G孤立性肺结节的诊断现状—培训课件.pptVIP

小 结 CT检查可提高肺内小结节的检出率 动态螺旋CT可做为SPN最初评价手段 PET/CT更具敏感性 SPN高度怀疑恶性，可通过VATS切除 * 美国癌症协会估计2005年新增172570肺癌病例（男性93010，女性79560），发病率：男性1/13, 女性1/18 ；Ia 期可手术肺癌5年生存率85％ * VATS 64cases 58％ 恶性（6例直径小于5mm） ELCAP 标准 8％ 恶性 * 不规整及毛刺产生病理学基础为恶性细胞通过小叶间隔淋巴道小气道血管向周围蔓延 * 可能是肿瘤内血液供应障碍，营养养不良，细胞坏死而发生钙化；也可能是肿瘤自身的内分泌功能（如黏液腺癌）使肿瘤内钙质沉着；亦可能是肿瘤间质生为成骨细胞而发生骨化。 * 95％薄壁良性，84％－95％厚壁恶性，病灶7mm也可有空洞 Graph of four different types of time-attenuation curve of nodule hemodynamics in consideration of both wash-in and washout phases of dynamic CT. Radiology 2005;237:675-683 Patterns of Nodule Enhancement at Early and Delayed Enhancement CT Patterns of Nodule Enhancement according to Histologic Diagnosis Fig. 4A —Metastatic adenocarcinoma in 57-year-old man with rectal cancer shows net enhancement of 25 H and washout of 5-31 H on dynamic helical CT and positive uptake on integrated PET/CT. Lung window of transverse thin-section (2.5-mm collimation) CT scan shows 9-mm nodule (arrow) in left upper lobe. Fig. 3A —Adenocarcinoma in 67-year-old man shows net enhancement of 25 H and washout of 5-31 H at dynamic helical CT and positive uptake at integrated PET/CT. Lung window of transverse thin-section (2.5-mm collimation) CT scan shows 16-mm nodule (arrow) in left upper lobe has lobulated and spiculated margin. Figure 3a. CT scans of tuberculoma with type II enhancement (25 HU wash-in) in a 58-year-old man. (a) Transverse thin-section (2.5-mm collimation) scan obtained with lung window at the level of the right main bronchus shows 21-mm nodule with lobulated and spiculated margin in the right upper lobe. (b) Serial images with dynamic enhancement curve for the nodule. Peak enhancement is 49 HU; net enhancement, 3 HU; and absolute loss of enhancement (washout), 1 HU. Figure 4a. CT scans of organizing pneumonia (focal pneumonia without specific microorganism) with type III enhancement ( 25 HU wash-in with persistent enhancement) in a 58-year-old woman. (a) Transverse thin-section (2.5-mm collimation) scan obt