Primary pulmonary meningioma and minute pulmonary meningothelial-like nodules: Rare pulmonary nodular lesions requiring more awareness in clinical practice

In this editorial,we comment on an article by Ruan et al published in a recent issue of the World Journal of Clinical Case.Pulmonary meningothelial proliferative lesions,including primary pulmonary meningiomas,minute pulmonary meningothelial-like nodules,and metastatic pulmonary meningiomas are rare pulmonary lesions.These lesions are difficult to differentiate from lung cancers based on clinical and imaging manifestations.Herein,we briefly introduce the clinical,imaging,and pathological characteristics of these lesions and discuss their pathogenesis to strengthen the current understanding of pulmonary meningothelial proliferative lesions in clinical diagnosis and therapy.

Unexpected diffuse lung lesions in a patient with pulmonary alveolar proteinosis:A case report

BACKGROUND Pulmonary alveolar proteinosis(PAP)often presents nonspecifically and can be easily confused with:(1)Idiopathic interstitial lung fibrosis;(2)alveolar carcinoma;(3)pulmonary tuberculosis;and(4)other lung diseases such as viral pneumonia,mycoplasma pneumonia,and chlamydial pneumonia.CASE SUMMARY Diagnosis:In this case,a patient was diagnosed with PAP through transbronchial cryobiopsy(TBCB)and quantitative metagenomic next-generation sequencing,which confirmed the impairment of surfactant turnover as the underlying cause of PAP.Interventions:High-volume total lung lavage was performed for this patient.Outcomes:The patient's clinical condition had improved significantly by the 6-month follow-up,with a 92%finger oxygen saturation.A repeat chest computed tomography scan revealed scattered patchy ground-glass shadows in both lungs,which was consistent with alveolar protein deposition but with a lower density than in the radiograph from October 23,2022.CONCLUSION TBCB has unique advantages in diagnosing atypical alveolar protein deposition,particularly for enabling the early detection of PAP.This information can help patients take preventive measures to prevent or halt PAP development by avoiding dusty environments and seeking treatment with total lung lavage and inhaled granulocyte macrophage colony-stimulating factor.

Virtual bronchoscopic navigation without fluoroscopy guidance for peripheral pulmonary lesions in inexperienced pulmonologist

Objective:Fluoroscopy guidance is generally required for endobronchial ultrasonography with guide sheath(EBUS-GS)in peripheral pulmonary lesions(PPLs).Virtual bronchoscopic navigation(VBN)can guide the bronchoscope by creating virtual images of the bronchial route to the lesion.The diagnostic yield and safety profiles of VBN without fluoroscopy for PPLs have not been evaluated in inexperienced pulmonologist performing EBUS-GS.Methods:Between January 2016 and June 2017,consecutive patients with PPLs referred for EBUS-GS at a single cancer center were enrolled.The diagnostic yield as well as safety profiles was retrospectively analyzed,and our preliminary experience was shared.Results:A total of 109 patients with 109 lesions were included,99(90.8%)lesions were visible on EBUS imaging.According to the procedure time needed to locate the lesion on EBUS,24.8%(27/109)were deemed technically difficult procedures;however,no significant relationships were identified between candidate parameters and technically difficult procedures.The overall diagnosis yield was 74.3%(81/109),and the diagnostic yield of malignancy was 83.7%(77/92).Lesions larger than 20 mm[odds ratio(OR),2.758;95%confidence interval(95%CI),1.077-7.062;P=0.034]and probe of within type(OR,3.174;95%CI,1.151-8.757,P=0.026)were independent factors leading to a better diagnostic yield in multivariate analysis.About 30 practice procedures were needed to achieve a stable diagnostic yield,and the proportion of technically difficult procedures decreased and stabilized after 70 practice procedures.Regarding complications,one patient(0.9%)had intraoperative hemorrhage(100 mL)which was managed under endoscopy.Conclusions:VBN without fluoroscopy guidance is still useful and safe for PPLs diagnosis,especially for malignant diseases when performed by pulmonologist without previous experience of EBUS-GS.VBN may simplify the process of lesion positioning and further multi-center randomized studies are warranted.

Effects of in vitro cultivated Calculus Bovis compound on pulmonary lesions in rabbits with schistosomiasis

AIM:To explore the interventional effects and mechanism of in vitro cultivated Calculus Bovis compound preparation(ICCBco) on pulmonary lesions in portal hypertensive rabbits with schistosomiasis. METHODS:The experimental group included 20 portal hypertensive rabbits with schistosomiasis treated by ICCBco.The control group included 20 portal hypertensive rabbits with schistosomiasis treated by praziquantel. The morphological changes of the pulmonary tissues were observed under light and electron microscopy.The expression of fibronectin(FN) and laminin(LN) in the lung tissues was analyzed by immunohistochemistry. RESULTS:Under light microscope,the alveolar exudation in the lung tissue was more frequently observed in the control group,while the alveolar space was fairly dry in the lung tissue of ICCBco group.Under electron microscope,more alveolar exudation in the lung tissue,and moremacrophages,alveolar angiotelectasis and the blurred three-tier structure of alveolar-capillary barrier could be seen in the control group.In ICCBco group,fibers within the alveolar interspace slightly increased in some lung regions,and the structure of typeⅠepithelium,basement membrane and endodermis was complete,and no obvious exudation from the alveolar space,and novascular congestion could be observed.There was a positive or strong positive expression of FN and LN in the lung tissue of the control group,while there was a negative or weak positive expression of FN and LN in ICCBco group. CONCLUSION:ICCBco can effectively prevent pulmonary complications in portal hypertensive rabbits with schistosomiasis by means of improving lung microcirculation and lowering the content of extracellular matrix.

Effects of Lianhua Qingwen on Pulmonary Oxidative Lesions Induced by Fine Particulates(PM2.5) in Rats

Objective To investigate the antagonistic effects of different doses of Lianhua Qingwen on pulmonary injury induced by fine particulates PM2.5 in rats. Methods Fine particulates suspended in the environment were collected. Forty-eight healthy adult wistar rats were randomly divided into 6 groups with 8 rats in each group. Four groups of rats were exposed to PM2.5 by intratracheally dripping suspensions of fine particulates PM2.5(7.5 mg/kg) as dust-exposed model rats. Among them 24 rats in three groups received Lianhua Qingwen treatment(crude drug) at a dose of 2 g/kg, 4 g/kg, 8 g/kg per day for 3 days before dust exposure and were defined as low-dose, middle-dose and high-dose Lianhua Qingwen treatment groups respectively. The other dust-exposed model rats without treatment were assigned as PM2.5 control group. The un-exposed rats were set as saline control group(1.5 ml/kg saline) and blank control group. All rats were killed after 24 hours of the exposure. Lung tissue, serum and bronchoalveolar lavage fluid(BALF) were collected. The levels of malonaldehyde(MDA), lactate dehydrogenase(LDH), and glutathione peroxidase(GSH-PX) in blood serum and BALF, and superoxide dismutase(SOD) in blood surum were measured using fluorescent quantitation PCR; Expression of NF-E2-related factor 2(NRF-2), heme oxygenase 1(HO-1) and quinone oxidoreductase 1(NQO1) in lung tissues were measured using Western blot. Pathological changes of lung tissues in each group were also examined. Results Pathology revealed thickened alveolar septum, congestion of capillary, interstitial edema and infiltration of lymphocyte and neutrophil surrounding bronchiole in the PM2.5 control group, which weresignificantly relieved in the Lianhua Qingwen treatment groups. Compared to the blank and saline control groups, the PM2.5 control group had significantly higher levels of LDH and MDA(p<0.01) and lower level of GSH-PS(p<0.01) in BALF, significantly higher levels of LDH and MDA(p<0.05) and lower level of GSH-PS(p<0.05) in rat serum. The levels of MDA in blood serum and BALF were significantly lower in each treatment group than that in PM2.5 control group(all P<0.05). In both middle-dose and high-dose treatment group the measurements of LDH in serum and BALF as well as GSH-PX in serum were significant difference from those of PM2.5 control group(all P<0.05). Expressions of NRF-2, HO-1 and NQO1 in lung tissues were significantly different among middle-dose and high-dose treatment group compared with those in PM2.5 control group(all P<0.05). Conclusion Fine particulates PM2.5 in environment may induce pulmonary oxidative lesions in rats. Middle-dose and high-dose Lianhua Qingwen has antagonist effece on the injuries induced by fine particulates.

Paroxysmal atrial fibrillation ablation:Achieving permanent pulmonary vein isolation by point-by-point radiofrequency lesions

Pulmonary vein isolation by point-by-point radiofrequency catheter ablation constitutes the cornerstone of catheter ablation strategies for the treatment of atrial fibrillation. However, despite advances in pulmonary vein isolation ablation strategies, long-term success rates after ablation remain suboptimal, which highlights the need to develop techniques to achieve more durable lesions. Strategies proposed to improve the durability of pulmonary vein isolation can be divided into two groups: Those addressed to improving the quality of the lesion and those that optimize the detection of acute PV reconnection during the ablation procedure. This manuscript reviews the role and potential benefits of these techniques according to current clinical evidence.

The optimal slice thickness of CT in revealing lobulation of malignant solitary pulmonary nodules

Objective： The aim of this study was to determine an optimal slice thickness that was efficient in revealing Iobulation of malignant solitary pulmonary nodules （SPNs） on multi-slice spiral computed tomography （MSCT） images preliminarily. Methods： Fifty patients with malignant SPNs （diameter -〈 3 cm） underwent multidetector-row computed tomography of the chest in a single-breath-hold technique. The raw data were acquired with a collimation of 0.625 mm. Three sets of contiguous images were reconstructed with 1-, 2-, and 5-ram slice thickness, respectively. The Iobulation sign of SPNs on the computed tomography （CT） images presented in 1-, 2-, and 5-ram slice thickness was compared. Using the 1-mm sections as the gold standard, an optimal slice thickness in revealing Iobulation sign of SPNs was determined. Results： The 1-mm-thick images CT revealed 98 Iobulations （25 with chord distance 〈 1 ram; 30 with chord distance 1-2 ram; 43 with chord distance 〉 2 mm） of 45 malignant SPNs. 18 Iobulations with chord distance 〈 1 mm presented in 2-mm-thick sections were as same as those in I-ram-thick sections. Statistically significant difference in Iobulations number was found between that revealed in 2-ram-thick images and that in I-ram-thick images （P = 0.023 〈 0.05）. 16 Iobulations with chord distance 〈 1 mm presented in 5-mm-thick sections were as same as that in I-ram-thick sections. There was statistically significant difference in Iobulations number between that revealed in 5-mm-thick images and that in I-ram-thick images （P = 0.004 〈 0.05）. The 24 Iobulations with chord distance 1-2 mm presented in 2-ram-thick sections were as same as that in 1-mm-thick sections. No statistically significant difference in Iobulations number were found between that revealed in 2-mm-thick images and that in 1-mm-thick images （P = 0.261 〉 0.05）. 13 Iobulations with chord distance 1-2 mm presented in 5-ram-thick sections were as same as that in 1- mm-thick sections. There was statistically significant difference in Iobulations number between that revealed in 5-ram-thick images and that in I-ram-thick images （P = 0.003 〈 0.05）. 40 Iobulations with chord distance 〉 2 mm presented in 2-ram-thick sections were as same as that in I-ram-thick sections. No statistically significant difference in Iobulations number was found between that revealed in 2-ram-thick images and that in I-ram-thick images （P = 0.631 〉 0.05）. 36 Iobulations with chord distance 〉 2 mm presented in 5-mm-thick sections were as same as that in I-ram-thick sections. There was no statistically significant difference in Iobulations number between that revealed in 5-ram-thick images and that in I-ram-thick images （P = 0.264 〉 0.05）. Conclusion： It is suggested that the use of 1-mm slice thickness is suitable in revealing Iobulations with chord distance 〈 1 ram. A 2-mm slice thickness is suggested to be used in revealing Iobulafions with chord distance 1-2 mm and 5-mm slice thickness to be used in revealing Iobulations with chord distance 〉 2 mm.

Malignant solitary pulmonary nodules: size and attenuation measured on a PACS and CT workstation

Objective: The aim of our study was to determine the efficiency and effectiveness of picture archiving and communication system(PACS) workstation in detecting the sizes and attenuation of malignant solitary pulmonary nodules(SPNs). Methods: Forty patients with malignant SPNs(diameter ≤ 3 cm) underwent multidetector-row computed tomography(CT) of the chest in a single-breath-hold technique. The raw data were acquired with a collimation of 0.625 mm. The diameters and attenuation of malignant SPNs were measured on PACS and CT workstation respectively. The diameter was defined as the average value of the anteroposterior, lateral and superoinferior diameters on CT scans obtained with a mediastinal window setting. The superoinferior diameters were measured on MPR image. The diameters and attenuation of malignant SPNs and spending time in measuring were recorded. Results: The diameters of malignant SPNs measured on a PACS and CT workstation were 2.09 cm ± 0.87 cm, 2.07 cm ± 0.79 cm, respectively. There was not statistically significant difference in the diameters of malignant SPNs between that measured on a PACS workstation and that on a CT workstation(t = 1.580, P = 0.210 > 0.05). The attenuation of malignant SPNs measured on a PACS and CT workstation were 40.15 HU ± 7.53 HU, 39.99 HU ± 8.13 HU, respectively. There was not statistically significant difference in the attenuation of malignant SPNs between that measured on a PACS workstation and that on a CT workstation(t = 1.008, P = 0.298 > 0.05). The spending time in measuring on a PACS and CT workstation were 55 s ± 4.03 s, 56 s ± 3.95 s, respectively. No statistically significant difference was found in spending time in measuring between that on a PACS workstation and that on a CT workstation(t = 0.958, P = 0.315 > 0.05). Conclusion: The efficiency and effectiveness of PACS workstation is as same as those of CT workstation in detecting the sizes and attenuation of malignant SPNs. It is suggested that the size and attenuation of malignant SPNs are measured on a PACS and CT workstation.

NOTCH3 Mutations and CADASIL Phenotype in Pulmonary Arterial Hypertension Associated with Congenital Heart Disease

Background:The etiology of pulmonary arterial hypertension associated with congenital heart disease(PAHCHD)is complicated and the phenotype is heterogeneous.Genetic defects of NOTCH3 were associated withcerebral disease and pulmonary hypertension.However,the relationship between NOTCH3 mutations and theclinical phenotype has not been reported in CHD-PAH.Methods:We eventually enrolled 142 PAH-CHD patientsfrom Fuwai Hospital.Whole exome sequencing(WES)was performed to screen the rare deleterious variants ofNOTCH3 gene.Results:This PAH-CHD cohort included 43(30.3%)men and 99(69.7%)women with the meanage 29.8±10.9 years old.The pathogenic or likely pathogenic mutations of NOTCH3 were identified in five cases.Patients 2,5,8 and 11 carried the same NOTCH3 mutation c.1630C>T(pArg544Cys),which is the hot-spotmutation for cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy(CADASIL).Patient 3 carried the NOTCH3 mutation p.Arg75Gln that has also been reported to be associatedwith the CADASIL.Patients 2,5,8,11 took the examination of the cerebral magnetic resonance imaging(MRI)and confirmed the phenotype of CADASIL.Conclusions:We first reported the NOTCH3 rare mutationsand CADASIL phenotypes in CHD-PAH patients.The NOTCH3 rare variants were with a relatively high positiverate and CADASIL phenotypes were likely enriched in PAH-CHD patients.The preoperative neurological examinationmight be recommended for PAH-CHD patients to determine the surgical contraindications and reduceintraoperative neurological complications.

Robotic-assisted bronchoscopy in the diagnosis of peripheral pulmonary lesions

More peripheral pulmonary lesions(PPLs)are detected by low-dose helical computed tomography(CT)either in-cidentally or via dedicated lung cancer screening programs.Thus,using methods for safe and accurate diagnosis of these lesions has become increasingly important.Transthoracic needle aspiration(TTNA)and transbronchial lung biopsy(TBLB)are routinely performed during the diagnostic workup for PPLs.However,TTNA often car-ries the risk of pneumothorax,uncontrollable airway hemorrhage,and does not allow mediastinal staging in one procedure.In contrast,traditional TBLB often has a poorer diagnostic yield despite fewer complications.With the ongoing development of technology applied to bronchoscopy,guided bronchoscopy has become widely used and the diagnostic yield of TBLB has improved.Additionally,guided bronchoscopy continues to demonstrate a better safety profile than TTNA.In recent years,robotic-assisted bronchoscopy(RAB)has been introduced and imple-mented in the diagnosis of PPLs.At present,RAB has two platforms that are commercially available:Monarch TM and Ion TM;several other platforms are under development.Both systems differ in characteristics,advantages,and limitations and offer features not seen in previous guided bronchoscopy.Several studies,including cadaveric model studies and clinical trials,have been conducted to examine the feasibility and performance of RAB using these two systems;large multicenter studies are underway.In this review,published experimental results,focus-ing on diagnostic yield and complications of RAB,are analyzed and the potential clinical application of RAB is discussed,which will enable the operators to have a clear overview of RAB.

A Bronchopulmonary Onset of Candidemia Revealing a Granulomatosis with Polyangiitis

Candidemia is defined as being a yeast infection confirmed by the presence of at least one positive Candida blood culture. It is a life threatening infection causing high mortality. The clinical signs are generally compatible with the causative agent (whether there is a deep venous catheter or not). On the other hand and according to the 2012 Revised Chapel Hill Classification, granulomatosis with polyangiitis GPA is classified as a vasculitis associated with antineutrophil cytoplasmic antibodies ANCA. It is a systemic disease characterized by the anatomopathological aspect of granuloma. We report the case of a patient who presented an atypical and a very rare revealing mode of GPA which was a bronchopulmonary candidiasis complicated by candidemia. Despite its controversy, the combination in the acute phase of antifungal treatment based on intravenous voriconazole and glucocorticoid therapy has made it possible to control candidemia and calm vasculitis.

DIFFERENTIAL ULTRASONIC DIAGNOSES OF PULMONARY BENIGN AND MALIGNANT SPACE-OCCUPIED LESIONS OF THE PERIPHERAL TYPE

87 patients with pulmonary space-occupied lesions of the peripheral type which were either adhesive of close to pleura were examined using ultuasonography.Of them,64 cases of lung cancers and 23 of bening lesions were then confirmed by

Analysis of clinical and imaging features of Behcet's disease-related pulmonary lesions:a series of eight cases

To the Editor:Behcet's disease is a chronic vascular inflammatory disease that involves multiple systems of the body.Although the incidence of pulmonary damages is low in Behcet's disease,most of them are serious.The initial pulmonary damages of Behcet's disease are mainly manifested with mild cough,chest pain,and slight hemoptysis,which are easily misdiagnosed as pulmonary embolism,pneumonia,or other diseases.

Diagnostic value of thin-slice CT navigation combined with cytology in preoperative bronchoscopy of peripheral pulmonary lesions

Objective To evaluate the diagnostic value of thinsliceCT navigation combined with cytology in routinepreoperative bronchoscopy of peripheral pulmonary lesionsand compare the diagnostic effects of different cytologicalsampling methods. Methods The clinical data ofperipheral lung cancer patients with preoperative bronchoscopyand cytology sampling guided by thin-slice CTfrom May 2015 to July 2016 in Cancer Hospital,ChineseAcademy of Medical Sciences were retrospectively analyzed.The diagnostic accuracy,sensitivity and specificityof different cytological sampling methods for peripheralpulmonary lesions guided by thin-slice CT were compared,the factors affected the diagnostic sensitivity wereanalyzed,and the complications induced by these methodswere observed. Results The diagnostic sensitivity ofthin-slice CT navigation combined with bronchoalveolarlavage for peripheral pulmonary lesions was 39. 1%,andthe positive diagnosis rate was 35. 1%.

Solitary pulmonary nodules： comparison of multi-slice computed tomography perfusion study with vascular endothelial growth factor and microvessel density

Background The solitary pulmonary nodule （SPN） is one of the most common findings on chest radiographs. The objectives of clinical practice are to differentiate malignant nodules from benign nodules in the least invasive way and to make a specific diagnosis. This study was aimed to evaluate the correlation between perfusion imaging features and microvessel density （MVD） and vascular endothelial growth factors （VEGF） in SPNs using multi-slice computed tomography （MSCT）; and to provide the theoretical basis for SPN blood flow pattern and blood flow quantitative features. Also, the study called for the discussion of the method＇s clinical application value in the differential diagnosis of benign and malignant SPNs.Methods Sixty-eight patients with SPN underwent multi-location dynamic contrast enhanced （nonionic contrast material was administrated via the antecubital vein at a rate of 4 ml/s） MSCT. Precontrast and postcontrast attenuations on every scan was studied. Perfusion, peak height, and the ratio of the peak height of the SPN to that of the aorta were analyzed. Perfusion was calculated using the maximum gradient of the time-density curves （TDC） and the peak height of the aorta. The quantitative parameters （perfusion, peak height, ratio of peak height of the SPN to that of the aorta） of the blood flow pattern were compared with MVD and the VEGF expression of immunohistochemistry. Results The perfusion peak heights of malignant （（96.15±11.55） HU） and inflammatory （（101.15±8.41） HU） SPNs were significantly higher than those of benign （（47.24±9.15） HU） SPNs （P 〈0.05, P 〈0.05）. Ratios of SPN-to-aorta of malignant and inflammatory SPNs were significantly higher than those of benign SPNs （P 〈0.05, P 〈0.05）. No significant differences were found between the peak height and SPN-to-aorta ratio of malignant SPNs and inflammatory SPNs （P 〉0.05, P 〉0.05）. The precontrast densities of inflammatory SPNs were lower than those of malignant SPNs （P 〈0.05）. Perfusion values of malignant and inflammatory SPNs were significantly higher than those of the benign SPNs （P 〈0.05, P 〈0.05）. The VEGF positive expressions appeared in 32 patients with malignant SPNs and 2 patients with benign SPNs, and the average value of the MVD was higher in patients with malignant SPNs （36.88±6.76） than in patients with either benign （4.51±0.60） or inflammatory （26.11±5.43） SPNs （P 〈0.05, P 〈0.05）. There were statistically significant correlations between the CT perfusion feature and the MVD. The highest correlation was between the peak height of SPN and the MVD （r=0.657, P 〈0.05）.Conclusions Tumor microvessel density and VEGF expression facilitate the exploration of the pathophysiological basis of CT perfusion in SPNs. Multi-slice CT perfusion has shown strong positive correlations with angiogenesis in SPNs.

Contrast enhanced MR angiography in pulmonary sequestration

Objective To evaluate the feasibility of contrast enhanced three-dimensional(3D)magnetic resonance angiography(MRA)in identifying the systemic blood supply in pulmonary sequestration.Methods Three patients who were suspected of pulmonary sequestration were examined by contrast enhanced 3D MRA.MR images were compared with surgical findings.Results Contrast enhanced 3D MRA clearly demonstrated systemic arteries from the descending thoracic aorta supplying the basilar segments of the lower lobe in each case.Pulmonary veins from these segments,which drained into the left atrium in two cases,were also detected.MRA images were consistent with those observed in surgery.Conclusion Contrast enhanced 3D MRA allows accurate diagnosis of pulmonary sequestration and may obviate the need for more invasive investigations.

经支气管镜腔内诊断肺外周结节技术及进展

肺周围型病变,包括肺外周结节,是常见的肺部问题。随着肺结节患者的增加,对组织取样的需求也随之增加。安全而精准的活检技术用于鉴别病变良、恶性对患者非常有益。电子支气管镜技术是近几十年来诊断肺周围型病变的活检技术之一,各种引导技术,例如径向超声支气管镜和虚拟支气管镜导航已被证实能改善常规支气管镜的性能。本文对有关先进支气管镜技术的现有研究进行综述,并探讨先进支气管镜技术在肺外周结节诊断中的应用价值。

同轴活检技术应用于CT引导经皮肺活检对不明原因肺部病变的临床意义

目的探讨同轴活检技术应用于CT引导经皮肺活检对不明原因肺部病变的临床意义。方法选取2015年5月至2019年5月清远市人民医院收治的306例不明原因肺部阴影患者作为研究对象,按照不同活检方式分为实验组(n=154)与对照组(n=152)。实验组采用同轴活检技术,对照组采用单纯针刺活检技术。比较两组手术成功率、并发症发生率、成功手术时间和成功手术接受辐射剂量。结果实验组小结节病灶手术成功率为98.3%,高于对照组的84.5%,差异有统计学意义(P<0.05);实验组深部病灶手术成功率为98.9%,高于对照组的90.7%,差异有统计学意义(P<0.05);实验组气胸、咯血发生率均低于对照组,差异有统计学意义(P<0.05);实验组成功手术时间短于对照组,成功手术接受辐射剂量少于对照组,差异有统计学意义(P<0.05)。结论同轴活检技术应用于CT引导经皮肺活检中对疑难穿刺病灶(小病灶和深部病灶)的手术成功率高于单纯针刺活检技术,可降低气胸和咯血发生率,减少患者接受的辐射剂量,缩短手术时间,且该项技术操作简单,成本低廉,只需在传统的单纯针刺活检技术的基础上附加同轴技术即可,值得临床推广应用。

基于人工智能技术的肺部CT扫描对肺纯磨玻璃结节浸润性病变及浸润程度的诊断价值

目的探讨基于人工智能技术的肺部CT扫描诊断肺纯磨玻璃结节浸润性病变及浸润程度的临床价值。方法回顾性分析2021年9月至2022年9月于天门市第一人民医院行手术治疗并经病理活检证实为肺纯磨玻璃结节的55例患者的临床资料,参考2021年世界卫生组织肺肿瘤新分类,根据病理结果分为非浸润性病变组(n=25,25个结节)与浸润性病变组(n=30,35个结节)。所有患者术前均行肺部CT检查,并利用人工智能系统对肺结节进行定性、定量参数分析。比较非浸润性病变组与浸润性病变组结节CT定性、定量参数;比较微浸润性腺癌、浸润性腺癌患者结节CT定性、定量参数;分析CT定性、定量参数对肺纯磨玻璃结节浸润程度预测的影响因素,并分析其预测效能。结果两组结节形态、分叶征、空泡征、支气管异常征、血管异常征、胸闷牵拉征占比及结节最长径、最短径、平扫CT值比较差异有统计学意义(P<0.05)。浸润性腺癌患者的结节形态规则占比低于微浸润性腺癌患者,分叶征、血管异常征、胸闷牵拉征占比均高于微浸润性腺癌患者,平扫CT值大于微浸润性腺癌患者,差异有统计学意义(P<0.05)。Logistic二元回归分析结果显示,分叶征、空泡征、血管异常征、平扫CT值增加是肺纯磨玻璃结节浸润性病变的危险因素(P<0.05);而分叶征、血管异常征、平扫CT值增加是肺纯磨玻璃结节浸润程度的危险因素(P<0.05)。ROC曲线分析结果显示,血管异常征诊断肺纯磨玻璃结节浸润性病变的效能最高(AUC为0.703,灵敏度92.00%,特异度48.60%),分叶征鉴别诊断肺纯磨玻璃结节浸润程度的效能最高(AUC为0.745,灵敏度75.00%,特异度73.90%)。结论基于人工智能技术的肺部CT扫描诊断肺纯磨玻璃结节浸润性及浸润程度有较高的临床价值,且人工智能技术CT扫描获得的内部血管征参数对诊断结节浸润性病变效能高,分叶征对鉴别诊断结节浸润程度效能更高,值得进一步深入研究。

基于胸部薄层CT扫描的肺磨玻璃影病变“四分型法”在临床中的应用研究

目的探讨基于胸部薄层CT扫描(TSCT)的肺磨玻璃影(GGO)病变“四分型法”在临床中的应用价值。方法回顾性分析2020年1月至2022年12月于首都医科大学宣武医院接受胸腔镜手术治疗的1541例患者的临床资料,共包含肺GGO病变2005例次。采用“四分型法”对肺GGO病变进行分型:Ⅰ型,无空泡征和(或)细支气管征的纯GGO(p-GGO);Ⅱ型,有空泡征和(或)细支气管征的p-GGO;Ⅲ型,仅在肺窗可见实性成分的异质性磨玻璃影(h-GGO);Ⅳ型,在肺窗和纵隔窗均可见实性成分的部分实性磨玻璃影(ps-GGO)。分析肺GGO病变影像学特征[最大径、病变类型、发生部位、分型、肿瘤实性成分占比(CTR)等]与术后病理检查结果的关联性。结果1541例患者自发现肺GGO至接受手术治疗的时间为0.10~156.00个月,平均11.23个月,其间肺GGO病变变化不明显1255例次(62.59%),最大径增大536例次(26.73%),密度增高45例次(2.24%),最大径增大伴密度增高169例次(8.43%)。术前肺GGO最大径为(13.21±7.90)mm;主要为单发病变[1098例次(54.76%)];多分布于右肺上叶[757例次(37.76%)]。肺GGO类型:Ⅰ型248例次(12.37%),Ⅱ型682例次(34.01%),Ⅲ型862例次(42.99%),Ⅳ型213例次(10.62%)。CTR≤25%有950例次(47.38%),25%<CTR≤50%有616例次(30.72%)、50%<CTR≤75%有314例次(15.66%),CTR>75%有125例次(6.23%)。肺GGO病变中,良性病变186例次(9.28%),恶性病变1819例次(90.72%),其中包括腺体前驱病变744例次,浸润期病变1075例次。分析结果显示,肺GGO病变术后病理检查结果与GGO最大径、病变类型、发生部位、分型、CTR及随访变化情况均存在关联性(P<0.05)。对应分析结果显示,与肺GGO病变CTR相比,肺GGO病变分型散点与术后病理恶性变[不典型腺瘤样增生(AAH)、原位腺癌(AIS)、微浸润腺癌(MIA)、浸润期腺癌(IA)]散点在二维分布图中更为接近,提示基于“四分型法”的肺GGO影像学特征与术后病理恶性变有更好的对应关系。结论基于TSCT的肺GGO病变“四分型法”有助于临床医师更好地评估以GGO为主要影像学表现的早期肺癌的风险度。