肺癌與肺結(jié)核的影像學(xué)診斷

1、肺癌與肺結(jié)核的影像學(xué)診斷,肺癌分類(lèi),Lung cancer, bronchogenic carcinoma病理分型：鱗、小、腺、大臨床分型：中央型、周?chē)汀⒖v隔型,Squamous cell Ca,30-40%，generally central (70% hilar or perihilar in subsegmental or larger bronchi)strong association with cigarette

2、smokingabout 15% bronchogenic carcinomas are cavitary, and of these, nearly 60% are squamous cell lesions, wall typically thick and nodular,,intralumenal growth pattern- often resulting in distal atelectasis or post-obs

3、tructive pneumonitis (a non-infectious process). the lowest frequency of distant metastases, spreads to involve local nodes by direct extensionthe most favorable prognosis Hypertrophic osteoarthropathy,adenocarcinoma,

4、as common as squamous cell carcinoma (30-40%). generally peripheral (75%)uncommonly cavitate commonly metastasizes early to lymph nodes, the pleura, adrenal glands, CNS, and bone.,Small cell Ca,15-20% of primary lung

5、malignancies the strongest association with cigarette smokingthe most likely to produce ectopic hormones- most commonly resulting in Cushings syndrome (ACTH) or syndrome of inappropriate antidiuretic hormone (SIADH),ge

6、nerally central (85-90% within a lobar or mainstem bronchi) and has a tendency to invade longitudinally along the bronchial wall, in a submucosal and intramural fashion Internal necrosis is common, but cavitation is ext

7、remely rarethe worst prognosis, despite typically good response to initial chemotherapy,Large Cell Ca,only 5-10%strongly associated with cigarette smokingtypically peripheral and generally large (over 4 to 6 cm), with

8、 rapid growth, early metastases, and a poor prognosis,Pancoast tumor,apical density (superior pulmonary sulcus) destruction or adjacent rib or vertebra Horner's syndrome pain in arm usually bronchogenic Ca (squam

9、ous type) also: mets, malignant neurogenic tumor,影像診斷,目的：明確診斷，TNM分期手段：X線平片、CT、MRI、PET等,T1: A tumor less than or equal to 3 cm in greatest dimension, surrounded by lung or visceral pleura, without bronchoscopic evidence

10、 of invasion more proximal than the lobar bronchus (i.e., not in the main bronchus).,TUMOR,,,T2: A tumor with any of the following features:i) Larger than 3 cm in largest dimension,ii) Associated with atelectasis or pos

11、t-obstructive pneumonitis that extends to the hilar region, but does not involve the entire lung,iii) Invades the visceral pleura,T3: A tumor of any size that directly invades any of the following: the chest wall (includ

12、ing superior sulcus tumors), diaphragm, mediastinal pleura, parietal pericardium; or tumor in the main bronchus less than 2 cm distal to the carina (but without involvement of the carina); or tumor associated with atelec

13、tasis or obstructive pneumonitis of the entire lung.,T4: A tumor of any size that invades any of the following: mediastinum, heart, great vessels, trachea, esophagus, vertebral body, carina; or any tumor with a malignant

14、 pleural or pericardial effusion; or with satellite tumor nodules within the ipsilateral primary-tumor lobe of the lung.,Regional Lymph Node Status (N),N1: Ipsilateral peribronchial or hilar nodal metastases; or intrapul

15、monary nodes involved by direct extension of the primary tumor. All N1 nodes lie distal to the mediastinal pleural reflection.,N2: Ipsilateral mediastinal and subcarinal lymph nodal metastases. Midline pre-vascular and r

16、etrotracheal nodes are considered ipsilateral [5], while nodes to the contralateral side of midline are considered N3,N3: Contralateral mediastinal or contralateral hilar nodal metastases; also includes ipsilateral or co

17、ntralateral scalene or supraclavicular nodes. Other cervical nodes are classified M1,Distant Metastasis (M)M0: No distant metastasis M1: Distant metastasis present; or separate tumor nodules in the ipsilateral nonprima

18、ry-tumor lobes of the lung. Separate tumor nodules in the contralateral lung are considered M1 if they are of the same histologic cell type as the primary lesion. A contralateral lung tumor with a different cell type is

19、considered a synchronous primary lesion and should be staged independently,原發(fā)肺結(jié)核,原發(fā)綜合征,支氣管淋巴結(jié)結(jié)核 tuberculosis of bronchial lymph nodes,原發(fā)肺結(jié)核,肺浸潤(rùn)及增殖infiltration and proliferation,浸潤(rùn)肺結(jié)核,2、TB浸潤(rùn)、空洞及支氣管播散infiltrative pulmo