《医学ppt--孤立性肺结节petct良恶性鉴别诊断》由会员分享，可在线阅读，更多相关《医学ppt--孤立性肺结节petct良恶性鉴别诊断（27页珍藏版）》请在金锄头文库上搜索。
1、,孤立性肺结节 CT、PET-CT良恶性鉴别诊断,Solitary pulmonary nodule: benign versus malignant Differentiation with CT and PET-CT Ann Leung and Robin Smithuis 原文地址：http:/www.radiologyassistant.nl/en/460f9fcd50637,孤立性肺结节的鉴别诊断，在临床中经常遇到。根据结节的良恶性差异，处理方法有很大差别。 在这篇文章中，我们主要探讨CT和PET-CT的相关征象在孤立性肺结节良恶性鉴别诊断中的意义。,The differential
2、 diagnosis of a solitary pulmonary nodule is broad and management depends on whether the lesion is benign or malignant. In this overview we will discuss some of the new features that can help to differentiate between benign and malignant nodules based upon CT and PET-CT findings,目录（contents）,CT征象 钙化
3、 大小 生长速度 形状 边界 充气支气管征 实性和磨玻璃成分 强化特征 PET-CT征象 结论,CT: benign versus malignant Calcification Size Growth Shape Margin Air Bronchogram sign Solid and Ground-glass components Contrast enhancement PET-CT: benign versus malignant Conclusion,钙化,良性钙化征象： 弥漫性 中心性 层状 爆米花样 弥漫性、中心性、层状及爆米花样钙化多见于良性结节。主要见于肉芽肿性疾病和错构瘤
4、。 其他类型钙化多见于恶性结节，不应该认为属于良性表现。 在已知有原发肿瘤存在的情况下，其钙化类型不一定适用此结论。例如：骨肉瘤或软骨肉瘤的病人，其钙化多表现为弥漫性；同样的，中心性和爆米花样钙化也可见于胃肠道肿瘤或接受过化疗的病人。,Calcification,Diffuse, central, laminated or popcorn calcifications are benign patterns of calcification. These types of calcification are seen in granulomatous disease and hamartoma
5、s. All other patterns of calcification should not be regarded as a sign of benignity. The exception to the rule above is when patients are known to have a primary tumor. For instance the diffuse calcification pattern can be seen in patients with osteosarcoma or chondrosarcoma. Similarly the central
6、and popcorn pattern can be seen in patients with GI-tumors and patients who previously had chemotherapy.,结节大小,结节大小与恶性可能性之间的关系 孤立性肺结节（SPN）定义：肺实质内小于等于3cm的病灶（需除外肺不张和肿大的淋巴结）。大于3cm的病灶称为肿块（mass）。 之所以这样定义，是因为大于3cm的病灶多为恶性，而更小的病灶可能是良心或恶性。 Swensen. et al 研究了SPN大小与恶性可能性之间的关系（上图），结论是小的结节，良性可能性大。超过2000例小于4mm的结节，
7、无一例属于恶性。,Size,A solitary pulmonary nodule (SPN) is defined as a single intraparenchymal lesion less than 3 cm in size and not associated with atelectasis or lymphadenopathy. A lesion greater than 3 cm in diameter is called a mass. This distinction is made, because lesions greater than 3 cm are usual
8、ly malignant, while smaller lesions can be either benign or malignant. Swensen et al studied the relationship between the size of a SPN and the chance of malignancy in a cohort at high risk for lung cancer (1). Their findings are listed in the table on the left. They concluded that benign nodule det
9、ection rate is high, especially if lesions are small. Of the over 2000 nodules that were less than 4 mm in size, none was malignant,生长速度,与以前的CT片进行比较，在结节定性方面具有重要意义。超过2年无变化的结节多为良性。,Growth,Comparison with prior imaging studies is often the most useful procedure to determine the importance of the findin
10、g of a SPN, since stability over 2 years is highly associated with benignity.,形状,左：横断图像；右：冠状重建图像。三维比值=（最大）横径/长径 日本的相关研究证实，多角形、三维比值大于1.78的结节，多为良性。在肺的外围、胸膜下的结节也多为良性。 三维比值=（最大）横径/长径。大的三维比值说明病灶的形状是扁平的（是“片”不是“块”），这是良性的特征。,Shape,Japanese screening studies showed that a polygonal shape and a three-dimensio
11、nal ratio 1.78 was a sign of benignity (2,3). A polygonal shape means that the lesion has multiple facets (multi-sided). A peripheral subpleural location was also a sign of benignity in this study. The three-dimensional ratio is measured by obtaining the maximal transverse dimension and dividing it
12、by the maximal vertical dimension. A large three-dimensional ratio indicates that the lesion is relatively flat, which is a benign sign.,边缘,辐射冠征：绝大多数都为恶性（上图：恶性病灶周围的辐射冠征-毛刺）。 病灶边缘呈分叶状的，可以是良性或恶性 边缘光滑，多为良性。,Margin,Corona radiata sign - highly associated with malignancy (figure) Lobulated or scalloped m
13、argins - intermediate probability Smooth margins - more likely benign unless metastatic in origin,充气支气管征,最新研究表明，有充气支气管征的结节多为恶性。主要见于BAC（细支气管肺泡癌）和腺癌。 上图显示充气的支气管呈线样（粗箭）或囊状（细箭）透亮区，这是支气管走向不同造成的。,Air Bronchogram sign,Recent studies have showed that an air bronchogram is more commonly seen in malignant pul
14、monary nodules. It is most commonly seen in BAC (bronchoalveolar cell carcinoma) and adenocarcinoma. The case on the left shows an airbronchogram seen as a linear lucency (broad arrow) and as a more cystic lucency (small arrow) due to the fact that the bronchus is seen en face.,图中两个SPN，根据形态表现，哪个更像恶性
15、的？ 左边的结节边缘呈毛刺状，内部有透亮区；右侧者呈分叶状，边缘毛刺并与胸膜粘连，但是内部均质。 基于上面的表现，我们认为左侧者更像恶性的。最终证实，左侧者为腺癌，右侧为真菌感染。,On the left two solitary pulmonary nodules. Based upon the morphology, which lesion has the most malignant features? The lesion on the far left has a spicuated margin and has lucencies within it. The lesion ne
16、xt to it is lobulated in contour and has some spicules radiating to the pleura. It is however homogeneous in attenuation. Based on these findings we should be most concerned that the lesion on the far left is malignant. It proved to be an adenocarcinoma, while the other one was a fungal infection. The lucencies and frank air bronchograms should not mislead you in thinking that it probably is infection.,实性和磨玻璃成分,一项研究表明：结节内含有磨玻璃样成分的，更倾向于属于恶性。 结节内既含有部分实性成分，又含有磨玻璃成分的，为恶性的可能性
