高分辨率CT对周围型小肺癌的诊断价值

笔者对４７例直径≤２ｃｍ的周围型小肺癌和２１例直径≤３ｃｍ的肺良性结节进行高分辨率ＣＴ（ＨＲＣＴ）扫描并与普通ＣＴ相对比。结果表明：（１）仅见干周围型小肺癌的征象有脐凹征、伪足征、支气管气像。仅见于肺良性结节的征象是钙化。分叶征、毛刺、棘突、胸膜凹陷征等虽然多见于周围型小肺癌，但在肺良性结节中的出现率为１９％～３３％，成为这部分肺良性结节的误诊原因。（２）ＨＲＣＴ在２ｃｍ以下周围型小肺癌的检出、大小测量及征象显示率方面明显优于普通ＣＴ是值得提倡的检查方法。     

肺良性结节HRCT—病理对照研究

目的：本文对３３例肺良性结节进行高分辨力ＣＴ（ＨＲＣＴ）－病理对照研究。目的是探讨肺良性结节的ＨＲＣＴ周期特征、病理基础以及诊断价值。材料方法：前瞻怀分析病理确主仍的３３例肺良性结节的ＨＲＣＴ周围特征，并作相应的病理对照研究，随机选择１０例肺原发性小肺癌作对照。通过两位有经验的放射科医师，双盲法观察肺结节周围４种ＨＲＣＴ征象：（１）ＣＴ晕征；（２）ＣＴ血管造影征；（３）周围性肺气肿（４）灶周线 影     

良、恶性胸膜凹陷征的HRCT表现

目的：从病理角度认识良、恶性胸膜凹陷征的ＨＲＣＴ表现。方法：９例术后标本，充气后ＨＲＣＴ扫描，观察大体标本并与术前ＣＴ及标本ＣＴ扫描对照。结果：ＨＲＣＴ从断面上反映出了小肺癌时胸膜凹陷的完整形态。炎性灶胸膜凹陷轻，与肺癌时胸膜凹陷表现不同。结论：ＨＲＣＴ可客观地反映胸膜凹陷的大体病理形态，良、恶性胸膜凹陷有可能以ＣＴ予以鉴别。     

周围型肺癌胸膜凹陷征的螺旋高分辨率CT表现

研究周围型肺癌时胸膜凹陷征的螺旋ＨＲＣＴ表现。材料与方法：搜集经手术,病理证实的２型肺癌６０例,根据肿瘤大小及生长部位,总结其胸膜凹陷的不同螺旋ＨＲＣＴ表现,并分析其开原因。结论螺旋高分辨率ＣＴ尤其是３Ｄ重建有利于周围型癌胸膜凹陷征的显示。     

肺良性结节HRCT－病理对照研究

目的：本文对３３例肺良性结节进行高分辨力ＣＴ（ＨＲＣＴ）－病理对照研究。目的是探讨肺良性结节的ＨＲＣＴ周围特征、病理基础以及诊断价值。材料与方法：前瞻性分析病理确诊的３３例肺良性结节的ＨＲＣＴ周围特征，并作相应的病理对照研究。随机选择１０例肺原发性小肺癌作对照。通过两位有经验的放射科医师，双盲法观察肺结节周围４种ＨＲＣＴ征象：（１）ＣＴ晕征；（２）ＣＴ血管造影征；（３）周围性肺气肿；（４）灶周线状影。采用相关分析法，确定４种ＨＲＣＴ征象与肺内良性结节的相关性。结果：３３例肺良性结节ＨＲＣＴ－病理对照研究表明：ＣＴ晕征多见于肺部炎性病灶和肺结核瘤（敏感性７９％，特异性８９％）；ＣＴ血管造影征根据结节的部位良恶性各有差异；周围性肺气肿在病理上是由于炎症过程溶蛋白酶活性和瘢痕病变所致；灶周长线状影在良恶性结节无显著差异，短线状影有显著性差异。结论：ＣＴ晕征、ＣＴ血管造影征和周围性肺气肿对于≤３ｃｍ的肺内良性结节的ＨＲＣＴ诊断有重要价值     

X线胸片与CT诊断1cm左右周围型小肺癌

目的：探讨Ｘ线胸片与ＣＴ对１ｃｍ左右周围型小肺癌的诊断价值。资料与方法：回顾性分析经病理证实的１７例直径在１ｃｍ左右的周围型小肺癌的Ｘ线胸片资料与其中１１例ＣＴ资料。结果：胸片上分叶征２例，胸膜凹陷征１例。有系列Ｘ线胸片者见病变逐渐增大或从无到有。ＣＴ片病灶显示边缘清楚较整齐者７例，毛刺征３例，分叶征７例，血管集束征９例，空泡征或支气管充气征４例，胸膜凹陷征３例，空洞２例。结论：Ｘ线胸片是检出１ｃｍ左右周围型小肺癌的主要方法，但不能定性；ＣＴ是诊断１ｃｍ左右小肺癌的较好方法，但也有一定限度；二者结合可提高诊断准确率。     

高分辨率CT对弥漫性肺疾病诊断的评价

笔者对１６个正常成人新鲜肺叶标本进行了ＣＴ－高分辨率ＣＴ（ＨＲＣＴ）－标本对照研究，分析了５０例正常成人胸部ＣＴ和ＨＲＣＴ图像。结果表明：ＨＲＣＴ在显示肺部细小结构方面明显优于常规ＣＴ。笔者还分析了３０例弥漫性肺疾病的ＨＲＣＴ征象：（１）小叶间隔增厚；（２）蜂窝肺；（３）磨玻璃样表现；（４）胸膜下线；（５）小结节。小叶间隔不规则增厚伴小叶结构变形常见于肺间质纤维化。肺淋巴管转移癌小叶间隔亦增厚，但无小叶结构变形。“小叶间隔串珠”征高度提示肺淋巴管转移癌。     

孤立性肺结节的高分辨率CT定性

目的：评价肺部高分辨率ＣＴ（ＨＲＣＴ）对孤立性肺结节定性诊断能力。方法：对７５例结节（＜４ｃｍ）的ＨＲＣＴ表现进行分析。根据结节边缘、内部结构、大小、特殊征象及ＣＴ值测定将其分为三组,即典型恶性结节（１９）、典型良性结节（１８）及非典型结节（３８）。结果：对３３例恶性及４２例良性结节的正确诊断率分别为７２．７％和５９．５％。结节有分叶或切迹、其内密度不均匀、周围有短小毛棘或小棘状突起、伴胸膜凹陷征及供养血管等多见于小肺癌。结论：ＨＲＣＴ在征象显示率方面明显优于常规ＣＴ。误诊的主要原因是一些征象在良恶性结节中均可以出现     

肺内小病灶CT表现及其病理基础的研究：附76例分析

本文对７６例肺内小病灶（直径≤３ｃｍ）病例进行了ＣＴ－病理对照研究。结果表明，短毛刺征，深分叶征、棘状突起征、空泡征、血管集束征，胸膜凹陷征等对于诊断周围型小肺癌有重要临床价值；而尖角征、局限性胸膜肥厚粘连对诊断良性病灶有意义。本文重点讨论了血管集束征的定义，ＣＴ表现及病理基础；并就有争议的胸膜凹陷征提出一些粗浅的看法。旨在提高肺内小病灶良恶性诊断的准确率     

原发性周围型小肺癌与良性结节影像学鉴别

目的：探讨深分叶征、毛刺征、支气管气相、血管集束征、胸膜凹陷征在周围型小肺癌中的诊断价值。材料与方法：对32例直径≤2cm的周围型原发性肺小结节的影像学形态特征进行统计学分析。结果：深分叶征、钙化在小肺癌与良性结节两组病例间有显著统计学差异，毛刺征、血管集束征、支气管气相、胸膜凹陷征在小肺癌与良性结节两组病例间无显著统计学差异，但毛刺征、边缘模糊、血管集束征在小肺癌中出现率明显高于良性结节，边缘光滑、钙化较多则多为良性结节。结论：深分叶征、毛刺征、血管集束征是诊断小肺癌的重要征象；支气管气相、胸膜凹陷征并非肺癌的特征，边缘光滑、钙化较多则多为良性结节。     

2 cm以下周围型小肺癌的CT诊断(附32例分析)

目的 进一步提高对周围型小肺癌（SPLC）及早期肺癌的CT诊断水平.方法 收集经手术或穿刺病理证实直径小于等于2 cm SPLC 29例,经临床证实3例.全部病例先行常规扫描,病灶区再行薄层或高分辨率CT扫描,21例做了增强扫描,增强扫描前先平扫.结果 32例CT均表现为单发结节,其中,实性软组织密度结节23例,中心实性周边磨玻璃密度结节5例,不均匀较低密度结节4例.病灶具有毛刺征25例,分叶征21例,胸膜凹陷征10例,血管集束征8例,棘状突起征6例,小泡征5例,支气管气相征3例,脐凹征3例,小结节堆砌征1例,高密度点条征1例.结论 CT,特别是HRCT对SPLC及早期肺癌具有重要的诊断价值,征象出现越多肺癌的可能性越大;合理的窗技术对SPLC征象的显示有重要帮助.     

气腔密度影诊断周围型小肺癌的价值及其病理基础

目的:探讨气腔密度影诊断周围型小肺癌(SPLC)的价值及其病理基础.材料和方法:分析经手术病理证实的46例SPLC及40例良性结节的空泡征、细支气管充气征和空洞的CT表现.结果:在SPLC中空泡征及细支气管充气征的出现率显著高于良性结节,且均在腺癌和细支气管肺泡癌中的出现率最高.空洞罕见于SPLC.SPLC的空泡征/细支气管充气征多位于SPN的中外2/3部,而良性结节均位于内中2/3部.横断薄层扫描和多平面重建判别SPLC中的空泡征/细支气管充气征无显著差异.结论:空泡征及细支气管充气征的位置对周围型小肺癌具有较高的诊断价值.     

Comparison of plain chest radiography and high-resolution CT in human immunodeficiency virus infected patients with community-acquired pneumonia: a sub-Saharan Africa study

The objective of the study was to determine the proportion of patients with missed lesions on plain chest radiographs compared with high-resolution computed tomography (HRCT) in 49 human immunodeficiency virus (HIV) infected patients with community-acquired pneumonia (CAP). Patients underwent plain chest radiography and HRCT scans of the chest at admission. Microbiological investigations for CAP were performed. An experienced radiologist, without knowledge of clinical or pathological data, reported the chest radiographs and HRCT scans. The study group included 26 females and 23 males, aged 18-53 years (mean age 36 years). Organisms were isolated from 26 patients (53%). In 40 patients (82%), the HRCT scans demonstrated lesions not visualized on the plain chest radiographs. There was 100% correlation between plain radiographic and HRCT scan findings in nine cases (18%). Lesions that were not visualized on the plain radiographs but elucidated on HRCT included: pleural effusion (n = 14), ground-glass opacification (n = 20), pericardial effusion (n = 8), cavitation (n = 4), cysts (n = 4), bullae (n = 4), abscess (n = 1) and pneumothorax (n = 1). In 20 of 23 cases, hilar lymphadenopathy, identified on HRCT, was not recognized on plain chest radiographs. In patients in whom an organism was isolated, a correct HRCT diagnosis of pulmonary tuberculosis, bacterial pneumonia and Pneumocystis carinii pneumonia (PCP) was made in 80%, 84% and 100% of cases, respectively. The proportion of patients with missed lesions on plain chest radiographs in HIV infected patients with CAP was high. This has important implications for management and prognosis. HRCT scans correlate well with the microbiological diagnosis when reported by an experienced radiologist.     

孤立性肺结节CT诊断的评价（附54例分析）

目的：探讨孤立性肺结节的CT表现及诊断。方法：对54例3．0cm以下的孤立性肺结节CT表现进行回顾性分析,其中恶性肿瘤30例,良性病变24例。CT常规扫描加病灶薄层扫描28例,常规扫描后行病灶区HRCT26例,增强扫描4例。结果：26例行HRCT扫描者术前显示病灶特征性改变,并作出正确诊断者22例（84．6％）,病灶局部薄层扫描术前诊断正确者15例（57．6％）,3例恶性肿瘤及1例良性肿瘤增强扫描均显示明显强化。结论：HRCT对肺癌及限局性机化性肺炎的鉴别诊断有较高价值,对孤立性肺结节以HRCT结合增强扫描并综合分析CT表现有助于提高定性诊断。     

毛刺征在CT诊断周围型小肺癌中的价值

目的:探讨周围型小肺癌(SPLC)毛刺的CT表现、诊断价值及多平面重建(MPR)的检出作用。材料和方法:分析经手术或穿刺病理证实的135例SPLC及65例良性孤立性肺结节。统计CT边缘有毛刺征结节的例数,以宽度2mm为界将毛刺分为粗或细毛刺,以长度5mm为界分为长或短毛刺。对22例SPLC及15例良性结节进行MPR,并与横断薄层扫描对比分析。结果:细短毛刺明显多见于SPLC,敏感性为25.9%,特异性为98.5%,准确性为49.5%,阳性预测值(PPV)为97.2%。MPR对毛刺征的检出率高于横断薄层图像。结论:毛刺征对SPLC的诊断和鉴别诊断具有较高价值。     

Small solitary pulmonary nodule and high-resolution CT: a preliminary report

In the attempt to separate primary lung cancers and benign lesions presenting as solitary pulmonary nodules (SPNs) the authors studied prospectively 52 SPNs less than 30 mm in diameter by means of high-resolution (HRCT). Patients with known cancer were excluded. Margins, internal structure, bronchus sign, calcifications, pleural tag and gross morphology of SPN were considered. Spiculation, air inside the nodule and bronchus sign were found in cancer and in one benign lesion (spiculation). All other benign SPNs presented smooth margins without bronchus sign or air inside the mass. Final diagnosis was obtained with surgery, fine-needle-aspiration biopsy or 12-month follow-up. Of 52 nodules, 28 proved malignant, and 24 of 52 proved benign. Sensitivity and specificity of HRCT for diagnosing malignancy of the nodule were 100% and 96%, respectively. In conclusion, we think that HRCT is useful in the differentiation of cancers from benign lesions presenting as SPNs in the majority of patients without known neoplasm. Correspondence to: L. Volterrani     

肺血管集聚征在小肺癌CT诊断中的价值

目的 :探讨肺血管集聚征在小肺癌CT诊断中的价值。方法 :对 43例 2cm内的孤立性肺结节行CT薄层扫描 ,病灶局部放大 ,观察肺结节与血管的关系。结果 :43例中显示血管集聚征 2 4例 ,其中良性结节 3例 ,小肺癌 2 1例。结论 :肺血管集聚征在小肺癌CT诊断中具有重要的参考价值 ,CT薄层扫描有助于肺内良恶性病灶的诊断与鉴别     

多层螺旋CT多平面重建对小肺癌的基本征象检出

目的认识周围型小肺癌(SPLC)在多层螺旋CT多平面重建(MPR)中的基本征象,探讨MPR配合多层螺旋CT对SPLC基本征象的检出作用. 资料与方法搜集病理证实的SPLC 31例,良性小结节22例.多层螺旋CT扫描后MPR处理,并与横断薄层扫描对比分析. 结果 (1)SPLC的分叶征,棘突,毛刺征和支气管血管集束征在MPR中检出率高于横断薄层扫描.(2)MPR对于空泡征、支气管气相和支气管血管集束征的判别有其优势.(3)MPR能较真实地测定病灶大小. 结论 MPR能克服横断扫描角度限制,配合最新的多层螺旋技术达到各向同性成像获得高分辨率图像,可以为SPLC的诊断提供更多信息.     

High resolution chest CT in patients with pulmonary tuberculosis: characteristic findings before and after antituberculous therapy

OBJECTIVE: The purpose of this study was (a) to describe HRCT findings for pulmonary tuberculosis before and after treatment, and (b) to evaluate the possible use of HRCT to assess disease activity. PATIENTS AND METHODS: We prospectively studied 52 patients with newly diagnosed pulmonary tuberculosis that was proven bacteriologically. HRCT scans were performed before and after treatment. RESULTS: Micronodules, nodules, tree-in-bud appearance, consolidation, and cavities were the most common HRCT findings seen in active pulmonary tuberculosis. The disappearance of tree-in-bud appearance, pleural effusion and the presence of fibrotic change appear to be indications of the effectiveness of treatment. HRCT can differentiate old fibrotic lesions from newly active tuberculous lesions. CONCLUSIONS: HRCT may be helpful in the diagnosis of pulmonary tuberculosis and may be useful in the assessment of the efficacy of anti-tuberculous treatment.