肺癌与肺结核与影学诊断PPT课件.ppt

肺癌与肺结核的影像学诊断,.,肺癌分类,Lungcancer,bronchogeniccarcinoma病理分型：鳞、小、腺、大临床分型：中央型、周围型、纵隔型,.,SquamouscellCa,30-40%，generallycentral(70%hilarorperihilarinsubsegmentalorlargerbronchi)strongassociationwithcigarettesmokingabout15%bronchogeniccarcinomasarecavitary,andofthese,nearly60%aresquamouscelllesions,walltypicallythickandnodular,.,intralumenalgrowthpattern-oftenresultingindistalatelectasisorpost-obstructivepneumonitis(anon-infectiousprocess).thelowestfrequencyofdistantmetastases,spreadstoinvolvelocalnodesbydirectextensionthemostfavorableprognosisHypertrophicosteoarthropathy,.,adenocarcinoma,ascommonassquamouscellcarcinoma(30-40%).generallyperipheral(75%)uncommonlycavitatecommonlymetastasizesearlytolymphnodes,thepleura,adrenalglands,CNS,andbone.,.,SmallcellCa,15-20%ofprimarylungmalignanciesthestrongestassociationwithcigarettesmokingthemostlikelytoproduceectopichormones-mostcommonlyresultinginCushingssyndrome(ACTH)orsyndromeofinappropriateantidiuretichormone(SIADH),.,generallycentral(85-90%withinalobarormainstembronchi)andhasatendencytoinvadelongitudinallyalongthebronchialwall,inasubmucosalandintramuralfashionInternalnecrosisiscommon,butcavitationisextremelyraretheworstprognosis,despitetypicallygoodresponsetoinitialchemotherapy,.,LargeCellCa,only5-10%stronglyassociatedwithcigarettesmokingtypicallyperipheralandgenerallylarge(over4to6cm),withrapidgrowth,earlymetastases,andapoorprognosis,.,Pancoasttumor,apicaldensity(superiorpulmonarysulcus)destructionoradjacentriborvertebraHornerssyndromepaininarmusuallybronchogenicCa(squamoustype)also:mets,malignantneurogenictumor,.,影像诊断,目的：明确诊断，TNM分期手段：X线平片、CT、MRI、PET等,.,T1:Atumorlessthanorequalto3cmingreatestdimension,surroundedbylungorvisceralpleura,withoutbronchoscopicevidenceofinvasionmoreproximalthanthelobarbronchus(i.e.,notinthemainbronchus).,TUMOR,.,.,T2:Atumorwithanyofthefollowingfeatures:i)Largerthan3cminlargestdimension,.,ii)Associatedwithatelectasisorpost-obstructivepneumonitisthatextendstothehilarregion,butdoesnotinvolvetheentirelung,.,iii)Invadesthevisceralpleura,.,T3:Atumorofanysizethatdirectlyinvadesanyofthefollowing:thechestwall(includingsuperiorsulcustumors),diaphragm,mediastinalpleura,parietalpericardium;ortumorinthemainbronchuslessthan2cmdistaltothecarina(butwithoutinvolvementofthecarina);ortumorassociatedwithatelectasisorobstructivepneumonitisoftheentirelung.,.,.,T4:Atumorofanysizethatinvadesanyofthefollowing:mediastinum,heart,greatvessels,trachea,esophagus,vertebralbody,carina;oranytumorwithamalignantpleuralorpericardialeffusion;orwithsatellitetumornoduleswithintheipsilateralprimary-tumorlobeofthelung.,.,.,.,RegionalLymphNodeStatus(N),N1:Ipsilateralperibronchialorhilarnodalmetastases;orintrapulmonarynodesinvolvedbydirectextensionoftheprimarytumor.AllN1nodesliedistaltothemediastinalpleuralreflection.,.,N2:Ipsilateralmediastinalandsubcarinallymphnodalmetastases.Midlinepre-vascularandretrotrachealnodesareconsideredipsilateral5,whilenodestothecontralateralsideofmidlineareconsideredN3,.,N3:Contralateralmediastinalorcontralateralhilarnodalmetastases;alsoincludesipsilateralorcontralateralscaleneorsupraclavicularnodes.OthercervicalnodesareclassifiedM1,.,DistantMetastasis(M)M0:NodistantmetastasisM1:Distantmetastasispresent;orseparatetumornodulesintheipsilateralnonprimary-tumorlobesofthelung.SeparatetumornodulesinthecontralaterallungareconsideredM1iftheyareofthesamehistologiccelltypeastheprimarylesion.Acontralaterallungtumorwithadifferentcelltypeisconsideredasynchronousprimarylesionandshouldbestagedindependently,.,.,原发肺结核,原发综合征,.,支气管淋巴结结核tuberculosisofbronchiallymphnodes,原发肺结核,.,肺浸润及