孤立性肺结节petct良恶性鉴别诊断课件

孤立性肺结节CT、PET-CT良恶性鉴别诊断Solitarypulmonarynodule:benignPET-CTversusmalignantDifferentiationwithCT原文地址:radiologyassistantnl/en/460f9fcd50637孤立性肺结节的鉴别诊断,在临床中经常遇到。根据结节的良恶性差异,处理方法有很大差别。在这篇文章中,我们主要探讨CT和PET-CT的相关征象在孤立性肺结节良恶性鉴别诊断中的意义。ThedifferentialdiaghaethlitthepsionabenignleisarianaandusssomeofthenewfeaturesthnhelptoferentiatebetweenandmalignantnodulesbaseduponCTan目录(contents)CT征象CT:benignversusmalignantCalcification生长速度SizeGrowth6.充气支气管征Margin实性和磨玻璃成分6.AirBronchogramsignSolidandGround-glass强化特征components8,ContrastenhancementPET-CT征象PET-CT:benign结论versusmalignantConclusio钙化DiffuseCentralLaminatedPopcorn良性钙化征象:弥漫性爆米花样■弥漫性、中心性、层状及爆米花样钙化多见于良性结节主要见于肉芽肿性疾病和错构瘤其他类型钙化多见于恶性结节,不应该认为属于良性表现。■在已知有原发肿瘤存在的情况下,其钙化类型不一定适用此结论。例如:骨肉瘤或软骨肉瘤的病人,其钙化多表现为弥漫性;同样的,中心性和爆米花样钙化也可见于胃肠道肿瘤或接受过化疗的病人CalcificationDiffuse,central,laminatedorpopcorncalcificationsarebenignpatternsofcalcificationThesetypesofcalcificationareseeningranulomatousdiseaseandhamartomasAllotherpatternsofcalcificationshouldnotberegardedasasignofbenignityTheexceptiontotheruleaboveiswhenpatientsareknowntohaveaprimarytumor.ForinstancethediffusecalcificationpatterncanJeseeninpatientswithosteosarcomaorchondrosarcomaSimilarlythecentralandpopcornpatterncanbeseeninpatientswithGI-tumorsandpatientswhopreviouslyhadchemotherapy结节大小odulesizeTotalMalignancy4mm20380%26815%≥20mm结节大小与恶性可能性之间的关系孤立性肺结节(SPN)定义:肺实质内小于等于3cm的病灶(需除外肺不张和肿大的淋E大于3cm的病灶称为肿块(mass之所以这样定义,是因为大于3cm的病灶多为恶性,而更小的病灶可能是良心或恶性Swensen.etal研究了SPN大小与恶性可能性之间的关系(上图)结论是小的结节,良性可能性大。超过2000例小于4mm的结节,无例属于恶性SizeAsolitarypulmonarynodule(SPn)isdefinedasasingletraparenchymallesionlessthan3cminsizeandnotssociatedwithatelectaorlymphadenAlesiongreaterthan3cmindiameteriscalledamassThisdistinctionismade,becauselesionsgreaterthan3cmllymalignantwhilesmallerlesionscanbeeitherbenignormalignantSwensenetalstudiedtherelationshipbetweenthesizeofaSPNandthechanceofmalignancyinacohortathighriskncer(1Theirfindingsarelistedinthetableontheleft.thatbenignnoduledetectionrateishighespeciallyiflesionsaresmall.oftheover2000nodulesthatwerelessthan4mminonewasmalignant生长速度与以前的CT片进行比较,在结节定性方面具有重要意义。超过2年无变化的结节多为良性。GrowthComparisonwithpriorimagingstudiesisoftenthemostusefulproceduretodeterminetheimportanceofthefindingofaSPN,sincestabilityover2yearsishighlyassociatedwithbenignity形状