孤立性肺结节的诊断现状.pptVIP

支气管管壁由外向内的肿瘤浸润、管壁产生的纤维性增殖性反应使支气管管壁增厚、僵硬，加上瘤内成纤维化反应的牵拉，使瘤内的支气管不仅未被肿瘤压扁，反而保持高度的通畅，甚至有所扩张，形成恶性肿瘤的含气支气管征特有的表现。 良性结节边缘的支气管未受肿瘤侵犯和成纤维化反应的影响，管壁仍很柔软，易受膨胀性生长的结节压迫，导致管腔变扁甚至闭塞。结核球引起支气管截断是由于后者参与形成包膜。炎性假瘤的含气支气管征由肺实质的渗出、实变、机化衬托引起，支气管形态自然，常见树枝状分叉，管腔内可有分泌物、出血或血栓，使支气管表现为断续状。 当前第62页\共有96页\编于星期三\3点 SPN血管特征 恶性结节增强超过良性结节 CT增强值低于15HU倾向于良性 CT净增值超过25HU，清除值5-31HU倾向恶性 当前第63页\共有96页\编于星期三\3点 AJR 2007; 188:57-68 当前第64页\共有96页\编于星期三\3点 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 当前第65页\共有96页\编于星期三\3点 Patterns of Nodule Enhancement at Early and Delayed Enhancement CT 当前第66页\共有96页\编于星期三\3点 Patterns of Nodule Enhancement according to Histologic Diagnosis 当前第67页\共有96页\编于星期三\3点 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. 当前第68页\共有96页\编于星期三\3点 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. 当前第69页\共有96页\编于星期三\3点 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. 当前第70页\共有96页\编于星期三\3点 钙化 55％良性结节有钙化 结节直径小于3cm，有下列钙化形式之一考虑良性：中