肺微小结节处理最新进展2013(1).pptVIP

层块连续切割 空泡征是本例最大特征，多种显示技术充分显示其特点。 手术AIS M72，AIS，最大径5mm F37，诊断AIS，手术AAH Use of thick versus thin sections for accurate characterization of a 5-mm subsolid nodule (arrow) in lung periphery. A, CT scan obtained with 5-mm-thick sections through left upper lobe shows a small apparently pure GGN in lung periphery. B, C, CT scans obtained with 1-mm-thick sections at same level reconstructed from original volume acquisition images with lung (B) and soft-tissue (C) windows show that nodule is actually a solid lesion, likely a calcified granuloma. Value of contiguous 1-mm-thick CT scans for establishing subtle interval growth. A, Magnified section through right upper lobe shows a subtle pure GGN (arrow). B, Follow-up scan obtained 20 months later allows comparison at precisely the same anatomic level, which is easily confirmed by comparison of adjacent vessels. In this case, a subtle increase in lesion size (arrow) is definitively established. Follow-up resection documented stage IA lepidic invasive adenocarcinoma. Value of initial short-term follow-up of benign GGNs. A, B, Target reconstructed 5-mm-thick (A) and 1-mm-thick (B) sections through right upper lobe show a focal ground-glass lesion (upper arrow in A), within which a few dilated peripheral airways can be identified. This appearance is strongly suggestive of a peripheral adenocarcinoma. Lower arrow in A points to normal lung. C, D, CT scans obtained with 5-mm-thick (C) and 1-mm-thick (D) sections 3 months later at same level as A and B show near-complete disappearance of lesion, likely representing focal nonspecific inflammation. Arrows in C indicate subtle new foci of ground-glass attenuation appearing in the interval, again consistent with nonspecific inflammation. Value of initial short-term follow-up of malignant GGNs. Consecutive 1-mm-thick sections through right lower lobe section obtained at same anatomic level over a 6-month period (A, baseline; B, 3 months; C, 6 months) show rapid transformation of initial p