肺部转移瘤的影像诊断 PPT

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• 三、瘤周出血
比较典型的CT表现是结 节周围出现磨玻璃样密 度或边缘模糊的晕(晕 轮征)。但晕征不具特 异性，还可见于其他疾 病，如侵袭性曲霉菌病、 念珠菌病、Wegener肉 芽肿、伴咯血的结核瘤、 细支气管肺泡癌和淋巴 瘤等。胸片上表现为边 缘不规则的多发结节。 血管肉瘤和绒癌的肺转 移最易发生出血，可能 因为新生血管壁脆弱而 易破裂。
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• 二、钙化
肺结节发生钙化常提示为良性，最常见于肉芽肿性病变，其次是错构瘤。但
有些恶性肿瘤的肺内转移性结节也可发生钙化或骨化，可见于骨肉瘤、软骨
肉瘤、滑膜肉瘤、骨巨细胞瘤、结肠癌、卵巢癌、乳腺癌、甲状腺癌的肺转 移和经治疗的转移性绒癌。钙化机制包括：①骨形成(骨肉瘤或软骨肉瘤)。 ②营养不良性钙化(甲状腺乳头状癌、骨巨细胞瘤、滑膜肉瘤或经过治疗的转 移性肿瘤)。③黏液性钙化(胃肠道和乳腺黏液腺癌)。CT是发现钙化的准确方 法，但不能区分转移性结节与肉芽肿性病变或错构瘤内的钙化。
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• 2. 淋巴道转移：淋巴转移以癌性淋巴管炎及淋巴结肿大为特征。多见于胃癌和乳腺癌。HRCT是诊断淋巴道转移的重要方法，当胸 片正常时，HRCT间有典型表现。表现为支气管血管束增粗，并有结节，小叶间隔呈串珠状改变或增粗，小叶中心有结节灶，并有 胸膜下结节。可并有肺门淋巴结增大，以单侧为主
• 3. 肿瘤直接侵犯：纵隔、胸膜和胸壁的恶性肿瘤直接蔓延到肺部，表现为大小不等的diffuse micronodular lung disease), each nodule being < 3mm in diameter and occupying more than two-thirds of lung volume on chest radiograph, can be differentiated by its distribution. Centrilobular distribution is seen in DPB (diffuse panbronchiolitis), infectious bronchiolitis, H. influenza, bronchogenic disseminated tuberculosis, pneumoconiosis, primary lymphoma, and foreign body-induced necrotizing vasculitis. Perilymphatic distribution is noted in pneumoconiosis, sarcoidosis, amyloidosis. Random distribution is found in miliary tuberculosis and pulmonary metastasis. The nodules in pulmonary metastatic disease appeared to be slightly larger and are more variable in size than those in miliary tuberculosis. They show relatively well defined margins. Miliary metastases are most likely to be due to thyroid, renal carcinoma, bone sarcoma, trophoblastic disease, or melanoma.
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• 1.血行转移：多发是肺转
移瘤特征（在多发肺结节 中，转移瘤占70%～ 80%），表现为两肺多发 结节灶，边缘多清楚、密 度均匀，以两肺中下野、 外周常见，67%见于胸膜 下， 25%发生在肺野外 1/3。较大的病灶可达 10cm以上，较小的病灶为 粟粒结节病灶，小结节及 粟粒病灶多见于甲状腺癌、 肝癌、胰腺癌及绒毛膜上 皮癌转移；多发及单发的 较大结节及肿块多见于肾 癌、结肠癌、黑色素瘤、 骨肉瘤及精原细胞瘤等的 转移。
和MRI可以显示肺内转移灶与原发灶的关系和肋骨及胸膜的侵犯情况。
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• Chest CT scans show a
spiculated mass in the apex of the left lung with multiple small nodular lesions in both lungs. Some of the nodules appear as cavitary or ring-like lesions. Discussion Cavitation of metastatic nodules is not as common as with primary lung carcinoma. The frequency of it is 4%, in contrast to 9% of primary lung carcinomas. Among metastatic nodules associated with cavitation, 70% are metastatic squamous cell carcinoma. The head and neck in males and the genitalia in females are the most common primary organ sites. Cavitation is observed rarely in metastatic adenocarcinoma, particularly that from colon cancer. Metastatic sarcoma can also be accompanied by cavitation, and pneumothorax is a relatively frequent complication. Chemotherapy is known to induce cavitation in metastatic pulmonary nodules.