孤立性肺結(jié)節(jié)petct良惡性鑒別診斷課件

孤立性肺結(jié)節(jié)CT、PET-CT良惡性鑒別診斷Solitarypulmonarynodule:benignPET-CTversusmalignantDifferentiationwithCT原文地址:radiologyassistantnl/en/460f9fcd50637孤立性肺結(jié)節(jié)1孤立性肺結(jié)節(jié)的鑒別診斷,在臨床中經(jīng)常遇到。根據(jù)結(jié)節(jié)的良惡性差異,處理方法有很大差別。在這篇文章中,我們主要探討CT和PET-CT的相關(guān)征象在孤立性肺結(jié)節(jié)良惡性鑒別診斷中的意義。ThedifferentialdiaghaethlitthepsionabenignleisarianaandusssomeofthenewfeaturesthnhelptoferentiatebetweenandmalignantnodulesbaseduponCTan孤立性肺結(jié)節(jié)的鑒別診斷,在臨床2目錄(contents)CT征象CT:benignversusmalignantCalcification生長速度SizeGrowth6.充氣支氣管征Margin實(shí)性和磨玻璃成分6.AirBronchogramsignSolidandGround-glass強(qiáng)化特征components8,ContrastenhancementPET-CT征象PET-CT:benign結(jié)論versusmalignantConclusio目錄(contents)3鈣化DiffuseCentralLaminatedPopcorn良性鈣化征象:彌漫性爆米花樣■彌漫性、中心性、層狀及爆米花樣鈣化多見于良性結(jié)節(jié)主要見于肉芽腫性疾病和錯(cuò)構(gòu)瘤其他類型鈣化多見于惡性結(jié)節(jié),不應(yīng)該認(rèn)為屬于良性表現(xiàn)?！鲈谝阎性l(fā)腫瘤存在的情況下,其鈣化類型不一定適用此結(jié)論。例如:骨肉瘤或軟骨肉瘤的病人,其鈣化多表現(xiàn)為彌漫性;同樣的,中心性和爆米花樣鈣化也可見于胃腸道腫瘤或接受過化療的病人鈣化4CalcificationDiffuse,central,laminatedorpopcorncalcificationsarebenignpatternsofcalcificationThesetypesofcalcificationareseeningranulomatousdiseaseandhamartomasAllotherpatternsofcalcificationshouldnotberegardedasasignofbenignityTheexceptiontotheruleaboveiswhenpatientsareknowntohaveaprimarytumor.ForinstancethediffusecalcificationpatterncanJeseeninpatientswithosteosarcomaorchondrosarcomaSimilarlythecentralandpopcornpatterncanbeseeninpatientswithGI-tumorsandpatientswhopreviouslyhadchemotherapyCalcification5結(jié)節(jié)大小odulesizeTotalMalignancy4mm20380%26815%≥20mm結(jié)節(jié)大小與惡性可能性之間的關(guān)系孤立性肺結(jié)節(jié)(SPN)定義:肺實(shí)質(zhì)內(nèi)小于等于3cm的病灶(需除外肺不張和腫大的淋E大于3cm的病灶稱為腫塊(mass之所以這樣定義,是因?yàn)榇笥?cm的病灶多為惡性,而更小的病灶可能是良心或惡性Swensen.etal研究了SPN大小與惡性可能性之間的關(guān)系(上圖)結(jié)論是小的結(jié)節(jié),良性可能性大。超過2000例小于4mm的結(jié)節(jié),無例屬于惡性結(jié)節(jié)大小6SizeAsolitarypulmonarynodule(SPn)isdefinedasasingletraparenchymallesionlessthan3cminsizeandnotssociatedwithatelectaorlymphadenAlesiongreaterthan3cmindiameteriscalledamassThisdistinctionismade,becauselesionsgreaterthan3cmllymalignantwhilesmallerlesionscanbeeitherbenignormalignantSwensenetalstudiedtherelationshipbetweenthesizeofaSPNandthechanceofmalignancyinacohortathighriskncer(1Theirfindingsarelistedinthetableontheleft.thatbenignnoduledetectionrateishighespeciallyiflesionsaresmall.oftheover2000nodulesthatwerelessthan4mminonewasmalignantSize7生長速度與以前的CT片進(jìn)行比較,在結(jié)節(jié)定性方面具有重要意義。超過2年無變化的結(jié)節(jié)多為良性。生長速度8GrowthComparisonwithpriorimagingstudiesisoftenthemostusefulproceduretodeterminetheimportanceofthefindingofaSPN,sincestabilityover2yearsishighlyassociatedwithbenignityGrowth9形狀左:橫斷圖像:右:冠狀重建圖像。三維比值=(最大)橫徑/長徑日本的相關(guān)研究證實(shí),多角形、三維比值大于1.78的結(jié)節(jié),多為良性。在肺的外圍、胸膜下的結(jié)節(jié)也多為良性三維比值=(最大)橫徑/長徑。大的三維比值說明病灶的形狀是扁平的(是“片”不是“塊”),這是良性的特征形狀10孤立性肺結(jié)節(jié)petct良惡性鑒別診斷課件11孤立性肺結(jié)節(jié)petct良惡性鑒別診斷課件12孤立性肺結(jié)節(jié)petct良惡性鑒別診斷課件13孤立性肺結(jié)節(jié)petct良惡性鑒別診斷課件14孤立性肺結(jié)節(jié)petct良惡性鑒別診斷課件15孤立性肺結(jié)節(jié)petct良惡性鑒別診斷課件16孤立性肺結(jié)節(jié)petct良惡性鑒別診斷課件17孤立性肺結(jié)節(jié)petct良惡性鑒別診斷課件18孤立性肺結(jié)節(jié)petct良惡性鑒別診斷課件19孤立性肺結(jié)節(jié)petct良惡性鑒別診斷課件20孤立性肺結(jié)