HRCT扫描结合MSCT动态增强扫描在肺内孤立性结节的诊断价值

目的：评价HRCT扫描结合MSCT动态增强扫描在诊断肺内孤立性结节（SPNs）的价值。方法：收集直径小于3cm的肺内孤立性结节患者48例,其中周围型肺癌28例,单发转移瘤5例,肺炎性假瘤5例,结核瘤4例,肺血管瘤2例,支气管肺腺瘤2例、肺错构瘤2例。48例患者均先行常规胸部CT扫描,然后对兴趣区行HRCT扫描,然后行胸部动态增强扫描,并测量其CT值增强幅度。结果：HRCT扫描结合MSCT动态增强扫描诊断肺内孤立性小结节的正确率为90%,HRCT扫描可以更好显示病灶边缘特征及内部结构,动态增强扫描可见肺内恶性结节大多均匀增强,且增强CT值大于20HU,平均增强CT值为35HU。良性结节多周边增强,且增强CT值小于10HU。结论：根据SPNs的HRCT基本形态特征,并结合MSCT动态增强扫描强化特征有助于肺内孤立性结节的定性诊断,提高术前诊断正确率。     

高分辨螺旋CT增强扫描诊断肺内孤立小结节

目的 :评价高分辨螺旋CT增强扫描诊断肺内孤立小结节的价值。材料和方法 :直径小于 3cm的肺内孤立小结节患者 40例 ,其中周围性肺癌 2 9例 ,转移瘤 1例 ,肺炎性肿块 5例 ,结核瘤 2例 ,肺错构瘤、肺囊肿及肺血管瘤各 1例。40例患者先行常规CT扫描 ,发现病变后局部行高分辨螺旋CT扫描 ,仍不能定性诊断时行高分辨螺旋CT增强扫描。 40例病例均行前瞻性对比研究。结果 :高分辨螺旋CT增强扫描诊断肺内孤立性小结节的正确率为 81% ,肺内恶性结节大多均匀增强且增强CT值大于 2 0Hu ,平均增强CT值为 3 6Hu。良性结节多周边增强且增强CT值小于 10Hu。结论 :高分辨螺旋CT增强扫描有助于肺内孤立性小结节定性诊断 ,同时强调必须结合病变的基本形态特征综合考虑。     

螺旋CT动态增强扫描对孤立性肺结节及其周围血管表现的分析

目的探讨肺内孤立性结节动态增强扫描的强化程度，强化曲线与其周围血管强化的异常改变。资料与方法回顾性分析42例经手术、病理证实的≤3cm的孤立性肺结节，行螺旋CT动态增强扫描，其中周围型肺癌19例，结核瘤8例，炎性结节15例，在静脉注射碘对比剂100ml（3．5ml／s）前后，对病灶进行薄层扫描，测量增强前后各扫描层面的CT值，计算结节的最大强化CT值，时间-密度曲线及其周围肺血管改变，确定结节的强化类型。结果肺癌和炎性结节的最大强化值与结核瘤有非常显著性差异，周围型肺癌的强化范围20～70Hu，平均40Hu，在15例炎性结节中有9例强化后CT值〉70Hu，8例结核瘤强化后CT值均〈20Hu，结节强化‘类型：完全强化型26例，其中肺癌16例，炎性结节10例；周围强化型9例，其中结核瘤6例，炎性结节3例；包膜强化型5例，其中肺癌3例，结核瘤2例；表现结节内血管征8例，其中肺癌6例，炎性结节3例；肺血管纠集征9例，其中肺癌8例。炎性结节2例。结论周围型肺癌、炎性结节较结核瘤显著强化，强化值≤12提示为结核瘤，结节内血管征及血管纠集征则对鉴别诊断炎性结节具有重要意义。     

螺旋CT增强扫描在孤立性肺结节诊断中的价值

目的 评价螺旋CT动态增强薄层扫描对孤立性肺结节（SPN）的诊断价值。资料与方法 回顾性分析79例经手术病理和临床观察证实的SPN患者的CT资料。其中周围型肺癌47例，结核瘤23例。炎性结节7例，错构瘤2例。在静脉注射碘对比剂100ml(3.5ml/s)前后，对病灶进行一系列薄层扫描，测量增强前后各扫描层面的CT值，计算结节的最大强化CT值和SPN/A0值。描绘结节的时间-密度曲线，分析结节的强化类型。结果 肺癌和炎性结节的最大强化值与结核瘤有非常显著性差异；肺癌和炎性结节的SPN/Ao值与结核瘤有非常显著性差异；肺癌和炎性结节的最大强化CT值和SPN/Ao值无显著性差异。肺癌和炎性结节的各时相强化值在注射碘对比剂40s,2min无显著性差异。在5min,8min有显著性差异。平扫3组间CT值无显著性差异。32例肺癌，5例结核瘤，2例炎性结节呈不均匀强化；12例肺癌，2例炎性结节呈均匀强化；3例肺癌，6例结核瘤和2例炎性结节呈周围型强化；9例结核瘤和1例错构瘤呈包膜样强化；1例炎性结节，3例结核瘤和1例错构瘤无强化，结论 螺旋CT增强薄层扫描能准确判断SPN的强化程度及类型。可提高SPN的诊断准确率。     

动态CT增强扫描对肺结节的定性价值研究

目的　研究动态CT增强扫描对孤立性肺结节 (SPN)的定性价值。资料与方法　随机选择 72例SPN患者 ,先行薄层 (3～ 5mm)平扫 ,再静脉注射对比剂 (优维显 ) 10 0ml后 ,对选定的结节中心行动态CT增强扫描 ,测量其增强前后的CT值 ,并对其中 36例行三维表面重建。结果　肺炎性结节以重度强化为主 ,净增值 >6 0HU ,动态曲线呈持续上升型 ;肺癌性结节以轻～中度强化为主 ,净增值为 2 0～ 6 0HU ,动态曲线呈缓慢持续升高型 ;肺结核结节以轻度强化为主 ,净增值 <2 0HU ,动态曲线呈平坦型。三维重建成像显示 :恶性肺结节以Ⅰ、Ⅱ型血管异常为主 ;良性肺结节以Ⅳ型血管异常为主。结论　 (1)动态CT增强扫描对SPN的鉴别诊断有较高价值。 (2 )动态CT增强中追加三维重建 ,亦有利于SPN的定性诊断。     

CT棘突征对周围型肺癌的诊断价值

目的：探讨肺内孤立结节球形状棘突CT征对周围型肺癌的诊断与鉴别诊断价值。方法：47例经临床手术病理和抗炎治疗后证实的孤立型肺结节中，周围型肺癌32例，肺良性病变15例。所有病例从肺尖至肺底扫描，层厚8mm，依病灶大小，加扫薄层4mm，部分病例（35例）经肘静脉注射对比剂对病灶行增强薄层扫描。对棘突CT征与周围肺癌CT表现的病理基础及鉴别诊断进行了讨论。结果：周围型肺癌的棘突CT征发生率为66%(21/32),比其它肺良性病变20%(3/15)高。结论：肺内孤立结节灶棘突CT征对周围型肺癌的诊断与鉴别诊断具有重要价值，是诊断肺癌的一个指征。     

孤立性肺结节增强扫描CT值的探讨

目的　探讨增强薄层CT扫描对孤立性肺结节 (SPN)良、恶性的诊断价值。方法　对 3 7例孤立性肺结节 (直径≤ 3cm)进行平扫和增强扫描 ,比较增强前后CT值变化 ,分析结节强化程度和强化类型对其良、恶性鉴别的意义 ;并对不同组织学类型肺癌强化程度和强化类型进行初步探讨。结果　恶性SPN强化值 ( CT值 )≥ 3 0HU ,良性SPN强化值 <3 0HU有显著性差异 ;不同组织类型肺癌强化程度和强化类型不同。结论　增强CT扫描能显示SPN的强化特征并有助于定性诊断 ,是鉴别SPN良、恶性的有效的影像学方法。     

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。     

周围型肺癌与肺结核球的同层CT动态增强研究

目的　采用同层动态CT增强扫描评价肺孤立性结节。方法　选择直径≤ 4cm的周围型肺癌 2 9例和肺结核球 7例 ,行同层动态CT增强研究 ,绘制其时间 -密度曲线。结果　肺癌与肺结核球的动态增强峰值差别较大。结论　同层CT动态增强扫描有助于肺癌与肺结核的鉴别诊断     

周围型肺癌的动态增强曲线的诊断价值

目的 :探讨动态增强曲线在周围型肺癌鉴别诊断中的价值。材料和方法 :研究 116例孤立性肺结节 (直径≤4cm) ,其中肺癌 88例 ,结核球 10例 ,炎性结节 15例 ,良性肿瘤 3例。在注入造影剂 1 5ml/kg前后 ,对病灶进行同层动态扫描 ,测量增强前后各次扫描时病灶的CT值 ,根据CT值绘出动态增强曲线。结果 :三者动态增强曲线的峰值中每两者之间均有显著差异 ,肺癌的增强峰值高于结核球而低于炎性结节。肺癌的动态增强曲线多呈慢升慢降型 ,抛物线状 ;炎性结节多呈快升慢降或快升快降型 ;结核球多呈一低平曲线。炎性结节达峰值的时间较肺癌快。结论 :周围型肺癌的动态增强曲线峰值、达峰值的时间、曲线形态不同于结核球、炎性结节 ,因而动态增强曲线有助于周围型肺癌的鉴别诊断     

CT增强扫描鉴别诊断肺内孤立小结节价值

目的评价CT增强扫描鉴别诊断肺内孤立小结节的价值。材料与方法直径8～20mm肺内孤立小结节患者26例小肺癌12例,灶性肺炎7例,结核结节4例,硬化性血管瘤1例,错构瘤2例。增强扫描前后均行薄层扫描(1．5～5mm层厚)。分别进行CT平扫及CT增强诊断的前瞻性对比研究。结果CT平扫诊断正确率为65％,CT增强后诊断正确率为77％,二者无显著差异。小肺癌、灶性肺炎及肺结核结节的平均增强CT值分别为42Hu,37Hu和3Hu。1例错构瘤和1例血管瘤因增强CT值大于40Hu而误诊为肺癌。结论CT增强对肺结核结节的诊断有帮助,肺癌和肺炎性病灶的CT增强鉴别诊断有困难。应强调以病灶基本形态为依据,增强CT对鉴别诊断有价值。1．0cm以下病灶的CT值测量不准确。     

Improvement in Follow-up Imaging With a Patient Tracking System and Computerized Registry for Lung Nodule Management

PurposeDespite established guidelines, radiologists’ recommendations and timely follow-up of incidental lung nodules remain variable. To improve follow-up of nodules, a system using standardized language (tracker phrases) recommending time-based follow-up in chest CT reports, coupled with a computerized registry, was created.Materials and MethodsData were obtained from the electronic health record and a facility-built electronic lung nodule registry. We evaluated two randomly selected patient cohorts with incidental nodules on chest CT reports: before intervention (September 2008 to March 2011) and after intervention (August 2011 to December 2016). Multivariable logistic regression was used to compare the cohorts for the main outcome of timely follow-up, defined as a subsequent report within 13 months of the initial report.ResultsIn all, 410 patients were included in the pretracker cohort versus 626 in the tracker cohort. Before system inception, 30% of CT reports lacked an explicit time-based recommendation for nodule follow-up. The proportion of patients with timely follow-up increased from 46% to 55%, and the proportion of those with no documented follow-up or follow-up beyond 24 months decreased from 48% to 31%. The likelihood of timely follow-up increased 41%, adjusted for high risk for lung cancer and age 65 years or older. After system inception, reports missing a tracker phrase for nodule recommendation averaged 6%, without significant interyear variation.ConclusionsStandardized language added to CT reports combined with a computerized registry designed to identify and track patients with incidental lung nodules was associated with improved likelihood of follow-up imaging.     

Assessment of lung development using hyperpolarized helium-3 diffusion MR imaging

PURPOSE: To determine whether hyperpolarized helium-3 (HHe) diffusion MR can detect the expected enlargement of alveoli that occurs with lung growth during childhood. MATERIALS AND METHODS: A total of 29 normal subjects aged four to 30 years underwent HHe diffusion MR imaging with the b-value pair 0, 1.6 second/cm(2). A second acquisition during a separate breathhold was performed using the b-value pair 0, 4 second/cm(2) to evaluate the dependence on b-value. The mean apparent diffusion coefficient (ADC) and lung volume for each acquisition and each subject was determined. RESULTS: Subjects as young as four years of age were able to cooperate with the imaging procedure. The mean ADC increased with increasing subject age (r = 0.8; P < 0.001), with a 55% increase in mean ADC from the youngest to oldest subject. Lung volumes measured on MR were highly repeatable for the two HHe MR acquisitions (r = 0.980, P < 0.001). The mean ADC values measured with the two different b-value pairs were highly correlated (r = 0.975; P < 0.001), but the higher b-value pair resulted in slightly lower mean ADCs (P < 0.001). CONCLUSION: HHe diffusion MR appears to detect the expected increase in alveolar size during childhood, and thus HHe MR may be a noninvasive method to assess development of the lung microstructure.     

串珠征在周围型小细胞肺癌中的诊断价值

目的：探讨串珠征的形成机制,评价其在周围型小细胞肺癌(SCLC)、周围型肺腺癌及周围型肺鳞癌中的鉴别诊断意义。方法收集病理证实的周围型 SCLC 78例、周围型肺腺癌69例、周围型肺鳞癌33例,分别统计串珠征的阳性率、纵隔淋巴结的转移率及纵隔淋巴结大于肺原发灶的比例,对相关数据进行统计分析。结果78例周围型 SCLC中10例串珠征阳性(12.8%),且纵隔淋巴结均大于肺原发灶;78例中63例纵隔淋巴结转移(80.8%),42例纵隔淋巴结大于肺原发灶(53.8%)。69例周围型实性肺腺癌中,无1例出现串珠征,25例纵隔淋巴结转移(36.2%),2例纵隔淋巴结大于原发灶(2.9%)。33例周围型肺鳞癌中1例串珠征阳性(2.8%),该例肺门淋巴结明显小于肺原发灶,33例中13例纵隔淋巴结转移(39.4%),6例纵隔淋巴结大于原发灶(16.7%)。经统计分析,串珠征在周围型 SCLC与周围型肺鳞癌中差异无统计学意义,周围型 SCLC与周围型肺腺癌、肺鳞癌在纵隔淋巴结转移率及纵隔淋巴结大于肺原发灶的阳性率差异均有统计学意义。结论串珠征在一定程度上反映 SCLC 的生物学特性,在周围型SCLC与周围型肺腺癌、肺鳞癌的鉴别诊断中有重要价值,应结合纵隔淋巴结大小。     

Impact of lung volume on MR signal intensity changes of the lung parenchyma

PURPOSE: To test the hypothesis that, in magnetic resonance (MR) imaging of healthy individuals, equal relative changes in lung volume cause equal relative changes in MR signal intensity of the lung parenchyma. MATERIALS AND METHODS: In two experimental runs, 10 volunteers underwent spirometrically monitored MR imaging of the lungs, with MR images acquired at 10 incremental lung volumes ranging from total lung capacity to 10% above residual volume. Average signal intensity, signal variability, and signal intensity integrals were calculated for each volunteer and for each lung volume. The effect of lung volume on signal intensity was quantified using linear regression analysis complemented by the runs test. Slopes and intercepts of regression lines were compared with an analysis of covariance. Slopes of the lines of best fit for lung volumes and signal intensities from the two runs were compared to the slope of the line of identity. Comparisons between the two runs were visualized using Bland and Altman plots. RESULTS: The slopes of the 10 individual regression lines yielded no significant differences (F = 1.703, P = 0.101; F = 1.321, P = 0.239). The common slopes were -0.556 +/- 0.027 (P = 0.0001) for the first and -0.597 +/- 0.0031 (P = 0.0001) for the second experimental run. Both slopes displayed no significant nonlinearity (P = 0.419 and P = 0.067). There was a strong association between changes in lung volumes (rs = 0.991, P = 0.0001) and changes in signal intensity (rs = 0.889, P = 0.0001) in the two experimental runs. Lines of best fit for lung volume and signal intensities were not significantly different from the slope of the line of identity (P = 0.321 and P = 0.212, respectively). CONCLUSION: Equal changes in lung volume cause equal changes in MR signal intensity of the lung parenchyma. This linear and reproducible phenomenon could be helpful in comparing pulmonary MR signal intensity between individuals.     

Determination of regional pulmonary parenchymal strain during normal respiration using spin inversion tagged magnetization MRI

In clinical practice, the assessment of lung mechanics is limited to a global physiological evaluation, which measures, in the aggregate, the contributions of the pulmonary parenchyma, pleura, and chest wall. In this study, we used an MR imaging methodology which applies two-dimensional bands of inverted magnetization directly onto the pulmonary parenchyma, thus allowing for the quantification of local pulmonary tissue deformation, or strain, throughout inhalation. Our results showed that the magnitude of strain was maximal at the base and apex of the lung, but was curtailed at the hilum, the anatomical site of the poorly mobile bronchial and vascular insertions. In-plane shear strain mapping showed mostly positive shear strain, predominant at the apex throughout inhalation, and increasing with expanding lung volume. Anisotropy mapping showed that superior-inferior axial strain was greater than medial-lateral axial strain at the apex and base, while the opposite was true for the middle lung field. This study demonstrates that localized pulmonary deformation can be measured in vivo with tagging MRI, and quantified by applying finite strain definitions from continuum mechanics.     

超声引导经皮肺穿刺活检在肺外周型病变诊断中的价值

目的探讨超声引导下经皮肺穿刺活检对肺外周型病变定性诊断的应用价值。方法在超声引导下对80例胸部影像学检查显示的肺周边型肿块需明确诊断者行超声引导下经皮肺穿刺活检术。结果 80例病人均穿刺成功,成功率100%。病理诊断结果:恶性肿瘤64例,其中鳞癌38例,腺癌20例,大细胞癌2例,小细胞癌2例,恶性淋巴瘤1例,恶性间皮瘤1例;良性病变16例,其中良性错构瘤1例,结核8例,炎症7例。并发气胸、咯血各1例,并发症发生率为3%。结论超声引导下经皮肺穿刺活检术具有定位准确、操作简便、安全性好、并发症少及重复性强等优点,可作为肺外周型病变定性诊断的首选诊断方法。