呼吸肺肿瘤的影像诊断课件

1、Thanks for your attendance欢迎光临指导,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 Imaging Diagnosis of Lung Tumor,In todays lesson, we are going to study,Classifications of lung tumor 肺肿瘤的分类 Imaging appearance of central lung cancer 中心型肺癌的影像表现 Imaging appearance of peripheral lung cancer周围型肺癌的影像表现 Special appea

2、rances of lung cancer 肺癌的特殊表现 Imaging of metastatic lung cancer 肺转移瘤的影像表现,Classification肺肿瘤的分类,According to its origin, lung tumor can be classified as 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% are Primary lung cancer 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)Secon

3、dary : Metastatic lung cancer or lung metastasis 继发性: 转移性肺癌(肺转移癌),Primary lung cancer 肺癌,primary bronchogenic carcinoma 原发性支气管肺癌 Originated from the mucosa of the bronchi（bronchus) 起源于支气管粘膜上皮和腺体,Question: where does the blood supply of lung cancer come from? 肺癌的血液供应来自哪里？,Question: where does the blo

4、od supply of lung cancer come from? 肺癌的血液供应来自哪里？,A review: Blood circulations of lung: 1. Functional: pulmonary artery capillary pulmonary vein 2.Nutritional: bronchial artery,I see: the blood supply to Lung cancer comes from bronchial artery! A anatomical basis of interventional therapy.肺癌血供来自支气管动脉

5、是介入治疗的基础。,Pathological classifications of lung cancer肺癌病理类型:,(一)Cellular 细胞类型 1. Squamous cell carcinoma 鳞癌 2. Adenocarcinoma 腺癌 3. undifferentiated 未分化癌 (1) Small cell carcinoma 小细胞癌 (2) large cell carcinoma 大细胞癌 (large cell carcinoma belongs to Squamous cell carcinoma under electronic-microscope)

6、4. Bronchioloalveolar Carcinoma 细支气管肺泡癌 (二) Gross 大体病理类型,eview: Trachea 气管 Main bronchus 主支气管 Lobe bronchus 叶支气管 Segmental bronchus 段支 Subsegmental Sub-sub-sub- 亚段与亚亚段 Bronchiole 细支气管 Alveolus 肺泡,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） Bronchioloalveolar Carcinom

7、a 细支气管肺泡癌 BAC,二.pathological classification (gross) 大体病理类型: 按其发生部位分为：,More smoking,More lung cancer.Smoking is proven to be a risk factor of lung cancer. No-smoking, please.,二.Imaging appearances of Central Lung Cancer 中央型肺癌的影像表现,Direct signs: tumor mass, Bronchial obstruction 直接征象：肺门肿块,支气管阻塞 2. Ind

8、irect signs: signs of obstructive complications 间接征象： 即支气管阻塞所致肺部征象 A. Obstructive emphysema 阻塞性肺气肿 B . Obstructive pneumonia 阻塞性肺炎 C. Obstructive atelectasis 阻塞性肺不张,左主支气管内肺癌并左肺阻塞性肺气肿central lung cancer of left main bronchus with obstructive emphysema,右上叶中央型肺癌,右上叶中央型肺癌,左中央型肺癌、左下肺不张,倒“S”征:inverted S s

9、ign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.,三. Imaging appearance of peripheral lung cancer 周围型肺癌的影像表现,(一)General ideas: 1.No obstructive complications as in central cancers. only signs of the tumor mass Usually presents as Solitary Pulmonary Nodule, SPN 孤立性肺结节 2. Other diseases can show the same picture.

10、including:benign tumor, 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.A SPN in patient of 40yrs or above is most probably to be a lung cancer.,Solitary Pulmonary Nodule, SPN 孤立性肺结节,Tips of Terminology： Size of lesion: nodule 结节 小于3cm mass 肿块 3cm以上,Solitary Pulmonary Nodule, SPN 孤立性肺结节ima

11、ging specialties of lung tumor肺癌结节的影像特点,The followings are suggestive rather than diagnostic 1.well-defined边缘清 2. Lobular分叶征 3. Spicular毛刺征 4.thick-wall cavity. 厚壁空洞,Smoking is harmful to your health!,1.well-defined边缘清 2. Lobular分叶征 3. Spicular毛刺征 4.thick-wall cavity. 厚壁空洞,1.well-defined边缘清2. Lobula

12、r分叶征 3. Spicular毛刺征4.thick-wall cavity. 厚壁空洞,1.well-defined边缘清 2. Lobular分叶征 3. Spicular毛刺征 4.thick-wall cavity. 厚壁空洞,1.well-defined边缘清 2. Lobular分叶征 3. Spicular毛刺征 4.thick-wall cavity. 厚壁空洞,1.well-defined边缘清 2. Lobular分叶征 3. Spicular毛刺征 4.thick-wall cavity. 厚壁空洞,内见液平，合并感染,1.well-defined边缘清 2. Lobul

13、ar分叶征 3. Spicular毛刺征 4.thick-wall cavity. 厚壁空洞,1.well-defined边缘清 2. Lobular分叶征 3. Spicular毛刺征 4.thick-wall cavity. 厚壁空洞,右肺外围型小肺癌（腺癌）,左肺外围型（纵隔型）肺癌（腺癌）,左肺外围型（纵隔型）肺癌（腺癌）,左肺外围型（纵隔型）肺癌（腺癌）,左肺外围型（纵隔型）肺癌（腺癌）,1.well-defined边缘清 2. Lobular分叶征 3. Spicular毛刺征,Review: 1.Peripheral lung cancer Usually presents as

14、 Solitary Pulmonary Nodule, SPN 孤立性肺结节 2. Other diseases can show the same picture. including:benign tumor, 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.A SPN in patient of 40yrs or above is most probably to be a lung cancer.,东风吹，战鼓擂中国足球还怕谁？,四.Special appearances of lung cancer,(一) Panc

15、oasts tumor 肺尖癌 or Superior sulcus tumor 肺上沟瘤 peripheral lung cancer Originated in the apex of lung (二) Bronchioloalveolar carcinoma BAC 细支气管肺泡癌:,(一)Pancoasts tumor 肺尖癌,1.Clinical specialties 临床特点: (1).Invasion of brachial plexus causes shoulder and scapular pain 压迫臂丛引起臂肩痛, (2)Invasion of the stella

16、te ganglion: Horners 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,(一)Pancoasts tumor 肺尖癌,2.Imaging appearances 影像表现: (1) apical mass or opacity 肺尖部肿块或致密 (2) bone destruction of the ribs, preferably 2-4 ribs 伴肋骨破坏 2-4肋常见,四. Special types of lung cancer,(一) Pancoasts tumor 肺尖癌 or Superior sulcus tumor 肺上沟瘤 per

17、ipheral lung cancer Originated in the apex of lung (二) Bronchioloalveolar carcinoma BAC 细支气管肺泡癌:,(二) Bronchioloalveolar carcinoma BAC 细支气管肺泡癌:,1.Origin: from the terminal bronchiole or the alveolus. 起源：细支气管或肺泡2. Imaging appearances: diffuse nodules or masses on both lungs 表现:两肺广泛弥漫结节或肿块样病灶 The lesio

18、ns are different in size,with the biggest as the primary lesion. But in many cases it is impossible to tell the primary lesion.,细支气管肺泡癌:两肺广泛弥漫结节或肿块样病灶BAC:diffuse nodules or masses on both lung,细支气管肺泡癌:两肺广泛弥漫结节或肿块样病灶BAC:diffuse nodules or masses on both lung,细支气管肺泡癌:两肺广泛弥漫结节或肿块样病灶BAC:diffuse nodules

19、or masses on both lung,继发性肺肿瘤 即肺转移瘤Metastatic lung cancer,Origin: from all other organs, Lung: A mirror to see into the body 可来自身体任何部位 二. Imaging：diffuse nodules or masses on both lungs 两肺广泛弥漫结节或肿块样病灶 三. Differential diagnosis 鉴别诊断 Difficulty to differentiate from bronchioloalveolar carcinoma especi

20、ally in cases of no original cancers. 无肺外原发灶时, 肺转移瘤与细支气管肺泡癌难于区别,细支气管肺泡癌:两肺广泛弥漫结节或肿块样病灶BAC:diffuse nodules or masses on both lungs,肺转移癌（淋巴道）,螺旋CT诊断学 主 编 吴沛宏 副主编 江勋源等,Review I,Classifications of lung tumor肺肿瘤的分类 Imaging appearance of central lung cancer 中心型肺癌的影像表现 Imaging appearance of peripheral lung

21、 cancer周围型肺癌的影像表现 Special appearances of lung cancer 肺癌的特殊表现 Imaging of metastatic lung cancer 肺转移瘤的影像表现,一 Classification肺肿瘤的分类,According to its origin, lung tumor can be classified as 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% are Primary lung cancer 恶性中98%是原发性支气管肺癌,

22、简称肺癌 B. Sarcoma 2% 少数肺肉瘤 (二)Secondary : Metastatic lung cancer or lung metastasis 继发性: 转移性肺癌(肺转移癌),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） Bronchioloalveolar Carcinoma 细支气管肺泡癌 BAC,二.pathological classification (gross) 大体病理类型: 按其发生部位分为：,二.Imaging appearances of Ce

23、ntral Lung Cancer 中央型肺癌的影像表现,Direct signs: tumor mass, Bronchial obstruction 直接征象：肺门肿块,支气管阻塞 2. Indirect signs: signs of obstructive complications 间接征象： 即支气管阻塞所致肺部征象 A. Obstructive emphysema 阻塞性肺气肿 B . Obstructive pneumonia 阻塞性肺炎 C. Obstructive atelectasis 阻塞性肺不张,Review II,Primary lung cancer 1. 中央型： 2.周围型：肺内肿块影为主. 分叶,毛刺,空洞 Peripheral: Well-defined mass with lobular,spicular edge and cavity 3.两种特殊类型,Primary lung cance