PET-CT在非完全实性肺结节中的应用价值

肺癌在中国恶性肿瘤的发病率位居第一,随着低剂量薄层CT在肺癌筛查中的广泛应用,临床发现更多表现为非完全实性结节的肺腺癌,目前众多研究使CT影像学特征和肺腺癌病理的关系得到更进一步的认知,虽然CT能对部分非完全实性结节做出定性和定位诊断,但仍有部分非完全实性结节诊断困难,PET-CT结合了病灶的代谢信息和精确的定位信息,从而提高对肺部结节诊断的敏感性、特异性、准确性,综合多个文献PET-CT在非完全实性结节中的诊断分期价值较CT无明显提升,却在评估预后和制定合适手术方案上可以起到一定的作用,本文就PET-CT在SSN中的应用价值进行阐述。     

Spontaneous interferon production by pulmonary leukocytes is associated with lentivirus-induced lymphoid interstitial pneumonia

Ovine lentiviruses share genome sequence, structural features, and replicative mechanisms with HIV, the etiologic agent of AIDS. A lamb model of lentivirus-induced lymphoid interstitial pneumonia, comparable to lymphoid interstitial pneumonia associated with pediatric AIDS, was used to investigate production of leukocyte-soluble mediators. Lentivirus-infected lambs and adult sheep with severe lymphoid interstitial pneumonia had significantly elevated levels of spontaneous interferon (IFN) production from pulmonary leukocytes compared with ovine lentiviruses-infected animals with mild or no lesions of lymphoid interstitial pneumonia or non-infected controls. However, peripheral blood mononuclear cells from lentivirus-infected lambs did not spontaneously release significant amounts of IFN. IFN production by pulmonary lymph node lymphocytes was enhanced in the presence of lentivirus-infected alveolar macrophages. Animals with lentivirus-induced disease and spontaneous IFN production had enhanced virus replication within tissues. The ovine lentiviruses-induced IFN had a m.w. of between 25,000 and 35,000 and was resistant to freeze/thawing procedures. The IFN activity was sensitive to trypsin and stable to low pH and heat. IFN with similar physical and biochemical properties was produced when ovine lentiviruses was added to control leukocyte cultures. IL-2 and PGE2 production and responses to mitogen by pulmonary lymph node lymphocytes of lentivirus-diseased lambs were not statistically different from control animals. Increased local production of IFN in lentivirus-infected host tissues may serve to accelerate the entry of leukocytes into virus-induced lesions promoting cell-mediated tissue damage and also provide increased numbers of cells for virus replication.     

螺旋CT增强扫描对孤立性肺结节的诊断价值

目的:研究螺旋CT增强扫描时孤立性肺结节的诊断价值。方法:回顾分析经病理证实的恶性结节50例、炎性结节26例、结核瘤12例的螺旋CT增强扫描的表现。结果:恶性结节和炎性结节增强扫描的强化程度明显高于结核瘤(P＜0．05)。炎性结节强化峰值的时间较恶性结节延迟。恶性结节增强扫描出现点、条状及边缘强化。结论:螺旋CT增强扫描对孤立性肺结节的诊断具有重要临床应用价值。     

直径小于1 cm孤立性肺结节的18F-FDG PET/CT诊断研究进展

孤立性肺结节的鉴别诊断一直是胸部影像学的研究热点。早期且准确地鉴别肺内小结节的良恶性,对于患者治疗方案的确定以及随访情况的评估均具有重要的临床意义。~(18)F-FDG PET/CT在鉴别诊断恶性肿瘤方面具有明显优于其他传统检查的高特异性和高敏感性,其公认的恶性肿瘤的诊断阈值是最大化标准摄取值(maximum standard uptake value, SUVmax)为2.5,然而部分临床数据显示一些直径小于1 cm的恶性肺结节的SUVmax数值小于2.5。因此在早期研究中,~(18)F-FDG PET/CT在诊断直径较小的肺结节的其临床价值仍存在争议。为了尽量降低SUVmax的测量误差,提高~(18)F-FDG PET/CT诊断的准确率,衍生出了许多SUVmax辅助诊断方法以及优化的重建算法、放射性显像剂的联合应用等手段。本文将对~(18)F-FDG PET/CT鉴别诊断直径小于1 cm孤立性肺结节的研究进展进行综述。     

探讨CT技术在肺结节疾病诊断中的应用

目的：探讨CT技术在肺结节疾病诊断中的应用。利用CT技术提供的影像学特征,及时准确的诊断肺结节疾病,从而更具体更全面的提高对该疾病的认识,减少误诊的发生。方法：回顾性分析我院2010年-2012年确诊的符合相应临床诊治标准的肺结节患者48例的临床资料,通过CT扫描分析其具体的特征表现。结果：在所选的48例中,纵隔淋巴结增大45例,双侧肺门淋巴结增大44例,胸部淋巴结增大患者48例。肺部病变者33例,其中单发结节患者2例,多发结节患者25例,支气管血管束增粗者14例,磨玻璃样影案例者9例,实变案例5例。胸膜病发患者13例。结论：我们通过分析发现,胸部有典型影像学表现形式的肺结节病例诊断较容易,无典型影像学表现的患者诊断较为困难。因此我们认为利用CT技术诊断肺结节疾病具有特异性意义,值得临床医生重视。     

Lymphoid nodules of the urinary bladder in man

Basing on macro- microscopical investigation of the urinary bladder in 94 persons, died at the period of birth up to old years and by the time of death having not any disease of the urinary apparatus, structure and topography of the lymphoid nodules, their amount, density of distribution in the mucous membrane of various parts of the organ have been studied. The germinative centers in the lymphoid nodules of the urinary bladder are not revealed. The external appearance of the nodules is not the same; some have clear contours others have no clearly manifested borders. We call them prenodules. The lymphoid nodules are situated near to each other without any definite order. And only near the ureteral openings they are always revealed in a small amount, in the area of the triangle; they are oriented, as a rule, from the ureteral openings towards the exit from the urinary bladder. The amount of the lymphoid nodules in the organ's wall varies (at an average) from 18, in newborns, up to 415, in adolescents, and up to 129, in old persons. Distribution density of the lymphoid nodules in the fundal area of the urinary bladder is somewhat greater, than in its superior parts. The size of the lymphoid nodules during all age periods is not more than 900 mcm.     

Approach to the immunocompromised patient with pulmonary nodules

In immunocompromised hosts, the lung is a frequent site of opportunistic infection and pulmonary nodules are a common finding. Clinicians caring for these patients have an expanded selection of options available for empiric treatment and new diagnostic tools. Increased use of prophylaxis with broad-spectrum antifungals (eg, posaconazole and voriconazole) has complicated the approach to empiric therapy. This review discusses new developments in epidemiology, diagnosis, and therapy that inform the approach to the immunocompromised patient with pulmonary nodules.     

Fine needle aspiration cytology of primary pulmonary meningioma associated with minute meningotheliallike nodules. Report of a case with histologic,immunohistochemical and ultrastructural studies

BACKGROUND: Pulmonary meningioma is an unusual tumor located in the lung. Minute pulmonary meningotheliallike nodules are also uncommon tumor-like lesions found at the pleuropulmonary level as solitary or multiple nodules. The association of both entities is described in a recent report. CASE: A 58-year-old, male smoker without pathology underwent radiologic study before a surgical procedure. A peripheral nodule was found in the left lower lobe of the lung with benign characteristics. Fine needle aspiration cytology was performed under computed tomography guidance. Cytologic examination showed features of transitional meningioma and other lesions near the tumor. Minute pulmonary meningotheliallike nodules were also present. CONCLUSION: A diagnosis of meningioma should be considered when there is a combination of scanty material, whorls composed of concentrically arranged cells and isolated cells with intranuclear inclusions. The simultaneous presence of meningioma and meningotheliallike nodules corroborates the unifying hypothesis of their common origin and the nature of these rare pulmonary lesions.     

Microscopic anatomy of small-intestinal lymphoid patches in children and adults

Longitudinal histological sections of lymphoid patches (LP) in the small intestine, stained after van Gieson and with hematoxylin--eosin, obtained from 105 corpses of persons at the age of 0 up to 90 years have been studied. The LP parenchyma is presented as accumulation of lymphoid nodules++ with a germinative center, or without it and diffuse lymphoid tissue. The lymphoid nodules++ situate both in the mucous membrane and in the submucous tela of the small intestine. The area of the LP components in the newborns is the greatest--84% from the whole area of the LP section. During the human life it decreases and by the old age it makes 47%. The lymphoid nodules++ area with the germinative center in the newborns makes 21% from the area of the LP section, in children from 1 to 3 years of age it increases up to 50%, then it gradually decreases and in the elderly age it makes only 3.8%. The diffuse lymphoid tissue in the LP composition is revealed in all age periods. Size of the lymphoid nodules++ patches, situating in the jejunum and ileum walls in the newborns is the same. In children at the age of 10 days--12 years the LP nodules++ in the ileum are larger than those in the sejunum. The size of the LP noduli increase up to the period of the second childhood then decreases. The height of the lymphoid noduli in persons of mature, elderly and old ages decreases twice in comparison with the children of 3-12 years of age.     

Age-related aspects of the anatomy and topography of the human tubal tonsil

The tubal tonsil (TT) has been investigated in 60 preparations of the auditory tube (right and left), obtained from 30 corpses of persons at various age, those died from traumas and having neither any pathological changes in their acoustic organs, nor chronic inflammatory diseases by the time of death. The TT is presented as a solid or interrupted lymphoid tissue plate, situating in the mucosal membrane in the area of the pharyngeal opening to some extent in the inferior, posterior and anterior walls of the auditory tube. In newborns the TT is presented as a diffuse lymphoid tissue, where lymphoid nodules begin to form. The greatest amount of the lymphoid nodules in the TT are revealed in the infantile age and this sign is kept during subsequent age periods, including the first period of mature age. During these age periods on the surface of the mucosal membrane in the area of the pharyngeal opening numerous small eminences are seen--tubercles, corresponding in their position to lymphoid nodules under them. Beginning from the second mature period and up to old age the amount and size of the lymphoid nodules in the TT decreases. At that time on the surface of the mucosal membranes in the area of TT only single tubercles are revealed.     

Lymphoid structures in the female endometrium in ontogenesis

Lymphoid formations of human endometrium are presented in stroma of the uterine corpus mucous membrane as lymphoid cells (so called diffuse lymphoid tissue), lymphoid nodules and interepithelial lymphocytes in glandular and covering epithelium++. Peculiarities in organization of these formations are seen as slight saturation of the endometrium with lymphoid tissue, small size of lymphoid nodules++. The lymphoid structures in question reach their maximal development during the adolescent and first mature age. During the generative period among diffusely arranged T-lymphocytes sub-populations of T-suppressors predominate. This is probably connected with participation of suppressive mechanisms of local immunity in ensuring blastocyst implantation.     

The microscopic anatomy of the human pharyngeal tonsil in the postnatal period of ontogeny

Histological sections of the pharyngeal tonsil (PhT) have been investigated in 55 corpses of persons of both sex and various age, that had no disease connected with lesions of the PhT by the time of their death. The aim of the work is to determine relative areas of each structural element of the PhT in comparison to the whole section area taken as 100%. The PhT lymphoid tissue reached its maximal relative development at the first childhood. Then the lymphoid tissue area in the PhT histological sections decreases gradually, making already in the second mature age one half of the tonsil section area, and in the elderly age--nearly one-fourth. The decrease of the relative lymphoid tissue area takes place at the expense of decreasing area of the lymphoid nodules. The relative area of the connective stroma increases inversely to the relative decrease of the lymphoid tissue area parameters. The germinative centers in the lymphoid nodules are absent in newborns and old persons. The greatest value of the relative area of the germinative centers falls to the early infancy. The lymphoid nodules with the germinative centers, according to their relative area during all age periods, besides the newborn period, the second mature, elderly and old age periods, essentially exceed the area, that occupy the nodules without the germinative centers on the PhT sections.     

Comparative pathomorphologic study of the toxic properties of a corpuscular pertussis vaccine and of a cell-free pertussis preparation

The comparative study of morphological changes in the body of outbred mice under the action of corpuscular pertussis vaccine and acellular pertussis preparation has been made. The corpuscular vaccine has been shown to produce a pronounced, dynamically increasing toxic effect, thus causing the damage of lymphoid thymic and spleen cells, prolonged interstitial reaction in the lungs, destructive inflammatory process at the site of injection. The acellular pertussis preparation is less toxic, induces less pronounced changes in these organs at the early period of the experiment, stimulates the proliferation of lymphoid cells and lymphoblast transformation. As noted in this study, the damaging action of pertussis vaccine is mainly indicated by pathological phenomena appearing in the organs of the immune system, pulmonary parenchyma and muscular tissue (in the inoculation zone).     

慢性阻塞性肺疾病合并肺曲菌病一例及文献复习

目的:提高对慢性阻塞性肺疾病合并侵袭性肺曲菌病(COPD合并IPA)临床特点、诊断及治疗的认识.方法:回顾性分析2011年4月收治的一例COPD合并IPA患者的临床资料及诊治经过,并复习相关文献.结果:男患,“咳嗽、咳痰30余年,气短3年,加重1月余”入院,肺部CT示双肺多发结节影、空洞影,经抗炎、抗念珠菌治疗无效,CT下肺结节病灶活检病理示肺曲菌.抗曲菌治疗后症状好转、肺部影像明显吸收.结论:COPD合并IPA正逐渐引起重视,临床特征无明显特异性,肺部影像以结节影、空洞影多见,早期常规治疗无效时应积极抗曲菌治疗,可明显改善症状,降低死亡率,病理活检是确诊的依据.     

7例影像学表现为弥漫肺间质性病变的肺结核报道及文献复习

目的:通过对7例高分辨CT(High Resolution Computed Tomography,HRCT)表现为弥漫肺间质性病变的肺结核患者的相关资料进行分析,结合相关文献,提高对该类肺结核的认识。方法:分析本院2012.2~2015.3确诊的7例HRCT表现为弥漫肺间质性病变的肺结核的临床症状、体征、影像学资料及痰抗酸杆菌、结核菌素纯蛋白衍生物(Purified Protein Derivative,PPD)试验、T细胞斑点试验(T-SPOT.TB)、抗结核抗体、血常规、血沉(Erythrocyte Sedimentation Rate,ESR)等实验室检查、病理检查等资料。结果:6例经2次以上痰涂片阳性确诊为肺结核,1例抗结核治疗有效诊断为肺结核;弥漫肺间质性病变的肺结核患者HRCT上间质性病变的范围与抗酸杆菌的检出及发热症状的出现有关联;与盗汗、乏力、咯血等结核中毒症状及PPD、结核抗体、ESR等指标无明显相关关系。结论:弥漫肺间质性病变也可为肺结核的一种特殊表现,极易误诊为其他间质病变。当患者临床表现及实验室检查无特殊发现时,需考虑肺结核的可能并进行结核病相关检查,尤其是抗酸杆菌及肺组织病理检查,以尽早明确诊断。     

高分辨率CT与常规CT检查对肺小结节及早期肺癌诊断价值的对比研究

目的:对比高分辨率电子计算机断层扫描(CT)与常规CT检查对肺小结节及早期肺癌的诊断价值。方法:将2018年6月2020年1月我院收治的肺小结节及早期肺癌患者94例纳入研究。以随机数字表法将其分为观察组及对照组,每组各47例,对照组实施常规CT检查,观察组则实施高分辨率CT检查。比较两组CT肿瘤征象情况(主要包括毛刺征、分叶征、棘突征、钙化征、空泡征、支气管征、胸膜凹陷征、血管集束征),CT扫描图像质量,诊断肺小结节及早期肺癌的效能。结果:观察组各项CT肿瘤征象人数占比均高于对照组(P<0.05)。观察组CT扫描图像质量优良率为97.87%(46/47),高于对照组的72.34%(34/47)(P<0.05)。高分辨率CT诊断早期肺癌的灵敏度及准确度、特异度分别为96.67%(29/30)、95.74%(45/47)、94.12%(16/17),高于常规CT检查的74.19%(23/31)、74.47%(35/47)、75.00%(12/16)。结论:高分辨率CT检查对肺小结节及早期肺癌诊断价值显著高于常规CT检查,可作为临床肺小结节及早期肺癌诊断的有效影像学手段,值得临床应用。     

胸部CT结合AI诊断系统对疑似肺结节患者的诊断及对结节类型的评估价值

摘要 目的：探讨胸部CT结合AI诊断系统对疑似肺结节患者的诊断及对结节类型的评估价值。方法：选取2019年12月-2020年12月在我院进行CT检查的358例疑似肺结节患者,将其按照随机数字表法分为两组：对照组（放射科医生根据CT扫描结果,通过人工阅片分析记录检出结节数量和影像特征）,观察组（将CT扫描结果导入AI辅助诊断系统,经AI运算得到结节检出数量和影像特征）。AI辅助系统IMsight用于肺结节的图像分析和自动检测。通过组织病理学确定结节的良恶性。绘制受试者工作特征曲线（ROC）曲线以评估AI和CT结合图像的诊断价值。结果：病理结果最后确诊结节数量736个,恶性结节139个（18.89 %）,良性结节597个（81.11 %）。观察组诊断结节数量717个,检出率97.42%,对照组诊断出结节数量603个,检出率81.93 %。观察组较对照组的结节检出率、阳性检出率升高（P<0.05）,漏检率和假阴性率均显著降低（P<0.05）。当结节小于10 mm时,观察组较对照组的检出率升高（P<0.05）,观察组较对照组对磨玻璃密度结节和实性结节检出率升高（P<0.05）,观察组较对照组位于胸膜结节检出率升高（P<0.05）。观察组较对照组AUC（P<0.05）,表明AI系统下的结节检出准确率高。ROC曲线显示观察组的敏感性和特异性分别为88.39%和89.68 %,对照组的敏感性和特异性分别为75.24 %和82.34 %,观察组较对照组的ROC曲线敏感性和特异性升高（P<0.05）。结论：AI辅助诊断系统可有效提高肺结节的检出率,减少误检率及漏检率,值得在肺结节CT检测中应用推广。     

甲状腺结节的现代诊疗进展

绝大多数甲状腺结节都是经影像学检查无意间发现的,即使是良性甲状腺结节,也有必要进行治疗。临床医生需要综合患者的病史、体格检查及实验室、影像学或细胞学穿刺活检等检查结果尽可能明确诊断结节的良恶性。非手术微创治疗方法对于多数的良性结节行药物或放射性碘治疗如无水酒精注射(PEI)、激光光凝(ILP)、放射性碘消融(RFI)和微波消融(MWA)效果较好;而恶性或高度怀疑恶性及部分较大良性结节需行外科手术切除,根据结节的具体类型并结合各高危因素选择适当的切除范围,某些恶性结节术后还需进一步辅助碘131放射治疗并跟踪随访。本文综述了有关甲状腺结节的最新诊断和治疗进展,重点阐述了美国甲状腺协会关于甲状腺结节和分化型甲状腺癌的诊治指南的相关主张。     

Late effect of carbon disulfide on the lymph nodes in rats]

Cell composition of the cortical plateau, medullary cords and lymphoid nodules++ has been determined in 180 Wistar rats in 2 weeks, 1 and 3 months after inhalation of carbon disulfate vapour for 2, 7 and 14 days in a maximum permissible concentration (1 mg/m3) and in the control group. In 2 weeks after cessation of the vapour inhalation activity of lymphocytopoiesis, blastopoiesis, cell differentiation decreases, macrophagal and plasmocytic reactions are weakly manifested. In 1 month certain signs of compensatory-adaptive reaction are noted; they are seen as increasing proliferative processes and activation of cell differentiation in the lymphoid nodules++ and a sharp plasmatization of the medullary cords. In 3 months after the experiment retardation of lymphocytopoiesis is still definitely manifested in the cortical plateau and medullary cords and essential destructive processes are observed against the background of local increase of the functional activity of the lymphoid nodules++.     

Diagnostic pitfalls in fine needle aspiration of solitary pulmonary nodules: two cases with radio-cyto-histological correlation

Background

Fine needle aspiration is an important tool for diagnosis and preoperative evaluation of solitary nodules of the lung. It provides a definitive diagnosis in most patients at low cost with minimal trauma. However, because of the nature of the study and the presentation of the cells in a more distorted and incomplete tissue structure than a histological slide, false positive results can occur. Prior detailed clinical knowledge about the patient, procedures and methods of radiology in obtaining the aspirate specimen is extremely useful in the accurate interpretation of fine needle cytological specimens.

Case presentation

We report two cases of solitary pulmonary nodules in two elderly females, which were initially diagnosed as malignant by fine needle aspiration biopsy. Both cases subsequently underwent pulmonary lobectomy in which, one turned out to be a pulmonary hamartoma and the other appeared to be a middle lobe syndrome of the right lung with liver tissue contamination at the time of fine needle aspiration of the lung.

Conclusions

We are now strong believers that much care must be taken in the interpretation of fine needle aspiration of solitary nodules of the lung. Complete study of the entire specimen, including the cell block, is warranted, since what one interprets as malignant, could have different features in another part of the sample. Last but not the least, prior knowledge of the complete clinical history of the patient together with the salient radiological findings would greatly facilitate the cytopathologist to reach an accurate diagnosis.