肺癌与肺结核的影像学诊断课件

肺癌与肺结核

的影像学诊断肺癌与肺结核

的影像学诊断1肺癌分类Lungcancer,bronchogeniccarcinoma病理分型：鳞、小、腺、大临床分型：中央型、周围型、纵隔型肺癌分类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影像诊断目的：明确诊断，TNM分期手段：X线平片、CT、MRI、PET等影像诊断目的：明确诊断，TNM分期10T1:Atumorlessthanorequalto3cmingreatestdimension,surroundedbylungorvisceralpleura,withoutbronchoscopicevidenceofinvasionmoreproximalthanthelobarbronchus(i.e.,notinthemainbronchus).TUMORT1:Atumorlessthanorequal11肺癌与肺结核的影像学诊断课件12T2:Atumorwithanyofthefollowingfeatures:i)Largerthan3cminlargestdimensionT2:Atumorwithanyofthefo13ii)Associatedwithatelectasisorpost-obstructivepneumonitisthatextendstothehilarregion,butdoesnotinvolvetheentirelungii)Associatedwithatelectasi14iii)Invadesthevisceralpleuraiii)Invadesthevisceralpleu15T3:Atumorofanysizethatdirectlyinvadesanyofthefollowing:thechestwall(includingsuperiorsulcustumors),diaphragm,mediastinalpleura,parietalpericardium;ortumorinthemainbronchuslessthan2cmdistaltothecarina(butwithoutinvolvementofthecarina);ortumorassociatedwithatelectasisorobstructivepneumonitisoftheentirelung.T3:Atumorofanysizethatd16肺癌与肺结核的影像学诊断课件17T4:Atumorofanysizethatinvadesanyofthefollowing:mediastinum,heart,greatvessels,trachea,esophagus,vertebralbody,carina;oranytumorwithamalignantpleuralorpericardialeffusion;orwithsatellitetumornoduleswithintheipsilateralprimary-tumorlobeofthelung.T4:Atumorofanysizethati18肺癌与肺结核的影像学诊断课件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肺癌与肺结核的影像学诊断课件25原发肺结核原发综合征原发肺结核原发综合征26支气管淋巴结结核tuberculosisofbronchiallymphnodes原发肺结核支气管淋巴结结核原发肺结核27肺浸润及增殖infiltrationandproliferation浸润肺结核肺浸润及增殖浸润肺结核282、TB浸润、空洞及支气管播散infiltrativepulmonarytuberculosiswithcavity

浸润肺结核2、TB浸润、空洞及支气管播散浸润肺结核29肺癌与肺结核的影像学诊断课件30肺癌与肺结核的影像学诊断课件31结核球tuberculoma浸润肺结核结核球浸润肺结核32断层片tomography断层片33急性粟粒性TBMiliaryTB血行播散型肺结核急性粟粒性TB血行播散型肺结核34急性粟粒性肺结核急性粟粒性肺结核35肺癌与肺结核

的影像学诊断肺癌与肺结核

的影像学诊断36肺癌分类Lungcancer,bronchogeniccarcinoma病理分型：鳞、小、腺、大临床分型：中央型、周围型、纵隔型肺癌分类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影像诊断目的：明确诊断，TNM分期手段：X线平片、CT、MRI、PET等影像诊断目的：明确诊断，TNM分期45T1:Atumorlessthanorequalto3cmingreatestdimension,surroundedbylungorvisceralpleura,withoutbronchoscopicevidenceofinvasionmoreproximalthanthelobarbronchus(i.e.,notinthemainbronchus).TUMORT1:Atumorlessthanorequal46肺癌与肺结核的影像学诊断课件47T2:Atumorwithanyofthefollowingfeatures:i)Largerthan3cminlargestdimensionT2:Atumorwithanyofthefo48ii)Associatedwithatelectasisorpost-obstructivepneumonitisthatextendstothehilarregion,butdoesnotinvolvetheentirelungii)Associatedwithatelectasi49iii)Invadesthevisceralpleuraiii)Invadesthevisceralpleu50T3:Atumorofanysizethatdirectlyinvadesanyofthefollowing:thechestwall(includingsuperiorsulcustumors),diaphragm,mediastinalpleura,parietalpericardium;ortumorinthemainbronchuslessthan2cmdistaltothecarina(butwithoutinvolvementofthecarina);ortumorassociatedwithatelectasisorobstructivepneumonitisoftheentirelung.T3:Atumorofanysizethatd51肺癌与肺结核的影像学诊断课件52T4:Atumorofanysizethatinvadesanyofthefollowing:mediastinum,heart,greatvessels,trachea,esophagus,vertebralbody,carina;oranytumorwithamalignantpleuralorpericardialeffusion;orwithsatellitetumornoduleswithintheipsilateralprimary-tumorlobeofthelung.T4:Atumorofanysizethati53肺癌与肺结核的影像学诊断课件54

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