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)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目錄(contents)CT征象CT:benignversusmalignantCalcification生長速度SizeGrowth6.充氣支氣管征Margin實性和磨玻璃成分6.AirBronchogramsignSolidandGround-glass強化特征components8,ContrastenhancementPET-CT征象PET-CT:benign結(jié)論versusmalignantConclusio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CalcificationDiffuse,central,laminatedorpopcorncalcificationsarebenignpatternsofcalcificationThesetypesofcalcificationareseeningranulomatousdiseaseandhamartomasAllotherpatternsofcalcificationshouldnotberegardedasasignofbenignityTheexceptiontotheruleaboveiswhenpatientsareknowntohaveaprimarytumor.ForinstancethediffusecalcificationpatterncanJeseeninpatientswithosteosarcomaorchondrosarcomaSimilarlythecentralandpopcornpatterncanbeseeninpatientswithGI-tumorsandpatientswhopreviouslyhadchemotherapy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,是因為大于3cm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SizeAsolitarypulmonarynodule(SPn)isdefinedasasingletraparenchymallesionlessthan3cminsizeandnotssociatedwithatelectaorlymphadenAlesiongreaterthan3cmindiameteriscalledamassThisdistinctionismade,becauselesionsgreaterthan3cmllymalignantwhilesmallerlesionscanbeeitherbenignormalignantSwensenetalstudiedtherelationshipbetweenthesizeofaSPNandthechanceofmalignancyinacohortathighriskncer(1Theirfindingsarelistedinthetableontheleft.thatbenignnoduledetectionrateishighespeciallyiflesionsaresmall.oftheover2000nodulesthatwerelessthan4mminonewasmalignant生長速度與以前的CT片進行比較,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。GrowthComparisonwithpriorimagingstudiesisoftenthemostusefulproceduretodeterminetheimportanceofthefindingofaSPN,sincestabilityover2yearsishighlyassociatedwithbenignity形狀