肺癌與肺結(jié)核

的影像學(xué)診斷肺癌與肺結(jié)核

的影像學(xué)診斷1肺癌分類Lungcancer,bronchogeniccarcinoma病理分型：鱗、小、腺、大臨床分型：中央型、周圍型、縱隔型肺癌分類Lungcancer,bronchogenic2SquamouscellCa30-40%，generallycentral(70%hilarorperihilarinsubsegmentalorlargerbronchi)strongassociationwithcigarettesmokingabout15%bronchogeniccarcinomasarecavitary,andofthese,nearly60%aresquamouscelllesions,walltypicallythickandnodularSquamouscellCa30-40%，general3intralumenalgrowthpattern-oftenresultingindistalatelectasisorpost-obstructivepneumonitis(anon-infectiousprocess).thelowestfrequencyofdistantmetastases,spreadstoinvolvelocalnodesbydirectextensionthemostfavorableprognosisHypertrophicosteoarthropathy

intralumenalgrowthpattern-o4adenocarcinomaascommonassquamouscellcarcinoma(30-40%).generallyperipheral(75%)uncommonlycavitatecommonlymetastasizesearlytolymphnodes,thepleura,adrenalglands,CNS,andbone.adenocarcinomaascommonassqu5SmallcellCa15-20%ofprimarylungmalignanciesthestrongestassociationwithcigarettesmokingthemostlikelytoproduceectopichormones-mostcommonlyresultinginCushingssyndrome(ACTH)orsyndromeofinappropriateantidiuretichormone(SIADH)SmallcellCa15-20%ofprimary6generallycentral(85-90%withinalobarormainstembronchi)andhasatendencytoinvadelongitudinallyalongthebronchialwall,inasubmucosalandintramuralfashionInternalnecrosisiscommon,butcavitationisextremelyraretheworstprognosis,despitetypicallygoodresponsetoinitialchemotherapygenerallycentral(85-90%with7LargeCellCa

only5-10%stronglyassociatedwithcigarettesmokingtypicallyperipheralandgenerallylarge(over4to6cm),withrapidgrowth,earlymetastases,andapoorprognosisLargeCellCa

only5-10%8Pancoasttumorapicaldensity(superiorpulmonarysulcus)destructionoradjacentriborvertebraHorner'ssyndromepaininarmusuallybronchogenicCa(squamoustype)also:mets,malignantneurogenictumorPancoasttumorapicaldensity(9影像診斷目的：明確診斷，TNM分期手段：X線平片、CT、MRI、PET等影像診斷目的：明確診斷，TNM分期10T1:Atumorlessthanorequalto3cmingreatestdimension,surroundedbylungorvisceralpleura,withoutbronchoscopicevidenceofinvasionmoreproximalthanthelobarbronchus(i.e.,notinthemainbronchus).TUMORT1:Atumorlessthanorequal11肺癌與肺結(jié)核的影像學(xué)診斷課件12T2:Atumorwithanyofthefollowingfeatures:i)Largerthan3cminlargestdimensionT2:Atumorwithanyofthefo13ii)Associatedwithatelectasisorpost-obstructivepneumonitisthatextendstothehilarregion,butdoesnotinvolvetheentirelungii)Associatedwithatelectasi14iii)Invadesthevisceralpleuraiii)Invadesthevisceralpleu15T3:Atumorofanysizethatdirectlyinvadesanyofthefollowing:thechestwall(includingsuperiorsulcustumors),diaphragm,mediastinalpleura,parietalpericardium;ortumorinthemainbronchuslessthan2cmdistaltothecarina(butwithoutinvolvementofthecarina);ortumorassociatedwithatelectasisorobstructivepneumonitisoftheentirelung.T3:Atumorofanysizethatd16肺癌與肺結(jié)核的影像學(xué)診斷課件17T4:Atumorofanysizethatinvadesanyofthefollowing:mediastinum,heart,greatvessels,trachea,esophagus,vertebralbody,carina;oranytumorwithamalignantpleuralorpericardialeffusion;orwithsatellitetumornoduleswithintheipsilateralprimary-tumorlobeofthelung.T4:Atumorofanysizethati18肺癌與肺結(jié)核的影像學(xué)診斷課件19

20RegionalLymphNodeStatus(N)N1:Ipsilateralperibronchialorhilarnodalmetastases;orintrapulmonarynodesinvolvedbydirectextensionoftheprimarytumor.AllN1nodesliedistaltothemediastinalpleuralreflection.RegionalLymphNodeStatus(N)21N2:Ipsilateralmediastinalandsubcarinallymphnodalmetastases.Midlinepre-vascularandretrotrachealnodesareconsideredipsilateral[5],whilenodestothecontralateralsideofmidlineareconsideredN3N2:Ipsilateralmediastinalan22N3:Contralateralmediastinalorcontralateralhilarnodalmetastases;alsoincludesipsilateralorcontralateralscaleneorsupraclavicularnodes.OthercervicalnodesareclassifiedM1N3:Contralateralmediastinal23DistantMetastasis(M)M0:NodistantmetastasisM1:Distantmetastasispresent;orseparatetumornodulesintheipsilateralnonprimary-tumorlobesofthelung.SeparatetumornodulesinthecontralaterallungareconsideredM1iftheyareofthesamehistologiccelltypeastheprimarylesion.AcontralaterallungtumorwithadifferentcelltypeisconsideredasynchronousprimarylesionandshouldbestagedindependentlyDistantMetastasis(M)24肺癌與肺結(jié)核的影像學(xué)診斷課件25原發(fā)肺結(jié)核原發(fā)綜合征原發(fā)肺結(jié)核原發(fā)綜合征26支氣管淋巴結(jié)結(jié)核tuberculosisofbronchiallymphnodes原發(fā)肺結(jié)核支氣管淋巴結(jié)結(jié)核原發(fā)肺結(jié)核27肺浸潤及增殖infiltrationandproliferation浸潤肺結(jié)核肺浸潤及增殖浸潤肺結(jié)核282、TB浸潤、空洞及支氣管播散infiltrativepulmonarytuberculosiswithcavity

浸潤肺結(jié)核2、TB浸潤、空洞及支氣管播散浸潤肺結(jié)核29肺癌與肺結(jié)核的影像學(xué)診斷課件30肺癌與肺結(jié)核的影像學(xué)診斷課件31結(jié)核球tuberculoma浸潤肺結(jié)核結(jié)核球浸潤肺結(jié)核32斷層片tomography斷層片33急性粟粒性TBMiliaryTB血行播散型肺結(jié)核急性粟粒性TB血行播散型肺結(jié)核34急性粟粒性肺結(jié)核急性粟粒性肺結(jié)核35肺癌與肺結(jié)核

的影像學(xué)診斷肺癌與肺結(jié)核

的影像學(xué)診斷36肺癌分類Lungcancer,bronchogeniccarcinoma病理分型：鱗、小、腺、大臨床分型：中央型、周圍型、縱隔型肺癌分類Lungcancer,bronchogenic37SquamouscellCa30-40%，generallycentral(70%hilarorperihilarinsubsegmentalorlargerbronchi)strongassociationwithcigarettesmokingabout15%bronchogeniccarcinomasarecavitary,andofthese,nearly60%aresquamouscelllesions,walltypicallythickandnodularSquamouscellCa30-40%，general38intralumenalgrowthpattern-oftenresultingindistalatelectasisorpost-obstructivepneumonitis(anon-infectiousprocess).thelowestfrequencyofdistantmetastases,spreadstoinvolvelocalnodesbydirectextensionthemostfavorableprognosisHypertrophicosteoarthropathy

intralumenalgrowthpattern-o39adenocarcinomaascommonassquamouscellcarcinoma(30-40%).generallyperipheral(75%)uncommonlycavitatecommonlymetastasizesearlytolymphnodes,thepleura,adrenalglands,CNS,andbone.adenocarcinomaascommonassqu40SmallcellCa15-20%ofprimarylungmalignanciesthestrongestassociationwithcigarettesmokingthemostlikelytoproduceectopichormones-mostcommonlyresultinginCushingssyndrome(ACTH)orsyndromeofinappropriateantidiuretichormone(SIADH)SmallcellCa15-20%ofprimary41generallycentral(85-90%withinalobarormainstembronchi)andhasatendencytoinvadelongitudinallyalongthebronchialwall,inasubmucosalandintramuralfashionInternalnecrosisiscommon,butcavitationisextremelyraretheworstprognosis,despitetypicallygoodresponsetoinitialchemotherapygenerallycentral(85-90%with42LargeCellCa

only5-10%stronglyassociatedwithcigarettesmokingtypicallyperipheralandgenerallylarge(over4to6cm),withrapidgrowth,earlymetastases,andapoorprognosisLargeCellCa

only5-10%43Pancoasttumorapicaldensity(superiorpulmonarysulcus)destructionoradjacentriborvertebraHorner'ssyndromepaininarmusuallybronchogenicCa(squamoustype)also:mets,malignantneurogenictumorPancoasttumorapicaldensity(44影像診斷目的：明確診斷，TNM分期手段：X線平片、CT、MRI、PET等影像診斷目的：明確診斷，TNM分期45T1:Atumorlessthanorequalto3cmingreatestdimension,surroundedbylungorvisceralpleura,withoutbronchoscopicevidenceofinvasionmoreproximalthanthelobarbronchus(i.e.,notinthemainbronchus).TUMORT1:Atumorlessthanorequal46肺癌與肺結(jié)核的影像學(xué)診斷課件47T2:Atumorwithanyofthefollowingfeatures:i)Largerthan3cminlargestdimensionT2:Atumorwithanyofthefo48ii)Associatedwithatelectasisorpost-obstructivepneumonitisthatextendstothehilarregion,butdoesnotinvolvetheentirelungii)Associatedwithatelectasi49iii)Invadesthevisceralpleuraiii)Invadesthevisceralpleu50T3:Atumorofanysizethatdirectlyinvadesanyofthefollowing:thechestwall(includingsuperiorsulcustumors),diaphragm,mediastinalpleura,parietalpericardium;ortumorinthemainbronchuslessthan2cmdistaltothecarina(butwithoutinvolvementofthecarina);ortumorassociatedwithatelectasisorobstructivepneumonitisoftheentirelung.T3:Atumorofanysizethatd51肺癌與肺結(jié)核的影像學(xué)診斷課件52T4:Atumorofanysizethatinvadesanyofthefollowing:mediastinum,heart,greatvessels,trachea,esophagus,vertebralbody,carina;oranytumorwithamalignantpleuralorpericardialeffusion;orwithsatellitetumornoduleswithintheipsilateralprimary-tumorlobeofthelung.T4:Atumorofanysizethati53肺癌與肺結(jié)核的影像學(xué)診斷課件54

55RegionalLymphNodeStatus(N)N1:Ipsilateralperibronchialorhilarnodalmetastases;orintrapulmonarynodesinvolvedbydirectextensionoftheprimarytumor.AllN1nodesliedistaltothemediastinalpleuralreflection.RegionalLymphNodeStatus(N)56N2:Ipsilateralmediastinalandsubcarinallymphnodalmetastases.Midlinepre-vascularandretrotrachealnodesareconsideredipsilateral[5],whilenodestothecontralateralsideofmidlineareconsideredN3N2:Ipsilateralmediastinalan57N3:Contralateralmediastinalorcontralateralhila