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1、肺部GGO病理解读及HRCT评价1GGO(ground-glass opacity,GGO)GGO(ground-glass opacity,GGO)，肺毛玻璃样病变，是周围，肺毛玻璃样病变，是周围型肺癌最早期的型肺癌最早期的CTCT表现表现容易被我们忽视或者被认为是正常的容易被我们忽视或者被认为是正常的CTCT图像图像随着随着CTCT技术的发展及人们健康意识的增强，我们将面临越来越技术的发展及人们健康意识的增强，我们将面临越来越多这种的病人多这种的病人一、一、GGOGGO的病理解读的病理解读23456ab7GGO的定义GGOGGO定义定义 ：在在高分辨率高分辨率CT(HRCT) CT(HRC
2、T) 上表现为密度轻度增上表现为密度轻度增加加, ,但其内的支气管血管束仍可但其内的支气管血管束仍可显示显示的病变的病变, ,纵隔窗上病灶往往纵隔窗上病灶往往不能显示或仅能显示磨玻璃样不能显示或仅能显示磨玻璃样病灶中的实性成分病灶中的实性成分8GGO的病理解读GGO GGO 病理病理：由于肺泡内气体减少、细胞数量相对增由于肺泡内气体减少、细胞数量相对增多、肺泡上皮细胞增生、肺泡间隔增厚及终末气道部多、肺泡上皮细胞增生、肺泡间隔增厚及终末气道部分充填等因素所致分充填等因素所致的的病理变化病理变化。Pathology:Pathology: Ground-glass opacity may be c
3、aused by partial airspace filling; interstitial thickening with inflammation, edema, fibrosis, or neoplastic proliferation; or interstitial thickening with partial airspace filling. 9a.Transverse lung-window thin-section (1.25-mm-thick) CT scan shows8-mm round, well-defined GGO nodule (arrow) in lef
4、t upper lobe.b. Photomicrograph shows columnar tumor cells growing along thickened alveolar walls (lepidic growth).ab10AAH AAH in 55-year-old man. in 55-year-old man. a.Transverse lung-window thin-section (2.5-mm-thick) CT scan shows 12-mm round, well-defined a.Transverse lung-window thin-section (2
5、.5-mm-thick) CT scan shows 12-mm round, well-defined GGO nodule (arrow) in left upper lobe. GGO nodule (arrow) in left upper lobe. b.shows alveolar wall thickening and increased numbers of alveolar lining cells with minimal wall b.shows alveolar wall thickening and increased numbers of alveolar lini
6、ng cells with minimal wall thickening.thickening.ab11GGO演变为演变为周围型周围型肺癌的过肺癌的过程程肺泡上皮不典型样增生肺泡上皮不典型样增生（AAHAAH）原位癌（原位癌（AISAIS）进展期肺癌进展期肺癌12肺癌前病变演化成原位癌的病理变化过程肺癌前病变演化成原位癌的病理变化过程基底细胞增生基底细胞增生轻度不典型增生轻度不典型增生中度不典型增生中度不典型增生重度不典型增生重度不典型增生原位癌原位癌肺泡上皮不典型样增生肺泡上皮不典型样增生肺泡上皮不典型样增生肺泡上皮不典型样增生（AAHAAHAAHAAH）原位癌原位癌（AISAIS）13肺
7、腺癌病变病理衍化过程图（腺癌）肺腺癌病变病理衍化过程图（腺癌） 侵袭性侵袭性AISAAH14二、高分辨率二、高分辨率CTCT对对GGOGGO的评价的评价15肺良好的自然对比，是肺良好的自然对比，是CTCT成像的有利条件；成像的有利条件；多多排排螺螺旋旋CTCT，主主要要是是指指1616排排以以上上螺螺旋旋CTCT，具具有有高高时时间间、高高空空间间、高高密密度度辨辨分分率率以以及及高高信信噪噪比比的的成成像像特特点；点；任意层厚重建，能检出任意层厚重建，能检出1mm1mm的小病灶；的小病灶；高高分分辨辨率率CT(HRCT)CT(HRCT)对对肺肺内内小小病病灶灶细细节节的的显显示示优优于于常常
8、规规CTCT，能能检检出出0.5mm0.5mm的的小小病病灶灶，是是评评价价GGOGGO最最佳佳的的无无创性方法。创性方法。16肺多排螺旋CT扫描技术参数层厚层厚( (任意层厚重建）任意层厚重建）0.3-1mm重建算法重建算法高分辨率算法高分辨率算法矩阵矩阵512512扫描时间扫描时间0.5sPicth1mm曝光量（尽量低毫安）曝光量（尽量低毫安）KV/mAS ：120-140/50-80窗宽窗位窗宽窗位肺肺 窗窗：+700 -700Hu纵隔窗：纵隔窗： 50 300Hu靶重建靶重建FOVFOV20-50cm17容积扫描容积扫描准备准备各各向向同同性性成成像像图像处理图像处理多层、无间隔、连续
9、的图像多层、无间隔、连续的图像18薄层，小薄层，小FOVFOV，多发方位重建，多发方位重建19第一种分型第一种分型第二种分型第二种分型局限性局限性GGO的的CT分型分型20单纯型单纯型GGO(pure GGOGGO(pure GGO，pGGO) :pGGO) : 整个病灶密整个病灶密度浅淡度浅淡, , 内见血管或支气管壁内见血管或支气管壁, , 完全无实性完全无实性组织成分组织成分, , 只能在肺窗下看到只能在肺窗下看到 混合型混合型GGO (mixed GGO,mGGO):GGO (mixed GGO,mGGO): 病灶内部见部病灶内部见部分实性组织分实性组织, , 相应部分血管被遮盖相应部
10、分血管被遮盖, , 实性病变实性病变部分可在纵隔窗下看到部分可在纵隔窗下看到第一种分型第一种分型21: :单纯磨玻璃样影单纯磨玻璃样影: :密度不均的磨玻璃样影密度不均的磨玻璃样影 : :中央高密度中央高密度, ,外围淡薄模糊磨玻璃样影外围淡薄模糊磨玻璃样影 : :单纯结节影单纯结节影第二种分型第二种分型22GGO分型和肿瘤发生及CT表现 型型：纯磨玻璃样结节纯磨玻璃样结节, ,病理改变为肿瘤细胞沿肺泡病理改变为肿瘤细胞沿肺泡壁生长壁生长, ,无肺泡塌陷无肺泡塌陷, ,肿瘤内弹性纤维轻度增生肿瘤内弹性纤维轻度增生23 型型：低密度不均匀结节低密度不均匀结节, ,病理为肿瘤细胞沿肺泡壁生病理为肿
11、瘤细胞沿肺泡壁生长长, ,伴有散在肺泡塌陷伴有散在肺泡塌陷, ,肿瘤内弹性纤维、重度增生肿瘤内弹性纤维、重度增生, ,但但其网状结构仍保存其网状结构仍保存24 型型：中心高密度伴周边磨玻璃样结节中心高密度伴周边磨玻璃样结节, ,病理为肺泡塌病理为肺泡塌陷陷, ,瘤体中心弹性纤维增生瘤体中心弹性纤维增生, ,伴弹性纤维网状结构断裂伴弹性纤维网状结构断裂, ,周边区肿瘤细胞伏壁生长周边区肿瘤细胞伏壁生长25 型型：均匀软组织密度结节均匀软组织密度结节, ,病理上肿瘤呈实体生病理上肿瘤呈实体生长长, ,无含气肺泡组织无含气肺泡组织, ,肿瘤内弹性纤维增生肿瘤内弹性纤维增生, ,网状结网状结构中断、破
12、坏构中断、破坏26型型:单纯磨玻璃样阴影单纯磨玻璃样阴影GGOGGO发展发展成肺癌成肺癌的动态的动态演变过演变过程程型型型型: :密度不均的磨玻璃样阴影密度不均的磨玻璃样阴影密度不均的磨玻璃样阴影密度不均的磨玻璃样阴影型型型型: : : :中央高密度中央高密度中央高密度中央高密度, , , ,外围淡薄模糊外围淡薄模糊外围淡薄模糊外围淡薄模糊的磨玻璃样阴影的磨玻璃样阴影的磨玻璃样阴影的磨玻璃样阴影 型型型型: :单纯结节单纯结节单纯结节单纯结节影影影影27GGO发展成肺癌CT表现的四步曲pGGOpGGO：pure GGO pure GGO （纯毛玻璃样病变）（纯毛玻璃样病变）mGGO:mGGO:
13、 mixed GGOmixed GGO（混合型毛玻璃样病变）（混合型毛玻璃样病变）SOLID SPNSOLID SPN(3cm)(3cm(3cm，肿块，实体瘤，进展期肺癌，肿块，实体瘤，进展期肺癌) )28pGGO：AAHmGGO：AISMASS:腺癌从病理学角度看肺癌的从病理学角度看肺癌的CT图像的演变过程图像的演变过程29Illustration of the relationship between the Noguchi histologic classification of adenocarcinoma of the lung (Noguchi types A though F)
14、and corresponding CT appearances of these lesions. 30nPersistent nodular ground-glass opacity in an 80-year-old man with adenocarcinoma. Adenocarcinoma was found at histopathologic analysis of an excised specimen.na. Initial thick-section CT image obtained at the level of the right inferior pulmonar
15、y vein shows a subtle nodule (arrow) in the middle lobe of the right lung. nb.Follow-up CT image obtained 12 months later shows an increase in the lesion size and an additional subtle internal solid component (arrow). nc.Follow-up thin-section CT image obtained at 16 months shows an increase in the
16、size of the solid component within the lesion (arrow). abc31nBAC. Sequential magnified 1-mm CT sections through the right upper lobe show minimal increase in size of a nodule with GGO over a 3-year period. The central area of higher attenuation represents a vessel bifurcation and not a solid compone
17、nt, which was better characterized on sequential images.3233（一）肺恶性（一）肺恶性GGO的的CT评评价价34GGO和AAHAtypical adenomatous hyperplasia in a 53-year-old woman.a.Thin-section CT image of the right lung shows an 11-mm well-defined nodular ground-glass opacity without a solid component in the lower lobe. b. photo
18、micrograph shows thickened alveolar walls lined by an intermittent single layer of atypical cuboidal pneumocytes.ab35 Concurrent atypical adenomatous hyperplasia and adenocarcinoma in a 71-year-old woman. Thin-section CT image at the level of the carina shows an 18-mm-diameter mixed nodular ground-g
19、lass opacity with a solid component in the upper lobe of the right lung and a 10-mm pure nodular ground-glass opacity in the lower lobe of the left lung. AAHcarcinoma of the bronchioloalveolar36 Multiple AAHs in a 42-year-oldwoman. CT scans show round well-defined, pure GGO nodules (arrow).Photomicr
20、ograph of the nodule in the left upper lobe show AAH.abc37bronchioloalveolar carcinoma in a 63-year-old woman.a.the right upper anterior segmental bronchus shows a 10-mm well-defined nodular ground-glass opacity without a solid component in the lower lobe of the right lung. Note the presence of pulm
21、onary vessels in the lesion. b. Photomicrograph specimen shows replacement of the alveolar lining by neoplastic columnar epithelium, without evidence of stromal invasion. GGO 和和 BAC (AIS)ab38bronchioloalveolar carcinoma in a 49-year-old woman. a.The level of the right bronchus intermedius shows a 14
22、-mm well-defined nodular ground-glass opacity with a solid component (arrow) in the lower lobe of the right lung, abutting the vertebral body. b. Photomicrograph shows BAC (AIS)ab39 Adenocarcinoma with mixed acinar and bronchioloalveolar carcinoma in a 50-year-old woman. a. Thin-section CT image sho
23、ws a 28-mm well-defined mixed ground-glass opacity lesion with peripheral ground-glass opacity in the upper lobe of the left lung. The mass abuts the pleura.b. Photomicrograph of a histologic specimen shows BAC (AIS).ab40 BAC and AAH in a 63-year-old woman. a. lung-window CT scan shows a 19-mm ovoid
24、, well-defined, pure GGO nodule in the left lower lobe. This lesion was confirmed as BAC after basal segmentectomy.b. lung-window thin-section CT scan shows a 9-mm round, well-defined, pure GGO nodule (arrow) in the left upper lobe. This lesion was confirmed as AAH after wedge resection. c. Nodule i
25、n the left lower lobe shows columnar or cuboidal cell lining thickened alveolar walls without evidence of stromal, vascular, or pleural invasion.abc41a. Transverse lung-window thin-section (1-mm-thick) CT scan shows a 22-mm irregular GGO nodule with bubble-lucency in the left lower lobe. This lesion
26、 was confirmed as adenocarcinoma with a predominant BAC component after lobectomy.b. Transverse lung-window thin-section (1-mm) CT scan shows a 12- mm round, well-defined pure GGO nodule in the right upper lobe. This lesion was confirmed as BAC. AAdenocarcinoma with a predominant BAC component and B
27、AC in a 48-year old woman. ab42 65-year-old-woman with multiple pure ground-glass opacities (PGGOs)a. Multiple small PGGOs were found in all lobes of lung. Computed tomographic slice reveals three PGGOs (arrows) in the right upper lobe. The lobe, including the maximal PGGO (10 mm in diameter), was r
28、emoved. b. Comprehensive histologic examination of resected specimens demonstrated existence of many smaller lesions revealing bronchioloalveolar carcinoma or atypical adenomatous hyperplasia. During 37 months of postoperative follow-up, only a slight increase in size or density was recognized in so
29、me residual PGGOs scattered in all lobes.ab43 Adenocarcinoma in a 56-year-old man.a.Thin-section CT image obtained shows a 14-mm nodular ground-glass opacity with no solid component in the upper lobe of the right lung.b.Photomicrograph of a histologic specimen shows adenocarcinoma with dense scleros
30、is.GGO与腺癌与腺癌ab44CT scan (1-mm section) of mixed subtype adenocarcinoma with BAC component (Noguchi type C lesion) shows a nodule with pure GGO, demonstrating that although nonsolid nodules are likely to represent AAH or BAC, an invasive component may rarely be present as in this case.45CT scan in a
31、64-year-old man shows an oval 2.1-cm left lower lobe nonsolid nodule (arrow). FNAB revealed adenocarcinoma.46支气管充支气管充气造影征气造影征轴位示：左上肺毛玻璃阴影轴位示：左上肺毛玻璃阴影47分叶征分叶征冠状位冠状位48毛刺征毛刺征矢状位矢状位BAC49CT:CT:左上肺毛玻璃阴影左上肺毛玻璃阴影短毛刺征短毛刺征50冠状位重建51矢状位重建典型胸膜凹陷征典型胸膜凹陷征BAC52左上肺尖段纯毛玻璃结节左上肺尖段纯毛玻璃结节:1.0:1.00.9cm0.9cm53冠状位重建：局灶性纯磨玻璃
32、密度影冠状位重建：局灶性纯磨玻璃密度影(Focal pure ground(Focal pure groundglass opacityglass opacity，pGGOpGGO54矢状位矢状位局部放大局部放大BAC55峰值时间后移峰值时间后移F， 68，腺，腺鳞癌鳞癌,HRCT动态增强特动态增强特征征56（二）肺良性（二）肺良性GGOGGO的的CTCT评价评价57肺局灶性间质纤维化与GGO Focal interstitial fibrosis in a 40-year-old womana.Thin-section CT image shows a 25-mm well-defined
33、nodular ground-glass opacity with no solid component in the lower lobe of the left lung. b.Photomicrograph of a histologic shows the lesion (arrow) with alveolar septal thickening and fibrosis and with intraalveolar infiltration by inflammatory cells.ab58 A 36-year-old woman with two nodular GGOsa.T
34、ransverse thin-section CT scan shows a 5.1-mm well defined round pure GGO nodule in the right middle lobe. focal interstitial fibrosis. b.The other 9-mm mixed GGO nodule containing a central solid portion is shown in the right lower lobe. bronchioloalveolar carcinoma ab59Focal nonspecific interstiti
35、al pneumonia. a, b.Thin-section CT scans at the level of the left pulmonary artery and aortic arch, respectively, show three foci of persistent GGO. c.Histologic specimen shows thickening of the alveolar wall with chronic inflammatory infiltrates. No tumor was identified.abc60A 34-year-old woman wit
36、h focal interstitial fibrosis showing a round pure GGO lesion a.Transverse thin-section CT scan shows an 8.5-mm well-defined round nodule with pure GGO. There was no evidence of spiculation or vascular convergence around the lesion. b.Photomicrograph of resection specimen shows alveolar interstitial
37、 thickening with fibrosis and type II pneumocyte proliferationab61 A 50-year-old woman with focal interstitial fibrosis appearing as mixed GGO with a spiculated margin and pleural traction. a.Transverse thin-section CT scan shows a mixed GGO nodule in the left upper lobe. Note the spiculated margin
38、and pleural retraction. b.This follow-up thin-section CT taken 2 months later shows a similar appearance. The lesion was resected under the impression of primary lung cancer. The pathologic diagnosis was of focal interstitial fibrosis without evidence of malignancyab62A 66-year-old man with focal in
39、terstitial fibrosis with a polygonal shape and peri-lobular linear density. Transverse thinsection CT scan shows a nodular GGO lesion with peri-lobular linear opacities (arrow) around the lesion in the right upper lobe. Note the pleural traction around the lesion63Nodular fibrosis with concave margi
40、ns in 67-year-old man. Both reviewers interpreted lesion as having concave margins (arrow), air bronchograms (arrowheads), and predominantly ground-glass appearance on transverse high-resolution CT images. Lesion size was measured 8 mm by reviewer 1 and 8.5 mm by reviewer 2. Pathologic diagnosis was
41、 nodular fibrosis.64Nodular fibrosis with polygonal shape in 72-year-old man. Both reviewers interpreted lesion (arrow ) as having coarse spiculation, pleural tag, and polygonal shape, and as being predominantly solid on transverse high resolution CT images. Lesion size was measured as 8 mm by revie
42、wer 1 and 9 mm by reviewer 2. Pathologic diagnosis was nodular fibrosis.65Intrapulmonary lymph nodethat showed peripheral subpleurallesion in 53-year-old woman.Both reviewers regarded lesion(arrow ) as predominantly solid lesion attached to major fissure on transverse high-resolution CT images. Lesi
43、on size was measured 9 mm by both reviewers. Pathologic diagnosis wasintrapulmonary lymph node.肺内淋巴结与肺内淋巴结与GGOGGO66CT scan in a 90-year-old woman with chronic congestive heart failure shows a tiny nodule adjacent to the right major fissure that is likely to represent a congested intrapulmonary lymph
44、 node (arrow). 67GGO与霉菌灶Thin-section CT image at the level of the main pulmonary artery shows a 23-mm poorly defined nodular ground-glass opacity in the upper lobe of the left lung. The lesion includes several peripheral solid portions (arrows) and a subtle groundglass opacity (arrowhead). 68Eosinop
45、hilic pneumonia in a 36-year-old man with peripheral blood eosinophilia. a.Thin-section CT image at the level of the aortic arch shows an ill-defined area of nodular ground-glass opacity in the upper lobe of the right lung. b.Thin-section CT image at the level of the upper lobar bronchus in the left
46、 lung shows a similar nodular ground-glass opacity.ab69GGO与结核灶False positive PET in patient with tuberculosis. a.Thin-section axial CT scan through the upper lobes at lung windows shows a left upper lobe nodule with irregular margins. b.Fused image from PET-CT shows increased metabolic activity with
47、in the nodule. Surgical resection revealed a granuloma with cultures positive for Mycobacterium tuberculosis.ab70（三）GGO的CT处理原则和步骤CTCT随访随访GGOGGO变化的重要性变化的重要性体积不变体积不变体积变大体积变大体积变小体积变小密度变实密度变实代谢较低代谢较低711 1、体积不变、体积不变72Persistent nodular ground-glass opacity in a 69-year-old man.a.Thin-section CT image obt
48、ained at the level of the left brachiocephalic vein shows a 14-mm poorly defined round nodular ground-glass opacity in the upper lobe of the left lung. b.Follow-up thin-section CT image obtained 4 months later shows the persistence and stable appearance of the lesion. The pathologic diagnosis, obtai
49、ned after a wedge resection, was focal interstitial fibrosis.ab73Pure nodular ground-glass opacity confirmed as focal interstitial fibrosis A.Thin-section CT shows 30 mm pure nodular ground-glass opacity in the right upper lobe.B.On follow-up CT scan after seven months, an interval change was not no
50、ted. ab74Pure nodular ground-glass opacity confirmed as atypical adenomatous hyperplasia in a 58-year-old man. A.Initial thin-section CT shows a 15 mm pure nodular ground-glass opacity B.On thin-section CT after 2 months, an interval change was not noted. All lesions were pathologically confirmed as
51、 atypical adenomatous hyperplasia by multifocal wedge resection.ab75Pure nodular ground-glass opacity confirmed as atypical adenomatous hyperplasia a. Initial CT shows 8 mm pure nodular ground-glass opacity in the right upper lobe.b. Thin-section CT after 10 months shows persistent pure nodular grou
52、nd glass opacity with the same size. ab762、体积变大体积变大一般为恶性病变体积变大一般为恶性病变77 Small adenocarcinoma detected on screening CT.Initial axial thin section CT at the level of the right upper lobe bronchus shows a 4 mm nodule in the right upper lobe. .Repeat CT scan 3 months later at the same level shows slight
53、 enlargement of the nodule. Biopsy revealed adenocarcinoma.ab78Growth of small nodule on follow up CT. (adenocarcinoma).Initial thin-section axial CT coned to the left lung shows a small left upper lobe nodule measuring approximately 4 mm in diameter. . Repeat scan 6 months later shows interval grow
54、th of the lesion . An invasive adenocarcinoma was found at surgery.ab79 BAC. Sequential magnified 1-mm CT sections through the right upper lobe show minimal increase in size of a nodule with GGO over a 3-year period. The central area of higher attenuation represents a vessel bifurcation and not a so
55、lid component, which was better characterized on sequential images.80Sequential magnified 5-mm CT sections through the left upper lobe show GGOinitially measuring 8mm in size over a 3-year period. Histologic analysis showed mixed subtype adenocarcinoma composed of acinar adenocarcinoma (40%) and BAC
56、 (60%). 81Computed tomogram from 57-year-old man (patient 1) with long-term follow-up of pure ground-glass opacity (PGGO) for more than 10 years. Patient had undergone operation for adenocarcinoma originating in right upper lobe 10 years previously. .Small PGGO in left upper lobe (arrow) was pointed
57、 out as a function of the retrospective review of conventional CT taken at that operation. .On follow-up 124 months later, high-resolution computed tomography shows enlargement of PGGO from 8 mm (A) to 25 mm in diameter. . Most of the resected specimen reveals bronchioloalveolar carcinomaabc82 Mixed
58、 subtype adenocarcinoma, progression of GGO to a nodule with mixed solid component and GGO. a.Magnified 1-mm CT section shows a discrete GGO (arrows). b.Follow-up CT scan obtained 1 year later shows clear progression of the disease, with the development of a central solid component, although there i
59、s no appreciable enlargement of the lesion (arrows).ab83 Mixed subtype adenocarcinoma.a Magnified 1-mm CT section through the left lower lobe shows a nodule with mixed solid component and GGO.b Follow-up CT scan obtained 6 months later shows increase in the extent of the solid component within the n
60、odule.ab84 Persistent nodular ground-glass opacity in an 80-year-old man with adenocarcinoma. Initial thick-section CT image obtained at the level of the right inferior pulmonary vein shows a subtle nodule (arrow) in the middle lobe of the right lung. Follow-up CT image obtained 12 months later show
61、s an increase in the lesion size and an additional subtle internal solid component (arrow).Follow-up thin-section CT imageobtained at 16 months shows an increase in the size of the solid component within the lesion (arrow). Adenocarcinoma was found at histopathologic analysis of an excised specimen.
62、abc85 a.Transverse CT scan in a 75-year-old man shows a 2.0-cm-diameter nonsolid left upper lobe nodule. FNAB revealed no malignant cells. b.The lesion was followed up with serial CT; 25 months later, the nodule was slightly increased in size and had converted to a partly solid attenuation lesion wi
63、th air bronchograms. Volumetric measurement showed the doubling time of the opacity to be 1375 days. Repeat FNAB showed bronchioloalveolar cell carcinoma.ab86、体积变小体积变小一般为良性病变体积变小一般为良性病变87 Resolution of nodular ground-glass opacity over time helps determine the benignity of a lesion in a 50-year-old
64、man. a.Initial thin-section CT image at the level of the inferior pulmonary vein shows a 12-mm poorly defined nodular ground-glass opacity in the right lower lobe. b. Follow-up CT image obtained approximately 2 months later shows that the lesion in a has resolved.ab88Focal inflammation mimicking ade
65、nocarcinoma. a.Magnified 1-mm CT section through the right upper lobe shows nodules with GGO initially diagnosed as probable BAC. b. Follow-up CT scan obtained 3 months later shows near complete resolution of the lesion (arrow),(focal nonspecific inflammation).ab89Transverse thin-section CT scans sh
66、ow transient PSN with multiplicity in a 43-year-old man.a.Scan shows a 16-mm PSN (arrow) in the left upper lobe. This patient had eosinophilia (eosinophil count, 574 per microliter). b. Follow-up scan obtained 1 month later shows disappearance of the PSN.ab90Transverse thin-section CT scans show tra
67、nsient PSN with ill-defi ned border in 37-year-old man.a.Scan shows a 27-mm PSN (arrow) with an ill-defi ned border in the right upper lobe. This patient had blood eosinophilia (eosinophil count, 1577 per microliter). b.At follow-up CT performed 3 weeks later, the PSN has disappeared.ab91Resolution
68、of spiculated SPN caused by infection.a.Axial CT scan at level of tracheal carina in a 52-year-old smoker who has fever, cough, and hemoptysis shows a spiculated nodule in the left upper lobe. b.Repeat axial CT 5 weeks later shows marked decrease in the size of the nodule. The patient had been treat
69、ed in the interval with broad spectrum antibiotics for a presumed infection.ab92 Decrease in size of malignant SPN on short term follow-up CT.Coned down axial CT scan through the left lower lobe shows an irregular nodule. Repeat CT scan 4 months later shows a slight decrease in the size of the nodul
70、e, which still has an irregular margin. Repeat CT scan 6 months after (B) shows a increase in size of the nodule, which has a lobulated margin. Transthoracic biopsy showed an adenocarcinoma.acb93、密度变实、密度变实密度变实要高度怀疑恶性密度变实要高度怀疑恶性94Evolution of pure ground glass nodule reflecting adenocarcinoma.Thin-se
71、ction axial CT through the right upper lobe shows a pure ground-glass attenuation nodule. Repeat scan 3 years later shows the nodule is predominantly solid with irregular margins, Transthoracic biopsy and subsequent surgical resection revealed an adenocarcinoma.a95 5 5、代谢较低、代谢较低CTCT表现表现GGOGGO，PET-CT
72、PET-CT表现低代谢，良表现低代谢，良恶性都有可能，关键看恶性都有可能，关键看CTCT特征特征962008-2-23:2008-2-23:胸部胸部CTCT扫描：扫描：右下肺小斑片右下肺小斑片状影，建议随状影，建议随访。访。 972008-8-232008-8-23胸部胸部CTCT扫描：扫描：右下肺小斑片右下肺小斑片状影，建议随状影，建议随访。访。 982008-9-8 2008-9-8 PET/CTPET/CT胸部胸部CTCT扫描：扫描：右下肺小斑片右下肺小斑片状影，呈低代状影，呈低代谢。谢。 99其后行其后行HRCTHRCT扫描扫描 100胸胸膜膜凹凹陷陷征征阳阳性性 101冠状位、矢状位
73、显示病灶冠状位、矢状位显示病灶,胸腔镜下肺叶切除并病理胸腔镜下肺叶切除并病理证实证实肺泡细胞癌。肺泡细胞癌。102CTCT：左上肺：左上肺0.5cm0.5cm小结节病灶，边缘不规则小结节病灶，边缘不规则103PET-CTPET-CT呈呈低代谢，低代谢，行胸腔镜行胸腔镜手术病理示：手术病理示：肺泡细胞癌。肺泡细胞癌。104AAHAAH（Atypical adenomatous hyperplasia）在普通人群很常在普通人群很常见，发生率为见，发生率为2.8%2.8%，6060岁以上发生率岁以上发生率6.6%6.6%，肺癌病人中发生率肺癌病人中发生率10%-23.2%10%-23.2%Atypi
74、cal adenomatous hyperplasia occurs in 2.8% of the general population and in 6.6% of the population at the age of 60 years or older. Moreover, it occurs much more frequently in patients with pulmonary adenocarcinoma, among whom the reported incidence ranges from 10% to 23.2%.三、小三、小 结结105Kim等学者研究结果表明等
75、学者研究结果表明81%81%持续存在的持续存在的GGOGGO在自然在自然人群中可能是人群中可能是AAHAAH，BACBAC或者腺癌，或者腺癌，19%19%可能是良性病变机可能是良性病变机化性肺炎或非特异性纤维化化性肺炎或非特异性纤维化Findings have been reported by Kim et al ，who retrospectively found in a nonscreened population that while 81% of persistent nonsolid nodules proved to be either AAH, BAC, or adenocar
76、cinoma with BAC features, the remaining 19% proved histologically to represent either organizing pneumonia or nonspecific fibrosis. 106发发现现越越来来越越微微小小的的肺肺部部病病变变CTCT对研究早期肺癌的对研究早期肺癌的巨大贡献巨大贡献107CT发现病灶越来越小，发现病灶密度越来越低电电子子显显微微镜镜显显微微镜镜放放大大镜镜CT108早期肺癌早期肺癌CTCT均表现为均表现为GGOGGO，但是，但是GGOGGO不一定全是不一定全是恶性病变；恶性病变；纯毛玻璃样病变纯毛玻璃样病变(GGO)(GGO)每个月、非纯毛玻璃样每个月、非纯毛玻璃样病变每个月、实性结节每月随访病变每个月、实性结节每月随访; ;随访间隔应视结节的大小和密度而定随访间隔应视结节的大小和密度而定, ,以下每个月、以下每个月、- -每个月、每个月、以上每月复查。以上每月复查。109“逆水行舟，不进则退逆水行舟，不进则退”“顺水行舟，小进也退顺水行舟，小进也退”110
