呼吸系統(tǒng)影像診斷腫瘤部分課件

呼吸系統(tǒng)影像診斷呼吸系統(tǒng)影像診斷1肺腫瘤分為原發(fā)性和轉(zhuǎn)移性兩大類原發(fā)性又分為良性、惡性惡性肺腫瘤98%為原發(fā)性支氣管肺癌（primarybronchogeniccarcinoma）簡稱肺癌Lungcancer肺腫瘤分為原發(fā)性和轉(zhuǎn)移性兩大類2一肺癌(Lungcancer)臨床表現(xiàn)：

早期無癥狀.最常見癥狀:嗆咳無痰或偶有白色粘液痰表現(xiàn),偶有痰中血絲副腫瘤綜合征腫瘤累及其它組織出現(xiàn)的癥狀與體征Lungcancer一肺癌(Lungcancer)臨床表現(xiàn)：Lun3肺癌組織學(xué)類型Histologycategory：小細(xì)胞肺癌

SCLC[=smallcelllungcarcinoma]非小細(xì)胞肺癌non-small-celllungcarcinoma鱗癌Squamouscellcarcinoma腺癌adenocarcinoma腺鱗癌adenosquamousCarcinoma大細(xì)胞癌LargeCellCarcinomaLungcancer肺癌組織學(xué)類型Lungcancer4按發(fā)生部位分型中央型centralbronchogeniccarcinoma：

肺段或肺段以上的支氣管，包括主、葉、段支氣管周圍型peripheralbronchogeniccarcinoma：

肺段以下-細(xì)支氣管以上的支氣管彌漫型diffusebronchogeniccarcinoma：細(xì)支氣管或肺泡按發(fā)生部位分型5肺癌的擴(kuò)散途徑淋巴轉(zhuǎn)移lymphaticmetastasis:最常見.血行轉(zhuǎn)移blood-bornemetastasis:常轉(zhuǎn)移至腦\腎上腺\骨\肝與肺直接蔓延directspread.肺癌的擴(kuò)散途徑淋巴轉(zhuǎn)移lymphaticmetastasi6

中央型肺癌centralbronchogeniccarcinoma

X線表現(xiàn)X-rayfeatures直接征象directsigns支氣管改變：

腔內(nèi)充盈缺損

intraluminalfillingdefect管壁增厚

increasedthickness不規(guī)則狹窄

irregularstenosis管腔截斷

interrupt杯口狀錐狀鼠尾狀肺門區(qū)塊影hilarmass

肺門影增大、密度增高Lungcancer中央型肺癌centralbronchogen7centralbronchogeniccarcinomaLungcancer支氣管改變示意圖centralbronchogeniccarcinoma8

centralbronchogeniccarcinomaX線間接征象indirectsigns管腔阻塞--阻塞征象:

阻塞性肺氣腫obstructiveemphysema

阻塞性肺不張obstructiveatelectasis阻塞性肺炎o(hù)bstructivepneumonia:

病變使支氣管阻塞,阻塞以遠(yuǎn)肺組織發(fā)生的肺炎阻塞性支氣管擴(kuò)張與粘液嵌塞obstructivebronchiectasisLungcancercentralbronchogeniccarcinom9

centralbronchogeniccarcinoma左上葉阻塞性肺不張obstructiveatelectasisLungcancercentralbronchogeniccarcinom10InvertedScurvesign反S征或橫S征obstructiveatelectasisInvertedScurvesignobstructi11centralbronchogeniccarcinoma

CTfeatures肺門腫塊hilarmass：邊緣呈分葉狀或不規(guī)則支氣管壁改變，超過3mmbronchialwallthickingorintraluminalfillingdefect,luminalcavityirregularstenosisorinterrupt阻塞性肺炎、肺氣腫、肺不張

obstructiveemphysema,obstructiveatelectasisobstructivepneumoniaobstructivebronchiectasis肺門、縱隔淋巴結(jié)腫大enlargementofhilarlymphnodesormediastinallymphnodes侵犯縱隔Lungcancercentralbronchogeniccarcinoma12中央型肺癌CT表現(xiàn)支氣管杯口狀阻塞Lungcancer中央型肺癌CT表現(xiàn)支氣管杯口狀阻塞Lungcancer13中央型肺癌centralbronchogeniccarcinoma

CT表現(xiàn)右下葉支氣管閉塞obliteration右下肺不張atelectasis肺門、縱膈淋巴結(jié)增大enlargementoflymphnodes侵犯右肺動脈Lungcancer中央型肺癌centralbronchogeniccarc14周圍型肺癌

peripherallungcancer基本表現(xiàn)：肺腫塊性或結(jié)節(jié)病變

noduleandmass早期癌earlycarcinoma腫塊直徑小于2cm，無他處轉(zhuǎn)移肺內(nèi)球形腫塊周圍型肺癌肺內(nèi)球形腫塊15周圍型肺癌

腫塊特點

Imagingfeatures

LungcancerShapeMargedensity周圍型肺癌

腫塊特點

Imagingfeatures

16LobulationsignLobulationsign17周圍型肺癌腫塊特點

細(xì)、短的毛刺Lungcancerspiculation周圍型肺癌腫塊特點

細(xì)、短的毛刺Lungcancers18胸膜凹陷征pleuralindentationsignLungcancer周圍型肺癌peripherallungcancer

腫塊特點

胸膜凹陷征pleuralindentationsignL19MPR重建胸膜凹陷征

pleuralindentationsign

LungcancerMPR重建胸膜凹陷征

pleuralindentati20血管集束征convergenceofbronchovascularstructures血管集束征convergenceofbronchovas21月暈征halosign

結(jié)節(jié)周圍環(huán)以磨玻璃影病理為出血性肺梗塞腫瘤細(xì)胞浸潤見于曲菌球,周圍型肺癌等月暈征halosign

結(jié)節(jié)周圍環(huán)以磨玻璃影22病灶胸膜側(cè)小片狀浸潤病灶胸膜側(cè)小片狀浸潤23不規(guī)則的厚壁空洞irregularthickwalledcavity：多見于較大腫塊內(nèi)壁厚、偏心、內(nèi)壁不規(guī)則、有壁結(jié)節(jié)Lungcancer周圍型肺癌腫塊特點

carcinomatouscavity

不規(guī)則的厚壁空洞irregularthickwalled24Lungcancer周圍型肺癌

腫塊特點

小圓形空泡征vacuolesign管狀支氣管充氣征airbronchogram多見<3cm腫塊內(nèi)Lungcancer周圍型肺癌

腫塊特點

小圓形空泡征25peripherallungcancer

腫塊特點小結(jié)肺內(nèi)球形腫塊分葉征signoflobulation：不規(guī)則毛刺征spiculationandspike：短、細(xì)，放射狀癌性空洞carcinomatouscavity：壁厚、內(nèi)壁不規(guī)則空泡征vacuolesign與支氣管充氣征胸膜凹陷征pleuralindentationsign血管集束征convergenceofbronchovascularstructures月暈征(halosign)病灶胸膜側(cè)小片狀浸潤鈣化少見CT增強(qiáng)均勻或不均勻強(qiáng)化Lungcancerperipherallungcancer

腫塊26肺上溝癌

(Pancoasttumor)

發(fā)生于肺尖的肺癌

Lungcancer肺上溝癌

(Pancoasttumor)

發(fā)生于肺尖的肺27

胸部正側(cè)位片(含DR\CR)用于篩查肺癌,胸部CT為肺癌診斷的首選,MRI一般不用于診斷肺癌,體檢篩查肺癌可選用胸部正側(cè)位片\DR\CR\低劑量CT.早期中央型肺癌X線胸片常無異常表現(xiàn),胸部CT能顯示支氣管管腔與管壁的異常.縱隔結(jié)構(gòu)浸潤的胸部CT表現(xiàn)為腫塊與縱隔間脂肪間隙消失,腫塊與縱隔結(jié)構(gòu)分界不清.MRI對支氣管病變與阻塞性改變顯示不佳,但可顯示肺門腫塊與縱隔轉(zhuǎn)移和浸潤.肺癌的血供主要為支氣管動脈,DSA可用于肺癌血供的顯示,用于肺癌介入治療前后.胸部正側(cè)位片(含DR\CR)用于篩查肺癌,胸部CT28肺癌TNM分期見P216肺癌TNM分期見P21629彌漫型肺癌diffusetype兩肺廣泛不對稱分布的細(xì)小結(jié)節(jié)，邊緣模糊，

可融合呈腫塊或大片實變,內(nèi)可見支氣管充氣征airbronchogram中下肺野較多Lungcancer細(xì)支氣管肺泡癌bronchioloalveolarcarcinoma彌漫型肺癌diffusetype兩肺廣泛不對稱分布30呼吸系統(tǒng)影像診斷腫瘤部分課件31肺癌轉(zhuǎn)移

肺門縱隔淋巴結(jié)轉(zhuǎn)移

Mediastinallymphnodemetastasis

胸膜轉(zhuǎn)移pleuralmetastasis

肺內(nèi)轉(zhuǎn)移directextension

直接蔓延或轉(zhuǎn)移至胸壁

遠(yuǎn)處轉(zhuǎn)移metastasis

肺癌轉(zhuǎn)移32呼吸系統(tǒng)影像診斷腫瘤部分課件33轉(zhuǎn)移性肺癌metastaticlungcancer

肺轉(zhuǎn)移瘤pulmonarymetastasis許多部位的惡性腫瘤可以轉(zhuǎn)移至肺,如絨癌、乳腺癌、肝癌、胃癌、骨肉瘤等。轉(zhuǎn)移途徑有血行、淋巴或臨近器官直接蔓延等轉(zhuǎn)移性肺癌metastaticlungcancer

肺轉(zhuǎn)34X線表現(xiàn)metastaticlungcancer雙肺多發(fā)棉球樣結(jié)節(jié)大小不等密度均勻邊界清楚中下肺野外帶較多血行轉(zhuǎn)移X線表現(xiàn)metastaticlungcancer雙35CT表現(xiàn)雙肺彌漫性結(jié)節(jié)或多發(fā)球形病灶密度均勻，邊緣光滑中下肺野及胸膜下區(qū)較多metastaticlungcancerCT表現(xiàn)雙肺彌漫性結(jié)節(jié)或多發(fā)球形病灶metastaticl36metastaticlungcancer淋巴轉(zhuǎn)移—癌性淋巴管炎

lymphangitiscarcinomatosa常有肺門或縱膈淋巴結(jié)增大自肺門向外呈放射狀分布的條索狀影串珠狀小點影metastaticlungcancer淋巴轉(zhuǎn)移—癌性淋37呼吸系統(tǒng)影像診斷腫瘤部分課件38肺內(nèi)結(jié)節(jié)性疾病的鑒別診斷P216.表4-2-1-6肺內(nèi)結(jié)節(jié)性疾病的鑒別診斷P216.表4-2-1-639呼吸系統(tǒng)影像診斷腫瘤部分課件40縱隔腫瘤

mediastinaltumor種類很多CT、MRI有明顯優(yōu)勢

定位很重要:縱隔腫瘤有特定或好發(fā)部位,定位后有助于定性縱隔腫瘤

mediastinaltumor種類很多41縱隔的分區(qū)和常見腫瘤前縱隔胸骨后緣--心臟大血管前方常見腫瘤胸內(nèi)甲狀腺胸腺瘤畸胎瘤心包囊腫縱隔的分區(qū)和常見腫瘤前縱隔42甲狀腺瘤胸內(nèi)延伸mediastinaltumor甲狀腺瘤胸內(nèi)延伸mediastinaltumor43胸腺瘤thymomamediastinaltumor胸腺瘤thymomamediastinaltumor44胸腺瘤

thymomamediastinaltumor胸腺瘤

thymomamediastinaltumor45畸胎瘤teratomamediastinaltumor畸胎瘤teratomamediastinaltumor46畸胎瘤

teratomamediastinaltumor畸胎瘤

teratomamediastinaltumo47心包囊腫PericardialCystmediastinaltumor心包囊腫mediastinaltumor48縱隔的分區(qū)和常見腫瘤中縱隔

前縱隔后緣--食管前方常見腫瘤淋巴瘤支氣管囊腫縱隔的分區(qū)和常見腫瘤49淋巴瘤

lymphomamediastinaltumor淋巴瘤

lymphomamediastinaltumo50支氣管囊腫bronchialcystmediastinaltumor支氣管囊腫bronchialcystmediastinal51縱隔的分區(qū)和常見腫瘤后縱隔中縱隔后緣--脊柱及兩側(cè)脊柱旁溝常見腫瘤神經(jīng)源性腫瘤縱隔的分區(qū)和常見腫瘤后縱隔52神經(jīng)源性腫瘤

neurogenictumourmediastinaltumor神經(jīng)源性腫瘤

neurogenictumourmedias53神經(jīng)源性腫瘤mediastinaltumorneurogenictumour神經(jīng)源性腫瘤mediastinaltumorneuroge54THANKSTHANKS55呼吸系統(tǒng)影像診斷呼吸系統(tǒng)影像診斷56肺腫瘤分為原發(fā)性和轉(zhuǎn)移性兩大類原發(fā)性又分為良性、惡性惡性肺腫瘤98%為原發(fā)性支氣管肺癌（primarybronchogeniccarcinoma）簡稱肺癌Lungcancer肺腫瘤分為原發(fā)性和轉(zhuǎn)移性兩大類57一肺癌(Lungcancer)臨床表現(xiàn)：

早期無癥狀.最常見癥狀:嗆咳無痰或偶有白色粘液痰表現(xiàn),偶有痰中血絲副腫瘤綜合征腫瘤累及其它組織出現(xiàn)的癥狀與體征Lungcancer一肺癌(Lungcancer)臨床表現(xiàn)：Lun58肺癌組織學(xué)類型Histologycategory：小細(xì)胞肺癌

SCLC[=smallcelllungcarcinoma]非小細(xì)胞肺癌non-small-celllungcarcinoma鱗癌Squamouscellcarcinoma腺癌adenocarcinoma腺鱗癌adenosquamousCarcinoma大細(xì)胞癌LargeCellCarcinomaLungcancer肺癌組織學(xué)類型Lungcancer59按發(fā)生部位分型中央型centralbronchogeniccarcinoma：

肺段或肺段以上的支氣管，包括主、葉、段支氣管周圍型peripheralbronchogeniccarcinoma：

肺段以下-細(xì)支氣管以上的支氣管彌漫型diffusebronchogeniccarcinoma：細(xì)支氣管或肺泡按發(fā)生部位分型60肺癌的擴(kuò)散途徑淋巴轉(zhuǎn)移lymphaticmetastasis:最常見.血行轉(zhuǎn)移blood-bornemetastasis:常轉(zhuǎn)移至腦\腎上腺\骨\肝與肺直接蔓延directspread.肺癌的擴(kuò)散途徑淋巴轉(zhuǎn)移lymphaticmetastasi61

中央型肺癌centralbronchogeniccarcinoma

X線表現(xiàn)X-rayfeatures直接征象directsigns支氣管改變：

腔內(nèi)充盈缺損

intraluminalfillingdefect管壁增厚

increasedthickness不規(guī)則狹窄

irregularstenosis管腔截斷

interrupt杯口狀錐狀鼠尾狀肺門區(qū)塊影hilarmass

肺門影增大、密度增高Lungcancer中央型肺癌centralbronchogen62centralbronchogeniccarcinomaLungcancer支氣管改變示意圖centralbronchogeniccarcinoma63

centralbronchogeniccarcinomaX線間接征象indirectsigns管腔阻塞--阻塞征象:

阻塞性肺氣腫obstructiveemphysema

阻塞性肺不張obstructiveatelectasis阻塞性肺炎o(hù)bstructivepneumonia:

病變使支氣管阻塞,阻塞以遠(yuǎn)肺組織發(fā)生的肺炎阻塞性支氣管擴(kuò)張與粘液嵌塞obstructivebronchiectasisLungcancercentralbronchogeniccarcinom64

centralbronchogeniccarcinoma左上葉阻塞性肺不張obstructiveatelectasisLungcancercentralbronchogeniccarcinom65InvertedScurvesign反S征或橫S征obstructiveatelectasisInvertedScurvesignobstructi66centralbronchogeniccarcinoma

CTfeatures肺門腫塊hilarmass：邊緣呈分葉狀或不規(guī)則支氣管壁改變，超過3mmbronchialwallthickingorintraluminalfillingdefect,luminalcavityirregularstenosisorinterrupt阻塞性肺炎、肺氣腫、肺不張

obstructiveemphysema,obstructiveatelectasisobstructivepneumoniaobstructivebronchiectasis肺門、縱隔淋巴結(jié)腫大enlargementofhilarlymphnodesormediastinallymphnodes侵犯縱隔Lungcancercentralbronchogeniccarcinoma67中央型肺癌CT表現(xiàn)支氣管杯口狀阻塞Lungcancer中央型肺癌CT表現(xiàn)支氣管杯口狀阻塞Lungcancer68中央型肺癌centralbronchogeniccarcinoma

CT表現(xiàn)右下葉支氣管閉塞obliteration右下肺不張atelectasis肺門、縱膈淋巴結(jié)增大enlargementoflymphnodes侵犯右肺動脈Lungcancer中央型肺癌centralbronchogeniccarc69周圍型肺癌

peripherallungcancer基本表現(xiàn)：肺腫塊性或結(jié)節(jié)病變

noduleandmass早期癌earlycarcinoma腫塊直徑小于2cm，無他處轉(zhuǎn)移肺內(nèi)球形腫塊周圍型肺癌肺內(nèi)球形腫塊70周圍型肺癌

腫塊特點

Imagingfeatures

LungcancerShapeMargedensity周圍型肺癌

腫塊特點

Imagingfeatures

71LobulationsignLobulationsign72周圍型肺癌腫塊特點

細(xì)、短的毛刺Lungcancerspiculation周圍型肺癌腫塊特點

細(xì)、短的毛刺Lungcancers73胸膜凹陷征pleuralindentationsignLungcancer周圍型肺癌peripherallungcancer

腫塊特點

胸膜凹陷征pleuralindentationsignL74MPR重建胸膜凹陷征

pleuralindentationsign

LungcancerMPR重建胸膜凹陷征

pleuralindentati75血管集束征convergenceofbronchovascularstructures血管集束征convergenceofbronchovas76月暈征halosign

結(jié)節(jié)周圍環(huán)以磨玻璃影病理為出血性肺梗塞腫瘤細(xì)胞浸潤見于曲菌球,周圍型肺癌等月暈征halosign

結(jié)節(jié)周圍環(huán)以磨玻璃影77病灶胸膜側(cè)小片狀浸潤病灶胸膜側(cè)小片狀浸潤78不規(guī)則的厚壁空洞irregularthickwalledcavity：多見于較大腫塊內(nèi)壁厚、偏心、內(nèi)壁不規(guī)則、有壁結(jié)節(jié)Lungcancer周圍型肺癌腫塊特點

carcinomatouscavity

不規(guī)則的厚壁空洞irregularthickwalled79Lungcancer周圍型肺癌

腫塊特點

小圓形空泡征vacuolesign管狀支氣管充氣征airbronchogram多見<3cm腫塊內(nèi)Lungcancer周圍型肺癌

腫塊特點

小圓形空泡征80peripherallungcancer

腫塊特點小結(jié)肺內(nèi)球形腫塊分葉征signoflobulation：不規(guī)則毛刺征spiculationandspike：短、細(xì)，放射狀癌性空洞carcinomatouscavity：壁厚、內(nèi)壁不規(guī)則空泡征vacuolesign與支氣管充氣征胸膜凹陷征pleuralindentationsign血管集束征convergenceofbronchovascularstructures月暈征(halosign)病灶胸膜側(cè)小片狀浸潤鈣化少見CT增強(qiáng)均勻或不均勻強(qiáng)化Lungcancerperipherallungcancer

腫塊81肺上溝癌

(Pancoasttumor)

發(fā)生于肺尖的肺癌

Lungcancer肺上溝癌

(Pancoasttumor)

發(fā)生于肺尖的肺82

胸部正側(cè)位片(含DR\CR)用于篩查肺癌,胸部CT為肺癌診斷的首選,MRI一般不用于診斷肺癌,體檢篩查肺癌可選用胸部正側(cè)位片\DR\CR\低劑量CT.早期中央型肺癌X線胸片常無異常表現(xiàn),胸部CT能顯示支氣管管腔與管壁的異常.縱隔結(jié)構(gòu)浸潤的胸部CT表現(xiàn)為腫塊與縱隔間脂肪間隙消失,腫塊與縱隔結(jié)構(gòu)分界不清.MRI對支氣管病變與阻塞性改變顯示不佳,但可顯示肺門腫塊與縱隔轉(zhuǎn)移和浸潤.肺癌的血供主要為支氣管動脈,DSA可用于肺癌血供的顯示,用于肺癌介入治療前后.胸部正側(cè)位片(含DR\CR)用于篩查肺癌,胸部CT83肺癌TNM分期見P216肺癌TNM分期見P21684彌漫型肺癌diffusetype兩肺廣泛不對稱分布的細(xì)小結(jié)節(jié)，邊緣模糊，

可融合呈腫塊或大片實變,內(nèi)可見支氣管充氣征airbronchogram中下肺野較多Lungcancer細(xì)支氣管肺泡癌bronchioloalveolarcarcinoma彌漫型肺癌diffusetype兩肺廣泛不對稱分布85呼吸系統(tǒng)影像診斷腫瘤部分課件86肺癌轉(zhuǎn)移

肺門縱隔淋巴結(jié)轉(zhuǎn)移

Mediastinallymphnodemetastasis

胸膜轉(zhuǎn)移pleuralmetastasis

肺內(nèi)轉(zhuǎn)移directextension

直接蔓延或轉(zhuǎn)移至胸壁

遠(yuǎn)處轉(zhuǎn)移metastasis

肺癌轉(zhuǎn)移87呼吸系統(tǒng)影像診斷腫瘤部分課件88轉(zhuǎn)移性肺癌metastaticlungcancer

肺轉(zhuǎn)移瘤pulmonarymetastasis許多部位的惡性腫瘤可以轉(zhuǎn)移至肺,如絨癌、乳腺癌、肝癌、胃癌、骨肉瘤等。轉(zhuǎn)移途徑有血行、淋巴或臨近器官直接蔓延等轉(zhuǎn)移性肺癌metastaticlungcancer

肺轉(zhuǎn)89X線表現(xiàn)metastaticlungcancer雙肺多發(fā)棉球樣結(jié)節(jié)大小不等密度均勻邊界清楚中下肺野外帶較多血行轉(zhuǎn)移X線表現(xiàn)metastaticlung