesions, although none of these were clinically significant. We conclude that routine lateral chest radiography is unhelpful in the follow-up of patients with lymphoma. Received 6 June 1996; Revision received 9 December 1996; Accepted 11 December 1996