CT灌注成像在肺炎性结节与肺癌性结节鉴别诊断中的效果观察

目的:分析在肺炎性结节与肺癌性结节鉴别诊断中采用CT灌注成像的诊断效果。方法:选择2018年3月至2018年8月期间,来我院进行手术切除或穿刺活检孤立肺结节患者共64例,患者先行肺部结节CT灌注成像检查,利用灌注软件计算患者肺癌和肺炎性结节患者的灌注参数。结果:64例患者中,肺癌结节患者52例(占比81.25%),肺炎性结节患者12例(占比18.75%)。肺炎性结节患者的血容量、强化峰值、结节-主动脉强化峰值比均大于肺癌性结节患者,组间对比差异存在统计学意义(P<0.05)。将血流量等于78mL·min^(-1)·100g^(-1)当做肺炎性结节和肺癌性结节的区分阈值,诊断的敏感性为88.46%。将结节-主动脉强化峰值等于8.5作为肺炎性结节和肺癌性结节的区分阈值,敏感性为81.76%。结论:在肺炎性结节与肺癌性结节鉴别诊断中,采用CT灌注成像诊断具有一定的临床鉴别意义。

64排螺旋CT动态增强扫描不同病理类型肺癌孤立性肺结节特点的研究

目的:研究排螺旋C T动态增强扫描不同病理类型肺癌孤立性肺结节的特点。方法:采用机器型号东芝64排128层螺旋C T机进行扫描,比较不同病理类型孤立性肺结节强化方式以及延迟扫描180s、300s、600s的廓清率以及强化率。结果:鳞癌结节、小细胞癌结节的CT动态增强扫描方式主要是以不均匀强化为主,而腺癌结节的CT动态增强扫描方式主要是以均匀强化为主。在延迟扫描180s、300s、600s中,小细胞癌结节的廓清率最高,腺癌结节的强化率最高,三者之间的差异比较,P<0.05,有统计学意义。结论:排螺旋C T动态增强扫描不同病理类型肺癌孤立性肺结节具有极大的临床意义,能够为临床治疗提供临床诊断依据,值得推荐。

囊腔性肺癌的超高分辨率CT研究

目的:一般认为,影像学上囊腔性肺癌定义为病灶内有明显类圆形或不规则含气囊腔的肺癌,囊常常有壁,与空泡不同,后者一般来说无壁。本研究拟回顾性分析囊腔性肺癌的超高分辨率CT特征,以期准确判断肿瘤侵袭性。方法:62例手术切除病理证实的囊腔性肺癌纳入研究,男性39例,女性23例,年龄30-73岁(中位年龄61岁)。超高分辨率CT扫描技术:调整体位使病灶位于体轴重力线上,1024矩阵扫描,高对比分辨率算法及迭代算法重建。在多平面重组三维正交图像的肺结节最大截面上完成分析,根据病变的非囊性成分分为磨玻璃和实性囊腔性肺癌2组。结果:磨玻璃组55个(88.7%),包括49例侵袭性病变和6例侵袭前病变,实性组7个(11.3%),包括4例腺癌、2例鳞癌和1例大细胞癌。对于磨玻璃组,病灶最大径、囊腔最大径、囊腔数目(单囊或多囊)、最大囊壁厚度对确定肿瘤有无侵袭性具有统计学上显著性意义(P<0.05),多因素Logistic回归分析显示病灶最大径、多囊性是判断病变侵袭性的独立预测因子。ROC曲线分析显示病灶最大径〉13.5mm诊断侵袭性病变的曲线下面积为0.940,敏感度和特异度分别为87.8%、83.3%。结论:对于磨玻璃囊腔性肺癌,病灶最大径、囊腔最大径、多囊和最大囊壁厚度对提示肿瘤侵袭性有价值,其中病灶最大径、多囊是判断肿瘤侵袭性的独立预测因子,病灶最大径大于13.5mm提示肿瘤为侵袭性。

Tongue image feature correlation analysis in benign lung nodules and lung cancer

Objective To analyze the differences in the correlation of tongue image indicators among patients with benign lung nodules and lung cancer.Methods From July 1;2020 to March 31;2022;clinical information of lung cancer patients and benign lung nodules patients was collected at the Oncology Department of Longhua Hos-pital Affiliated to Shanghai University of Traditional Chinese Medicine and the Physical Ex-amination Center of Shuguang Hospital Affiliated to Shanghai University of Traditional Chi-nese Medicine;respectively.We obtained tongue images from patients with benign lung nod-ules and lung cancer using the TFDA-1 digital tongue diagnosis instrument;and analyzed these images with the TDAS V2.0 software.The extracted indicators included color space pa-rameters in the Lab system for both the tongue body(TB)and tongue coating(TC)(TB/TC-L;TB/TC-a;and TB/TC-b);textural parameters[TB/TC-contrast(CON);TB/TC-angular second moment(ASM);TB/TC-entropy(ENT);and TB/TC-MEAN];as well as TC parameters(perAll and perPart).The bivariate correlation of TB and TC features was analyzed using Pearson’s or Spearman’s correlation analysis;and the overall correlation was analyzed using canonical correlation analysis(CCA).Results Samples from 307 patients with benign lung nodules and 276 lung cancer patients were included after excluding outliers and extreme values.Simple correlation analysis indi-cated that the correlation of TB-L with TC-L;TB-b with TC-b;and TB-b with perAll in lung cancer group was higher than that in benign nodules group.Moreover;the correlation of TB-a with TC-a;TB-a with perAll;and the texture parameters of the TB(TB-CON;TB-ASM;TB-ENT;and TB-MEAN)with the texture parameters of the TC(TC-CON;TC-ASM;TC-ENT;and TC-MEAN)in benign nodules group was higher than lung cancer group.CCA further demon-strated a strong correlation between the TB and TC parameters in lung cancer group;with the first and second pairs of typical variables in benign nodules and lung cancer groups indicat-ing correlation coefficients of 0.918 and 0.817(P<0.05);and 0.940 and 0.822(P<0.05);re-spectively.Conclusion Benign lung nodules and lung cancer patients exhibited differences in correla-tion in the L;a;and b values of the TB and TC;as well as the perAll value of the TC;and the texture parameters(TB/TC-CON;TB/TC-ASM;TB/TC-ENT;and TB/TC-MEAN)between the TB and TC.Additionally;there were differences in the overall correlation of the TB and TC be-tween the two groups.Objective tongue diagnosis indicators can effectively assist in the diag-nosis of benign lung nodules and lung cancer;thereby providing a scientific basis for the ear-ly detection;diagnosis;and treatment of lung cancer.

血管穿过征在周围型小肺癌中的临床价值及检查方法

目的探讨周围型小肺癌中血管穿过征的病理基础及诊断价值。方法回顾性分析67例周围型小肺癌血管穿过征的CT表现及病理资料,依据穿通血管的形态改变,与15例错构瘤血管穿过征进行比较。结果 23例周围型小肺癌穿通血管有血管聚集,44例周围型小肺癌穿通血管无改变;15例错构瘤对比组未见穿通血管走行异常改变。结论血管穿过征走行异常对周围型小肺癌诊断意义较大。

HRCT与PET／CT相结合对孤立性肺癌结节和结核球的鉴别诊断价值

目的探讨HRCT与PET/CT相结合对孤立性肺癌结节和结核球的鉴别诊断价值。方法回顾性分析经病理或临床证实的孤立性肺癌结节和结核球共60例,全部病例均行PET/CT显像和胸部HRCT检查。PET/CT用目测法结合半定量法判断良恶性,HRCT根据病灶的形态学特征判断良恶性,统计PET/CT诊断结果和HRCT与PET/CT相结合诊断结果。结果病理或临床证实的孤立性肺癌结节和结核球分别为38例和22例,单纯PET/CT正确诊断36例肺癌和14例结核球,2例肺癌PET/CT显像为阴性,其中1例经HRCT和PET/CT联合诊断为恶性;8例结核球PET/CT显像为阳性,其中7例经HRCT和PET/CT结合后正确诊断。单纯PET/CT诊断和联合诊断对孤立性肺癌结节和结核球鉴别的敏感性、特异性和准确性分别为94.74%、63.64%、83.33%和97.37%、95.45%、96.67%。结论 HRCT与PET/CT相结合能大大降低孤立性结核球良恶性判断的假阳性率,可明显提高孤立性肺癌结节和结核球的鉴别的准确性。

PET/CT检查在实性结节型肺癌术前分期中的必要性

分析18氟-脱氧葡萄糖(18F-FDG)正电子发射性电子计算机断层(PET/CT)检查技术在实性结节型肺癌术前分期中的必要性。方法:回顾性选择本中心2018年2月~2020年3月中206例实性结节型肺癌患者为研究对象,患者均于治疗前接受PET/CT检查。结果:PET/CT对实性结节型肺癌TNM分期的准确度分别为89.81%、96.23%以及98.41%,均明显高于常规CT,差异有统计学意义(P<0.05)。结论:18F-FDG PET/CT用于实性结节型肺癌术前分期,可精确判断患者的临床分期,为治疗提供支持。

The correlation between stroma analysis and MDCT early phase contrast enhancement in small solid lung adenocarcinoma

Objective: To evaluate correlations between proportion and distribution of tumor stroma and MDCT early phase enhancement character in solid lung adenocarcinoma, and compare with microvessel density and histological subtypes. Methods: Thirty-one patients with lung adenocarcinoma shown as solid solitary pulmonary nodules underwent routine con-trast-enhanced MDCT followed by surgical resections. CT character included net enhancement and distribution of enhance-ment. The largest cut surface of tumor specimens were stained by hematoxylin and eosin. About 25 fields of view of each specimen were scanned as digitized pictures at low magnification. Semi-auto segmentation software was used to calculate mean stroma proportion. Pearson correlation coefficient was used to represent the relationships between extent of tumor en-hancement, proportion of tumor stroma and MVD respectively. Fisher's exact test was used to analyze statistical differences in degree of CT enhancement among groups of different histological subtypes. Results: Proportion of invasive tumor stroma (13.2%-54.5%, mean 26.2 ± 8.8%) was correlated positively with net enhancement (8-60.8 HU, mean 31.2 ± 13.6 HU; r = 0.483, P = 0.006) which was more than MVD. 58.1% cases showed homogenous enhancement, 32.3% cases showed periph-eral inhomogenous enhancement, 3.2% cases showed central inhomogenous enhancement, 3.2% cases showed asymmetri-cal inhomogenous enhancement, and 3.2% cases showed no enhancement. 58.1% cases' stroma showed mixed distribution, 35.5% cases showed peripheral distribution, 3.2% cases showed central distribution, and 3.2% cases showed asymmetrical distribution. Significantly more adenocarcinomas classified with "net enhancement > 20 HU" were found in the acinar group than in the solid with mucin subtype (P = 0.005). Conclusion: Extent of CT enhancement reflects underlying not only the tumor angiogenesis but also stroma proliferation in solid small lung adenocarcinoma. Tumor stroma proportion could reflect the histopathologic basis of small lung adenocarcinoma's CT enhancement substantially than MVD. Distribution between enhancement and tumor stroma have good correspondence. Most of acinar adenocarcinomas have higher degree of CT net enhancement than solid with mucin adenocarcinomas.

Analysis of 96 cases of solitary pulmonary nodule diagnosed by MSCT

Objective:The aim of this study was to explore the diagnostic value of multi-slice computer tomography(MSCT) in solitary pulmonary nodule(SPN).Methods:Contrastive analysis of the differences of CT signs between benign and malignant SPN.Results:The typical sign of pleural indentation was a reliable sign for lung cancers.Vacuole sign suggested lung cancer highly.Blood vessels cluster involving the vein alone had big opportunity to lung cancer.Type I tumor-bronchial relation was the most common relation in lung cancers.Type V tumor–bronchial relation was the most common relation in benign SPN.Conclusion:MSCT had a very high diagnostic value in SPN.