呼吸肺肿瘤的影像诊断课件.ppt

Thanksforyourattendance欢迎光临指导 1 医药交流课件 影像学教研室江勋源 临床医技课 之呼吸系统的放射诊断肺肿瘤的影像诊断ImagingDiagnosisofLungTumor 2 Intoday slesson wearegoingtostudy Classificationsoflungtumor肺肿瘤的分类Imagingappearanceofcentrallungcancer中心型肺癌的影像表现Imagingappearanceofperipherallungcancer周围型肺癌的影像表现Specialappearancesoflungcancer肺癌的特殊表现Imagingofmetastaticlungcancer肺转移瘤的影像表现 3 Classification肺肿瘤的分类 Accordingtoitsorigin lungtumorcanbeclassifiedas根据肺肿瘤的起源分为 一 Primary原发性1 Benign rare良性少见2 Malignant 恶性A 98 arePrimarylungcancer恶性中 98 是原发性支气管肺癌 简称肺癌B Sarcoma 2 少数肺肉瘤 二 Secondary Metastaticlungcancerorlungmetastasis继发性 转移性肺癌 肺转移癌 4 Primarylungcancer肺癌 primarybronchogeniccarcinoma原发性支气管肺癌Originatedfromthemucosaofthebronchi bronchus 起源于支气管粘膜上皮和腺体 Question wheredoesthebloodsupplyoflungcancercomefrom 肺癌的血液供应来自哪里 5 Question wheredoesthebloodsupplyoflungcancercomefrom 肺癌的血液供应来自哪里 Areview Bloodcirculationsoflung 1 Functional pulmonaryarterycapillarypulmonaryvein2 Nutritional bronchialartery 6 Isee thebloodsupplytoLungcancercomesfrombronchialartery Aanatomicalbasisofinterventionaltherapy 肺癌血供来自支气管动脉是介入治疗的基础 7 Pathologicalclassificationsoflungcancer肺癌病理类型 一 Cellular细胞类型1 Squamouscellcarcinoma鳞癌2 Adenocarcinoma腺癌3 undifferentiated未分化癌 1 Smallcellcarcinoma小细胞癌 2 largecellcarcinoma大细胞癌 largecellcarcinomabelongstoSquamouscellcarcinomaunderelectronic microscope 4 BronchioloalveolarCarcinoma细支气管肺泡癌 二 Gross大体病理类型 8 eview Trachea气管Mainbronchus主支气管Lobebronchus叶支气管Segmentalbronchus段支SubsegmentalSub sub sub 亚段与亚亚段Bronchiole细支气管Alveolus肺泡 9 1 Central中心型 中央型 段支气管开口以上2 Peripheral外围型 周围型 肺段以下3 Diffuse 弥漫型 BronchioloalveolarCarcinoma细支气管肺泡癌BAC 二 pathologicalclassification gross 大体病理类型 按其发生部位分为 10 Moresmoking Morelungcancer Smokingisproventobeariskfactoroflungcancer No smoking please 11 二 ImagingappearancesofCentralLungCancer中央型肺癌的影像表现 Directsigns tumormass Bronchialobstruction直接征象 肺门肿块 支气管阻塞2 Indirectsigns signsofobstructivecomplications间接征象 即支气管阻塞所致肺部征象A Obstructiveemphysema阻塞性肺气肿B Obstructivepneumonia阻塞性肺炎C Obstructiveatelectasis阻塞性肺不张 12 左主支气管内肺癌并左肺阻塞性肺气肿centrallungcancerofleftmainbronchuswithobstructiveemphysema 13 14 15 16 右上叶中央型肺癌 17 医药交流课件 18 医药交流课件 19 医药交流课件 20 右上叶中央型肺癌 左中央型肺癌 左下肺不张 21 22 倒 S 征 inverted S sign右上中央型肺癌 肺门肿块与右上肺叶不张连在一起呈横行 S 状下缘 23 三 Imagingappearanceofperipherallungcancer周围型肺癌的影像表现 一 Generalideas 1 Noobstructivecomplicationsasincentralcancers onlysignsofthetumormassUsuallypresentsasSolitaryPulmonaryNodule SPN孤立性肺结节2 Otherdiseasescanshowthesamepicture including benigntumor tuberculoma inflammation其它肺部疾病也有类似表现 包括 肺良性肿瘤 结核球 炎症3 ASPNinpatientof40yrsoraboveismostprobablytobealungcancer 24 SolitaryPulmonaryNodule SPN孤立性肺结节 TipsofTerminology Sizeoflesion nodule结节小于3cmmass肿块3cm以上 25 SolitaryPulmonaryNodule SPN孤立性肺结节imagingspecialtiesoflungtumor肺癌结节的影像特点 Thefollowingsaresuggestiveratherthandiagnostic1 well defined边缘清2 Lobular分叶征3 Spicular毛刺征4 thick wallcavity 厚壁空洞 Smokingisharmfultoyourhealth 26 1 well defined边缘清2 Lobular分叶征3 Spicular毛刺征4 thick wallcavity 厚壁空洞 27 1 well defined边缘清2 Lobular分叶征3 Spicular毛刺征4 thick wallcavity 厚壁空洞 28 1 well defined边缘清2 Lobular分叶征3 Spicular毛刺征4 thick wallcavity 厚壁空洞 29 1 well defined边缘清2 Lobular分叶征3 Spicular毛刺征4 thick wallcavity 厚壁空洞 30 1 well defined边缘清2 Lobular分叶征3 Spicular毛刺征4 thick wallcavity 厚壁空洞 31 内见液平 合并感染 1 well defined边缘清2 Lobular分叶征3 Spicular毛刺征4 thick wallcavity 厚壁空洞 32 1 well defined边缘清2 Lobular分叶征3 Spicular毛刺征4 thick wallcavity 厚壁空洞 33 右肺外围型小肺癌 腺癌 34 医药交流课件 左肺外围型 纵隔型 肺癌 腺癌 35 医药交流课件 左肺外围型 纵隔型 肺癌 腺癌 36 医药交流课件 左肺外围型 纵隔型 肺癌 腺癌 37 医药交流课件 左肺外围型 纵隔型 肺癌 腺癌 38 医药交流课件 1 well defined边缘清2 Lobular分叶征3 Spicular毛刺征 39 Review 1 PeripherallungcancerUsuallypresentsasSolitaryPulmonaryNodule SPN孤立性肺结节2 Otherdiseasescanshowthesamepicture including benigntumor tuberculoma inflammation其它肺部疾病也有类似表现 包括 肺良性肿瘤 结核球 炎症3 ASPNinpatientof40yrsoraboveismostprobablytobealungcancer 40 东风吹 战鼓擂中国足球还怕谁 41 四 Specialappearancesoflungcancer 一 Pancoast stumor肺尖癌orSuperiorsulcustumor肺上沟瘤peripherallungcancerOriginatedintheapexoflung 二 BronchioloalveolarcarcinomaBAC细支气管肺泡癌 42 一 Pancoast stumor肺尖癌 1 Clinicalspecialties临床特点 1 Invasionofbrachialplexuscausesshoulderandscapularpain压迫臂丛引起臂肩痛 2 Invasionofthestellateganglion Horner s压迫交感神经引起Horner 综合征 同侧眼睑下垂 瞳孔缩小和眼球下陷 43 一 Pancoast stumor肺尖癌 2 Imagingappearances影像表现 1 apicalmassoropacity肺尖部肿块或致密 2 bonedestructionoftheribs preferably2 4ribs伴肋骨破坏2 4肋常见 44 45 46 四 Specialtypesoflungcancer 一 Pancoast stumor肺尖癌orSuperiorsulcustumor肺上沟瘤peripherallungcancerOriginatedintheapexoflung 二 BronchioloalveolarcarcinomaBAC细支气管肺泡癌 47 二 BronchioloalveolarcarcinomaBAC细支气管肺泡癌 1 Origin fromtheterminalbronchioleorthealveolus 起源 细支气管或肺泡2 Imagingappearances diffusenodulesormassesonbothlungs表现 两肺广泛弥漫结节或肿块样病灶Thelesionsaredifferentinsize withthebiggestastheprimarylesion Butinmanycasesitisimpossibletotelltheprimarylesion 48 细支气管肺泡癌 两肺广泛弥漫结节或肿块样病灶BAC diffusenodulesormassesonbothlung 49 细支气管肺泡癌 两肺广泛弥漫结节或肿块样病灶BAC diffusenodulesormassesonbothlung 50 细支气管肺泡癌 两肺广泛弥漫结节或肿块样病灶BAC diffusenodulesormassesonbothlung 51 继发性肺肿瘤即肺转移瘤Metastaticlungcancer Origin fromallotherorgans Lung Amirrortoseeintothebody可来自身体任何部位二 Imaging diffusenodulesormassesonbothlungs两肺广泛弥漫结节或肿块样病灶三 Differentialdiagnosis鉴别诊断Difficultytodifferentiatefrombronchioloalveolarcarcinomaespeciallyincasesofnooriginalcancers 无肺外原发灶时 肺转移瘤与细支气管肺泡癌难于区别 52 53 细支气管肺泡癌 两肺广泛弥漫结节或肿块样病灶BAC diffusenodulesormassesonbothlungs 54 55 56 57 58 肺转移癌 淋巴道 59 螺旋CT诊断学 主编吴沛宏副主编江勋源等 60 ReviewI Classificationsoflungtumor肺肿瘤的分类Imagingappearanceofcentrallungcancer中心型肺癌的影像表现Imagingappearanceofperipherallungcancer周围型肺癌的影像表现Specialappearancesoflungcancer肺癌的特殊表现Imagingofmetastaticlungcancer肺转移瘤的影像表现 61 一Classification肺肿瘤的分类 Accordingtoitsorigin lungtumorcanbeclassifiedas根据肺肿瘤的起源分为 一 Primary原发性1 Benign rare良性少见2 Malignant 恶性A 98 arePrimarylungcancer恶性中 98 是原发性支气管肺癌 简称肺癌B Sarcoma 2 少数肺肉瘤 二 Secondary Metastaticlungcancerorlungmetastasis继发性 转移性肺癌 肺转移癌 62 1 Central中心型 中央型 段支气管开口以上2 Peripheral外围型 周围型 肺段以下3 Diffuse 弥漫型 BronchioloalveolarCarcinoma细支气管肺泡癌BAC 二 pathologicalclassification gross 大体病理类型 按其发生部位分为 63 二 ImagingappearancesofCentralLungCancer中央型肺癌的影像表现 Directsigns tumormass Bronchialobstruction直接征象 肺门肿块 支气管阻塞2 Indirectsigns signsofobstructivecomplications间接征象 即支气管阻塞所致肺部征象A Obstructiveemphysema阻塞性肺气肿B Obstructivepneumonia阻塞性肺炎C Obstructiveatelectasis阻塞性肺不张 64 ReviewII Primarylungcancer1 中央型 2 周围型 肺内肿块影为主 分叶 毛刺 空洞Peripheral Well definedmasswithlobular spicularedgeandcavity3 两种特殊类型 65 Primarylungcancer 1 中央型2 周围型 3 特殊类型 肺尖癌与细支气管肺泡癌 specialtypesoflun