To the role of computed tomography in the algorithm of diagnosis of lung cancer

The paper summarizes the results of examination of 100 patients with malignant tumors of the lung. The results of X-ray study, linear tomography, and computed tomography (CT) used in the examination of patients with lung cancer were compared by using as an indicator the following parameters: to make diagnosis of lung cancer, to reveal mediastinal intergrowths, to detect enlarged lymph nodes, pulmonary metastases, and pleural lesions, to obtain information on tumor spread into the chest, to reveal growths into the vascular walls. To evaluate the efficiency of the techniques in solving the above diagnostic tasks, a statistical analysis including the estimation of their accuracy, specificity, and sensitivity was made. Recommendations for examination of patients with lung cancer were drawn up for therapeutic institutions of different types.     

A case of resectable lung adenocarcinoma associated with sarcoidosis

A 71-year-old woman with uveitis was referred to our hospital for further examination of the possible underlying diseases. In roentgenological examination with plain X-ray and CT scan, hilar and mediastinal lymphadenopathy and a mass shadow in the right upper lung field was observed, whereas fibrotic changes were not obvious in both lung fields. Transbronchial lung biopsy with fiberoptic bronchoscope revealed granulomatous interstitial pneumonia. CD4-positive lymphocytes were increased in bronchoalveolar lavage. The patient was diagnosed as having sarcoidosis. Subsequently, right upper lobectomy was performed, and Stage I lung adenocarcinoma was diagnosed. The patient is under follow up without medication and the disease has been stable for two years. A relationship between epithelioid granulomatosis and malignant diseases is discussed and a review of the literature is given. Since it is still controversial as to the incidence of malignant diseases in sarcoidosis patients, it is important to accumulate data on these associations.     

X线片和多层螺旋CT诊断及鉴别周围型肺癌的对比研究

目的:对比X线平片和多层螺旋CT诊断及鉴别周围型肺癌的效果。方法:选取了100例周围型肺癌患者,所有患者入院后先行X线片检查,后进行多层螺旋CT检查。通过观察并记录X线片与多层螺旋CT对周围型肺癌的影像学特征、临床TNM分期的诊断效果,评价X线平片和多层螺旋CT对周围型肺癌的诊断效果。结果:多层螺旋CT对周围型肺癌的肿块、分叶征、支气管气象征、空洞、胸膜凹陷、血管集束征,胸腔积液的检出率均高于X线片(P0.05)。根据外科病理TNM分期结果,多层螺旋CT对周围型肺癌的临床TNM分期诊断符合率为92.0%,X线对周围型肺癌的临床TNM分期诊断符合率为61.0%,多层螺旋CT对周围型肺癌的临床TNM分期诊断符合率明显高于X线(P0.05)。结论:多层螺旋CT对于周围型肺癌各类型影像学征象具有较好的检出率,对周围型肺癌临床TNM分期诊断准确性接近病理诊断结果。     

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。     

X-ray study in infants of the first year of life who had congenital heart diseases: traditions, specific features, new capacities

The paper analyzes the experience with ultrafast computed tomography (CT) used for 4 years to examine 178 babies with complicated congenital heart diseases (CHD), admitted to A.N. Bakulev Research Center of Cardiovascular Surgery, Russian Academy of Medical Sciences, for surgical treatment. It shows the comparative capacities of X-ray study, CT, and catheterized angiography in the diagnosis of CHD and concomitant lung diseases in patients of the first year of life in terms of the physiological and anatomic features of the course of disease. A complex of noninvasive radiation studies is shown to be of high informative value in evaluating the actual anatomy of complicated cardiac and pulmonary anomalies and in detecting the predictors of respiratory complications. The introduction of CT into the traditional algorithm of preoperative examination of patients with CHD has resulted in a considerable reduction in intracardiac diagnostic studies in neonates and infants of the first year of life.     

Disseminated pulmonary tuberculosis: significance of high-resolution computerized tomography]

Clinical and X-Ray studies were performed in 85 patients with disseminated pulmonary tuberculosis. All the patients underwent routine computerized tomography (CT) and high-resolution CT. According to the pathogenetic process, the authors identified hematogenic (n = 38), lymphogenic (n = 19), bronchogenic (n = 18) and mixed (n = 10) disseminations. High-resolution CT was found to have great advantages in detecting various types of tuberculous disseminations and in assessing the pattern of pulmonary abnormalities. Disseminated tuberculosis was revealed in 7 patients who had no pathological changes on routine lung X-ray films. The specific signs of hematogenic, lymphogenic disseminations and bronchgenic inoculations were identified in other forms of pulmonary tuberculosis. CT symptomatology is shown to be determined by the pathogenetic variant of its development and the stage of the process. Small focal changes in the lung were prevalent in patients with acute and subacute hematogenic forms of the disease. Infiltrates with decay cavities, thin-wall caverns, emphysema and bronchoectases were detected over the chronic course. Lymphogenic disseminations were characterized by the predominance of interstitial changes along with multiple minor foci. High-resolution CT had advantages in identifying decay cavities, signs of fibrosis and in evaluating mediastinal lymph nodes. CT data are of great significance for differential diagnosis of disseminated tuberculosis with lung metastases and diffuse interstitial diseases.     

不同放射剂量CT在早期非小细胞肺癌中筛检价值对比

摘要 目的：探讨与对比不同放射剂量计算机断层扫描(Computed Tomography,CT)在早期非小细胞肺癌中筛检价值。方法：2020年1月到2020年12月选择在本院经病理确诊为肺内磨玻璃样结节患者98例作为研究对象,所有患者都给予常规剂量正电子发射计算机断层扫描(Positron emission tomography,PET)/CT检查与低剂量PET/CT检查,记录成像特征、辐射剂量并判定筛检价值。结果：低剂量PET/CT对肺部增厚、边界不规则、钙化、囊变的检出率高于常规剂量PET/CT(P<0.05)。低剂量PET/CT与常规剂量PET/CT的图像质量优良率为98.0 %和96.9 %,对比差异无统计学意义(P>0.05)。低剂量PET/CT的有效放射剂量、剂量长度乘积低于常规剂量PET/CT(P<0.05)。低剂量PET/CT的最大标准摄取值(maximum standardized uptake value,SUVmax)值低于常规剂量PET/CT(P<0.05)。低剂量PET/CT与常规剂量PET/CT分别筛检非小细胞肺癌51例与37例,筛检敏感性分别为98.1 %和69.2 %,特异性分别为100.0 %和97.8 %。结论：低放射剂量PET/CT在肺结节中的应用不会影响图像质量,且能降低辐射剂量,提高对早期非小细胞肺癌患者的筛检效果。     

Computed tomography in the evaluation of the bronchopulmonary system in late periods after childhood partial resection of the lung

The authors used computed tomography (CT) as a basis to analyze the anatomic status of the bronchopulmonary system in 28 patients undergone resection of a part of the lung in childhood for chronic nonspecific lung inflammations and malformations. The findings confirmed the high diagnostic value of CT in the evaluation of the lung in different postoperative periods and showed a certain range of changes varying from significant in the lung operated on to progression of the primary disease to the collateral lung.     

能谱CT鉴别肺癌成骨性转移瘤与骨岛

目的:探讨能谱CT成像在鉴别诊断肺癌成骨性转移瘤(Osteoblastic metastases,OBMs)与骨岛(Bone island,BIs)的临床应用价值。方法:回顾性分析经病理证实的16例肺癌患者诊断为成骨性转移瘤36个病灶及临床诊断21例骨岛患者21个病灶,所有患者均行能谱CT扫描,测量各病灶40-140 ke V区间单能量水平CT值及钙(水)基物质浓度,最后计算出能谱曲线斜率k。采用独立样本t检验对两组各参数进行差异性比较分析。结果:OBMs的各水平单能量CT值、k值、钙(水)浓度均低于BIs,两组差异均有统计学意义(P0.05)。结论:能谱CT有助于鉴别诊断肺癌成骨性转移瘤与骨岛。     

Computed tomography in the evaluation of tumor regression after neoadjuvant therapy: X-ray surgery and X-ray morphological comparisons

An analysis was made of chest computed tomograms of 38 small-cell lung cancer patients subjected to radical surgical treatment after neoadjuvant therapy. CT data were compared with the findings of macro- and microscopic examination of surgical specimens. In 24 (63.2%) patients, computed tomograms made before surgery showed complete tumor response confirmed by gross examination in 22 (96.1%) of them. However, microscopic examination found cancer cells in 8 (33.3%) patients. In 2 (8.3%) patients, small residual tumors could be detected by sight, which was confirmed by pathological examination. In 14 (36.8%) patients with partial response, radiological and gross examination findings fully coincided. Nevertheless, in 2 (14.3%) cases the "residual tumor" appeared to be a segment of fibrocicatrical tissue under pathological examination. On the basis of the CT findings the values of diagnostic sensitivity, accuracy and specificity in tumor response evaluation were calculated which made up 87.5%, 68.4% and 54.5% respectively. With sufficiently high sensitivity, CT specificity is low. CT makes it possible to objectively define the response of small-cell lung cancer to neoadjuvant therapy. However, the conclusion about complete response to the treatment can be made only on the basis of a comprehensive evaluation of the results of all available investigation methods and pathological examination.     

多排螺旋CT对隐匿性肋骨骨折的诊断价值及最佳复查时间研究

目的:探讨多排螺旋CT对隐匿性肋骨骨折的诊断价值及最佳复查时间。方法:选取2017年7月到2018年7月期间在我院接受治疗的胸部外伤患者95例,在首次检查时均接受了X线平片和多排螺旋CT检查,比较首次检查时X线平片和多排螺旋CT的检出率,比较首次检查时X线平片和多排螺旋CT对不同类型骨折的诊断情况,比较各个时间段复查病例的肋骨骨折数与首次检查时的差异。结果:95例患者中最终86例确诊存在肋骨骨折,首次检查时多排螺旋CT的检出率为95.35%(82/86),高于X线平片的82.56%(71/86)(P0.05)。86例患者最终确定共存在骨折289处,首次检查时X线平片共检出246处,多排螺旋CT共检出274处,多排螺旋CT对线性骨折、凹陷性骨折的检出率高于X线平片(P0.05)。伤后11-20d、伤后41-50d、伤后51-60d的复查肋骨骨折数与首次检查肋骨骨折数比较无统计学差异(P0.05),伤后21-30d、伤后31-40d的复查肋骨骨折数高于首次检查肋骨骨折数(P0.05)。结论:多排螺旋CT对隐匿性肋骨骨折有较高的诊断价值,首次诊断时的检出率明显高于X线平片,伤后21-40d这个时间段是进行复查的较佳时间段,可获得较好效果。     

A pulmonary paragonimiasis case mimicking metastatic pulmonary tumor

Pulmonary paragonimiasis is a relatively rare cause of lung disease revealing a wide variety of radiologic findings, such as air-space consolidation, nodules, and cysts. We describe here a case of pulmonary paragonimiasis in a 27-year-old woman who presented with a 2-month history of cough and sputum. Based on chest computed tomography (CT) scans and fluorodeoxyglucose positron emission tomography (FDG-PET) findings, the patient was suspected to have a metastatic lung tumor. However, she was diagnosed as having Paragonimus westermani infection by an immunoserological examination using ELISA. Follow-up chest X-ray and CT scans after chemotherapy with praziquantel showed an obvious improvement. There have been several reported cases of pulmonary paragonimiasis mimicking lung tumors on FDG-PET. However, all of them were suspected as primary lung tumors. To our knowledge, this patient represents the first case of paragonimiasis mimicking metastatic lung disease on FDG-PET CT imaging.     

Magnetic resonance tomography in the diagnosis of lung metastases in the mediastinum and thorax

The results of MRI in 81 patients with morphologically verified lung cancer, mainly Stages IIIA and IIIB, were analyzed. They were compared with CT data in 37 cases and surgical findings in 28. MRI was performed by using Magnaview 0.04 T and Vectra 0.5 T apparatus in the T1- and T2-weighted SE and PC sequences as well in the fat-suppression mode. Thoracic metastases were evaluated from the direct signs tumor spread into the adjacent tissue and vessels. The criteria for the involvement of lymph nodes were their over 1-cm enlargement and characteristic changes in the intensity of signals from them. CT was found to yield less information on pleural, pericardial, and vascular invasion (66-75% sensitivity). MRI detected this type of cancer spread (88-94% sensitivity). Both techniques have nearly equal sensitivities in revealing intrathoracic lymphadenopathy. The interpretation of MRI data did not depend on the voltage of a magnetic field. It is recommended that MRI should be made after CT when there is a need for assessing large vessels or for making clear the data that remain open to question following CT.     

Radiation diagnosis of interstitial lung diseases

The authors analyzed the results of complex radiation study of 1192 patients with various interstitial lung diseases (ILD). An algorithm of differential diagnosis of diffuse and disseminated lesions of the lung was derived by using the findings. The X-ray morphological principle underlies the algorithm. The level of structural lesions of the lung and tissue reactions and the presence of granuloma shadows are the governing criteria for evaluating the gross structure in the differential diagnostic complex. Great emphasis is laid on the significance of computed tomography (CT), high performance CT in particular, which is becoming the priority radiation diagnostic technique in pulmonology. Morphofunctional studies, 99mTc AMA and 67Ga citrate pulmonary scintigraphy in particular, specify the magnitude of changes in the microcirculatory bed and the activity of intrathoracic lymph nodes.     

Détection de l’embolie pulmonaire aiguë : apport du scanner X faible dose à la tomoscintigraphie pulmonaire de ventilation et de perfusion

Ventilation and perfusion (V/Q) lung SPECT, performed according to the new recommendations of European Association of Nuclear Medicine (EANM), is a first-line examination for the detection of acute pulmonary embolism. Since low-dose CT scan acquisitions may be recorded during the same examination on hybrid cameras, the corresponding additional information should be assessed. The aim of this study is to compare the diagnostic information provided by lung V/Q SPECT, alone and combined with a low-dose CT scan. Each analysis is performed by two readers; one is more experienced (assistant, A) and one less (interne, I).ResultsThe addition of low-dose CT Scan to lung V/Q SPECT: (1) seldom changes the main diagnostic answer in example the presence or absence of pulmonary embolism (2% for A and 6% for I); (2) frequently gives more minor additional informations, 69% for A and 79% for I (localisation of the involved segments, non embolic pleuroparenchymal abnormalities…) and (3) is associated with a concordance of 87% between the two readers with regard to the final diagnosis of pulmonary embolism (84% for SPECT without CT scan). Seventy-nine percent of these discordances were associated with a low quality of ventilation images.ConclusionWhen added to V/Q lung SPECT, low-dose CT scan commonly provides an additional diagnostic information, without affecting interobserver reproducibility, but this information is generally minor without impact on the diagnosis of pulmonary embolism.     

肺癌诊断方法的比较与研究进展

近年来,随着周围环境的恶化,肺癌的发病率最高并且呈现逐年上升的趋势,且其早期表现隐匿,很容易被忽视,很多患者确诊时已属晚期,丧失去了治疗的最佳时机。.本文主要总结和比较了几种传统的肺癌诊断方法如X线片、CT、MRI、PET-CT,并介绍了几种肺癌的最新的诊断技术,比如肺泡灌洗液或血清肿瘤标记物的联合检测、呼出气中的有机化合物的构成分析以及纤维支气管镜镜检技术等。上述方法诊断肺癌的敏感性和特异性各有优势,临床医生在临床工作中应合理应用上述检测方法,必要时联用多种检测手段,尤其要重视支气管肺泡灌洗液癌胚抗原如Cyfra21-1和CEA的联合检测,利用其较高的敏感性以提早发现和诊断肺癌。     

多层螺旋CT低剂量扫描技术在胸部的应用价值

目的研究多层螺旋CT低剂量扫描技术对肺部疾病的诊断价值。方法将51例胸部CT检查者在同一时间分别行常规剂量（200mAs）与低剂量（25mAs）扫描。评定2种剂量对肺部CT常见征象的显示能力。结果在肺部CT常见征象的显示中,除病灶内结节的显示率低剂量扫描较常规剂量低外,其余征象如：钙化、毛刺、支气管征、形态和边缘等二者均无显著差异。结论胸部低剂量扫描技术能作为健康体检或肺部疾病治疗后复查的首选方法。     

Developmentally regulated expression of the calcitonin gene related peptide (CGRP) in rat lung endocrine cells

Calcitonin (CT) and the calcitonin gene-related peptide (CGRP) are generated by alternative RNA processing from a single CT/CGRP gene. Recently, we reported the existence of CGRP-immunoreactivity and CGRP mRNA in endocrine cells or Kulchitsky (K) cells of human and rat lung [Wada et al. 1987b]. In this report, an examination was made of developmental changes in the expression of the CGRP gene in rat lungs by immunohistochemistry, radioimmunoassay (RIA) and Northern hybridization. CGRP-positive K-cells in lung tissue appeared on the 18th day of gestation. Their number was greatest on the 20th day of gestation and then decreased postnatally. The level of CGRP in rat lung was found to be highest in a 1-day-old neonate by RIA. In the Northern hybridization of rat lung using the CGRP 3' non-coding region (exon 6) of the first human CT/CGRP gene as the probe, 1.0 kilobase (kb) CGRP mRNA was found to be abundant on the 20th day of gestation and in a 1 day-old neonate. It thus appears that CGRP in rat lung is essential for pulmonary adaptation at birth and/or from the last intrauterine stage to the early neonatal period.     

Antibiotic anaphylaxis

Pulmonary cancer when localized to the lung, is curable by operation. Tumors found by routine x-ray examination before they cause symptoms are much more often confined to the lung and as such are curable. Unlike other internal growths which are more hidden, lung tumors can often be seen early on x-ray films of the chest.X-ray films of the chest were made routinely on all patients entering a hospital, regardless of the nature of their illness. In all, some 40,000 films were made. Sixty patients were found to have unsuspected solitary lesions in the lung. Twenty-four of the lesions were diagnosed and treated by operation and removal. Twelve were diagnosed by other methods. Of the 36, eight were cancer of the lung, an incidence of 22 per cent. There were also 14 localized tuberculous nodules which are best treated by removal. Since early cancer is surgically curable, it is felt that everyone over the age of 40 should have a routine x-ray examination of the chest every six months. Solitary lesions of the lung found should be excised for diagnosis.     

A place of digital X-ray fluorography in the detection of lung diseases in the public health facilities of the Russian Federation

The paper shows the authors' opinion as to the use of digital X-ray fluorography (DXF) to detect pathology of the lung, primarily its tuberculosis and cancer from organizational-and-methodological and purely diagnostic standpoints. Based on a great body of data pooling 21,295 studies of patients, which comprised two (screening and routine clinical) groups, they authors state their views on the place and role of lung DXF in the work of public health facilities in the Russian Federation (RF). The objectivity of the authors' opinion is confirmed by the different nature of a lung abnormality detected by DXF at both the municipal and regional levels of the RF public health system and by a comparative analysis of the findings with those of film fluorography, routine X-ray study, linear tomography, X-ray computed tomography (XCT), and surgical evidence. The study has allowed the authors to express their opinion by recommending DXF as a method for primary diagnosis of lung diseases instead of film fluorography and routine X-ray study and to appreciate it in screenings. The authors' data indicate that XCT in its simplest variant rather than linear tomography should become the optimum method that specifies the diagnosis of lung diseases detected by DXT.