胸部恶性淋巴瘤的影像学诊断

目的 对照分析普通Ｘ线、ＣＴ在胸部淋巴瘤的改变，以期提高对其像学表现的认识。方法 对有病理证实的６０例常规摄Ｘ线正侧位胸片、肺门和纵隔分层，１６例行ＣＴ扫描。结果 表现为纵隔／和肺门淋巴结肿大，肺浸润、胸膜和心包病变。肺浸润分间质改变为主型、结节型、肺炎肺泡型和胸膜病变型。结论 同一病例多种影像学表现为其特点，多数病例可由平片及分层确诊，ＣＴ较其更敏感，影像学对胸内淋巴瘤病理分型的确定有待进一步探     

恶性淋巴瘤肺浸润的CT与X线表现

目的分析恶性淋巴瘤肺浸润的CT与X线表现。方法对经病理证实的32例恶性淋巴瘤肺浸润的CT扫描及X线表现作回顾性分析。结果恶性淋巴瘤肺浸润的影像异常可分为肿块结节型、血行播散型、肺内淋巴组织受侵犯型、胸膜病变型。27例合并肺门或纵隔淋巴结肿大。20例具有3种或3种以上上述类型影像表现。结论恶性淋巴瘤肺浸润有多种X线CT表现。最常见为肿块结节型。肿块及肺实变中见支气管充气征为其特征性表现。CT显示恶性淋巴瘤肺浸润较X线敏感。常规胸部CT扫描有助于诊断与精确分期。     

肺原发恶性雪旺氏瘤1例

恶性神经鞘瘤 ,亦称恶性雪旺氏瘤 ,其原发于胸腔内者多见于后纵隔 ,原发于肺者罕有报导。笔者临床收治一例。病例　男性 ,3 9岁 ,因慢性刺激性咳嗽、咳白色粘痰带鲜血4月余入院。入院检查 :临床查体听诊示左肺上叶细小湿罗音 ,化验检查无异常。胸片及ＣＴ等影像学检查提示左肺上叶一约 5× 5ｃｍ周围型占位 ,纵隔、肺门处均无异常改变。住院后完成准备 ,全麻下行经左后外侧第五肋间剖胸探查 ,术中见肿瘤位于左肺上叶边缘 ,与侧胸膜部分粘连浸润 ,探查纵隔未见明显肿大淋巴结。手术行左肺上叶切除 ,与胸膜粘连处行胸膜外剥离。术后病理提示高…     

纵隔型肺癌32例影像学诊断及鉴别诊断

目的 探讨纵隔型肺癌的影像学表现及鉴别诊断方法.方法 回顾性分析32例经病理证实的纵隔型肺癌的影像学表现.结果 纵隔型肺癌属于晚期肺癌,32例患者中,病变位于右肺上叶6例,左肺上叶4例,右肺门部14例,左肺门部8例.胸部X线片显示纵隔增宽,气管受压移位变形,8例伴有阻塞性肺炎,14例伴有胸腔积液.CT显示肿块在纵隔胸膜下与纵隔呈锐角,边缘不规则,增强后强化不均匀.病理类型小细胞癌21例,鳞状细胞癌9例,腺癌2例.结论 结合临床资料,仔细分析影像学改变,大部分纵隔型肺癌都可做出准确诊断,CT在鉴别诊断中更有价值.     

2cm以下周围型肺癌的影像学特征与病理表现

为了探讨２ｃｍ以下周围型肺癌的Ｘ线、ＣＴ表现及其特征,对１４例小肺癌患者术前做了胸片、体层片和ＣＴ薄层扫描,对影像学特征与病理进行了对照研究。结果显示,在胸片上,小肺癌多表现为小片状,结节状影。ＣＴ图像主要表现为血管集中征,颗粒样结节征,空泡征,胸膜凹陷征等,并对误诊原因进行分析。     

肺腺鳞癌的影像学表现和病理对照研究

目的探讨肺腺鳞癌影像学表现是否具有特殊性;瘤内的腺癌、鳞癌成分与Ｘ线表现及预后的关系。方法复习经手术切除、病理确诊为腺鳞癌者５１例,５２个病灶。全部病例均有正侧位胸片,ＣＴ２３例,ＭＲＩ６例。按照镜下腺癌成分含量分为＜４０％、４０％～６０％、＞６０％三组。结果（１）腺鳞癌的影像学表现：中央型３例;周围型４８例,占９４．１％。肿瘤直径２～１５ｃｍ,平均５．７ｃｍ。均呈分叶状、边缘光整１９例,占３９．６％;边缘不光整但无明显毛刺１８例（１９个病灶）,占３７．５％;有毛刺１４例,占２９．２％;偏心空洞８例,占１５．７％;胸膜皱缩１２例,占２５．０％。（２）瘤内成分含量与Ｘ线表现的关系：部位、边缘、密度、胸膜皱缩在三组之间差异无显著性。结论本组结果表明,肺腺鳞癌以周围型多见,肿瘤无特异性Ｘ线表现;腺癌成分含量与Ｘ线表现和预后无明显关系。     

常规CT及螺旋CT扫描在肺癌诊断中的对比研究

目的 对比观察常规ＣＴ与螺旋ＣＴ在肺癌诊断中的ＣＴ表现特征。方法 经病理证实的肺癌患者１３４例,中心型肺癌５６例,周围型肺癌７８例。所有病例均经常规ＣＴ或螺旋ＣＴ扫描,观察其ＣＴ表现特征,并对其进行比较。结果 ５６例中心型肺癌中,病变发生于右侧支气管３０例,左侧支气管２６例;螺旋ＣＴ扫描对肺癌阻塞性改变及纵隔内大血管受侵情况的显示率高于常规ＣＴ扫描,对病灶密度、肺门及纵隔淋巴结转移等方面的观察与常     

肺癌全肺及肺叶切除术后胸部X线与CT检查的对比研究

为探讨肺癌患者全肺或肺叶切除术后胸部改变的Ｘ线及ＣＴ诊断价值，将经手术切除全肺或肺叶后的７０例原发性肺癌患者的正位胸片与同期ＣＴ片进行对比研究。结果显示，膈肌升高７０例（１００．０％），纵隔器官移位６６例（９４．３％），纵隔脂肪组织移位９例（１２．９％），胸腔积液和随后形成的胸膜肥厚３４例（４８．６％）。Ｘ线正位片对术后两侧纵隔可作整体描述，ＣＴ可清楚显示主动脉弓回转３６例（５１．４％），对侧肺组织疝入１８例（３３．３％），右肺术后奇静脉食管窝变小或消失２６例（８３．９％），左肺术后扩大１７例（４３．６％）。ＣＴ诊断肺内肿瘤复发及转移各９例（１２．９％），Ｘ线诊断肺内肿瘤复发及转移为５例（７．１％）及６例（８．６％）；ＣＴ显示纵隔淋巴结肿大１５例（２１．４％）、Ｘ线为７例（１０．０％）。结果表明，常规Ｘ线片及ＣＴ对全肺或肺叶切除术后的评估各具优点，ＣＴ能直观地显示术后纵隔结构的再分布及术后空腔的细微变化，并可作密度值测量，能更多更早地发现术后胸内肿瘤复发转移及纵隔淋巴结肿大，因而更有价值。     

67例肺错构瘤临床X线影像学分析

目的：探讨肺错构瘤的临床、Ｘ线及ＣＴ影像特点。方法：６７例肺错构瘤,平均年龄５０．４岁,无症状体检发现４０例（５９．７％）。全部病例均有胸部正侧位照片,其中４２例有肺门及病灶断层照片。ＣＴ检查１０例,地 纤维镜检查１８例,全部病例均有病理证实。结果：本组病例Ｘ线分型大多数为肺实质型,Ｘ线表现除具有生肿瘤的一般征象外,约１２％的瘤体内可见斑点状或斑片状钙化,爆米花样钙化对肺错构瘤的定决策诊断有重要意     

以胸部病变为表现的恶性淋巴瘤33例临床分析

目的分析以胸部病变为表现的恶性淋巴瘤的临床特点。方法分析33例患者的临床表现、影像学改变、病理类型及诊治情况。结果临床主要表现为呼吸困难,咳嗽,胸痛等,胸部CT以纵隔淋巴结肿大及胸腔积液最多见,多数病例经穿刺活检确诊,以非霍奇金淋巴瘤为主。结论恶性淋巴瘤常侵犯胸部,临床及影像学表现缺乏特征性,应及早活检获取病理以利早期诊治。     

X线和CT对恶性滋养细胞肿瘤肺转移的诊断价值

目的观察分析X线胸片和肺CT在诊断恶性滋养细胞肿瘤(GTT)肺转移中的价值和意义.方法收集51例有肺转移GTT患者的临床资料.对35例X线胸片有疑问的患者进行肺CT检查.结果 CT诊断有肺转移而X线报告肺渗出性、斑片状改变12例;可疑结节影10例;肺纹理增多9例;阴性4例.治疗后X线正常而CT显示仍有病灶持续存在4例.结论 CT在诊断可疑、隐匿性、多发性病灶方面具有明显的优势.对X线阴性的GTT患者应尽量做肺CT检查,有助于期别的判定和治疗中监测.     

Thoracic CT scanning for mediastinal Hodgkin's disease: Results and therapeutic implications

Thoracic CT scans were performed on 42 newly diagnosed patients with Hodgkin's disease. Five of 10 patients with negative chest X ray (CXR) had abnormal thoracic CT scans. Among the remaining 32 patients with mediastinal Hodgkin's disease (MHD on CXR, pericardial (Ep) and chest wall invasion (Ec) were the two most common sites of involvement which were detectable by CT scan alone. All 14 cases with Ep had M/T ≥ 0.30 and 14 of 21 with M/T ≥ 0.30 had Ep. Six cases had extensive Ec. Ep and Ec accounted for 16 of 19 of the changes in treatment portal or philosophy based on CT scan findings. Because of the high risk of cardiac or pulmonary radiation toxicity in Ep or Ec, radiation treatment alone may be inadequate. Treatment of mediastinal Hodgkin's disease is reviewed here. The use of CT scans for identification of Ep, Ec, and other abnormalities will allow for more precise treatment, further define the use of conventional radiotherapy, combined modality therapy or whole lung irradiation, and allow more accurate analysis of treatment results.     

肺部肿瘤的影像学,支纤镜检及病理学对照分析（附80例报告）

目的：评价Ｘ线影像、ＣＴ、痰检、支纤镜检、针吸细胞学、冰冻切片等对肺部肿瘤的诊断价值。方法：对８０例肺部肿瘤的Ｘ线影像与ＣＴ、痰检、支纤镜、针吸细胞学、冰冻切征组织学进行对照分析。结果：Ｘ线一般能对肺部肿物作出诊断并初步定们；ＣＴ具有Ｘ线优点外，对显示某些特殊部位肿物以及纵隔、肺门等淋巴结肿大或转移优于Ｘ线；痰检适用于肺癌特别是中央型肺癌；支纤镜检适用于中央型肺部肿瘤；针吸细胞学适用于肺部肿瘤特别     

Three-dimensional volumetric assessment of response to treatment: stage I and II diffuse large cell lymphoma of the mediastinum

From 1981 to 1986, 12 patients with Stage I and II diffuse large cell lymphoma of the mediastinum were treated with 4 or more cycles of multiagent chemotherapy and for nine patients this was followed by mediastinal irradiation. The response to treatment was assessed by three-dimensional volumetric analysis utilizing thoracic CT scans. The initial mean tumor volume of the five patients relapsing was 540 ml in contrast to an initial mean tumor volume of 360 ml for the seven patients remaining in remission. Of the eight patients in whom mediastinal lymphoma volumes could be assessed 1-2 months after chemotherapy prior to mediastinal irradiation, the three patients who have relapsed had volumes of 292, 92, and 50 ml (mean volume 145 ml) in contrast to five patients who have remained in remission with residual volume abnormalities of 4-87 ml (mean volume 32 ml). Four patients in prolonged remission with CT scans taken one year after treatment have been noted to have mediastinal tumor volumes of 0-28 ml with a mean value of 10 ml. This volumetric technique to assess the extent of mediastinal large cell lymphoma from thoracic CT scans appears to be a useful method to quantitate the amount of disease at presentation as well as objectively monitor response to treatment.     

实时超声支气管镜引导下经支气管针吸活检术对肺癌的诊断作用

评价实时超声支气管镜引导下的经支气管针吸活检术（EBUS-TBNA）对肺癌的诊断价值。方法:回顾分析中山大学肿瘤防治中心2010年8月至2011年2月期间,46例经胸部CT或PET-CT检查显示为纵隔和/或肺门淋巴结肿大和/或胸内气管旁肿块（≥1 cm）的患者行EBUS-TBNA的资料（其中临床拟诊为肺癌并肺门和/或纵隔淋巴结转移25例,纵隔和/或肺门不明原因淋巴结肿大21例）,统计实时EBUS-TBNA在肺癌诊断中的敏感性、特异性、阳性预测值、阴性预测值及诊断率。结果:46例患者中,其中经病理学检查确诊为肺癌患者38例,淋巴结结核3例,淋巴结炎3例,结节病1例,淋巴瘤1例。46例患者中,经EBUS-TBNA诊断为肺癌34例,淋巴结核2例,淋巴结炎3例,结节病1例。38例肺癌患者共穿刺48组淋巴结,1例气管旁肿物,其中经EBUS-TBNA诊断为肺癌34例,假阴性4例,敏感性为89.5%,特异性为100%,阳性预测值为100%,阴性预测值为66.7%,诊断率为87.0%。EBUS-TBNA过程安全,全部病例无严重并发症发生,仅1例一过性发热。结论:实时EBUS-TBNA,并发症少,可在门诊进行,且诊断率、敏感性及阴性预测值高,是诊断肺癌安全、有效的方法。当常规支气管镜未能取到阳性病理结果时,亦可尝试通过对肺门或纵隔淋巴结或肺内肿块行EBUS-TBNA来诊断。      

Plain radiography and computed tomography of invasive thymomas: Clinico-radiologic-pathologic correlation

Fifteen computed tomography (CT) scans in nine patients with invasive thymoma are presented. The CT findings were an anterior mediastinal mass (89%), pleural deposits (78%), local infiltration of the mediastinum (100%), invasion of the cardiovascular structures (22%), lung invasion (11%) and diaphragmatic or subdiaphragmatic deposits (33%). Radiologic-pathologic correlation available in six patients showed a sensitivity of 89.5%, specificity of 87.5% and accuracy of 88.6% for CT. We conclude that CT is superior to plain radiography in the diagnosis of invasive thymoma. It provides an accurate pre-operative assessment by better demonstration of the full extent of abnormalities, and is useful in surgical planning, monitoring of therapeutic response and detecting recurrence.     

Sensitivity of chest radiography, computed tomography, and gallium scanning to metastasis of lung carcinoma

To determine the efficacy of radiologic techniques in preoperative staging of the mediastinum for lung carcinoma, the authors studied 45 patients with chest films supplemented with oblique views, esophagrams, gallium scans, and computed tomograms (CT). They interpreted the studies and correlated surgical findings using a modified classification of lymph node regions. The mediastinum was positive on chest films in 14 of the 21 cases with pathologically proved mediastinal metastases (33% false-negative). Gallium scans in cases with a positive primary were positive in 12 of 15 cases with mediastinal or hilar metastases (20% false-negative). Computed tomography showed nodes over 1 or 1.5 cm in size in or adjacent to the biopsy-positive node region in 18 of 19 patients (5% false-negative), extranodal mediastinal involvement, and 9 of 10 proven hilar metastases. Computed tomography is a sensitive screening technique in patients who would otherwise require an invasive staging procedure, but is not highly specific (false-positive rate 38%).     

Advantages and limitations of computed tomography scans for treatment planning of lung cancer

Forty-five Chest computed tomography (CT) scans performed on patients with lung carcinoma (LC) were evaluated in an attempt to understand the pattern of intrathoracic tumor spread and the advantages and limitations this technique offers for treatment planning when compared to planning done by conventional X rays. The following findings can help treatment planning. (1) When regular X rays do not show tumor location (i.e., hemithorax opacification), CT scan will show it in 68% of patients. If regular X rays show a well localized mass, unsuspected tumor extensions were disclosed in 78 % of these patients. Hence, CT scans should be done in all LC patients prior to treatment planning; (2) Mediastinal masses frequently spread anteriorly toward the sternum and posteriorly around the vertebral bodies toward the cord and costal pleura. This should be considered for radiotherapy boost techniques; (3) Lung masses spread in one third of cases toward the lateral costal pleura. Thus, the usual 1–2cm of safety margin around the LC are not sufficient in some cases; (4) Tumor size can appear much smaller in regular X rays than in CT scans. Hence, CT scans are necessary for accurate staging and evaluation of tumor response. Some CT scan limitations are: (1) Atelectasis blends with tumor in approximately half of the patients, thus obscuring tumor boundaries; (2) CT numbers and contrast enhancement did not help to differentiate between these two structures; and (3) Limited definition of CT scan prevents investigation of suspected microscopic spread around tumor masses.     

原发性气管癌的影像学诊断

 目的：提高原发性气管癌的影像学诊断水平。方法：进行8例原发性气管癌的X线、CT、MRI检查与临床病理对照分析。结果：8例影像学显示气管壁广基底菜花状或乳头状肿块影致管腔狭窄,肿块大小2~4.5cm,1例伴纵膈淋巴结肿大转移。病理诊断：气管鳞癌4例,腺样囊性癌４例。结论：MRI多体位进行气管癌检查,在显示气管癌的形态、大小、气管壁浸润、纵膈淋巴结有无转移等信息优于X线和CT,有助于临床治疗方法选择及预后判断。