Imageology inspection methods of lung cancer
Imageology Check Method One of lung cancer, inspection methods
Imageology increasing number of inspection methods for detection and clinical staging of lung cancer have different values. Determined in the pathological diagnosis of clinical stage should be as clear as possible to develop treatment programs.
(A) chest X-ray examination
After the anterior and lateral chest X-ray is the lung of the most basic way to check. High KV C110130kV) airway radiograph shows the more traditional X-ray is superior, but also display the heart, the diaphragm and spinal lesions in the side line shift. Its main drawback is that can not be displayed within the mediastinal lymph nodes, small peripheral lung cancer are also vulnerable to penetration. Has been reported in the high-kV radiography, the lateral chest of 8% of patients can still provide valuable information. First, the film depends on the quality of diagnostic accuracy, including radiographic and darkroom techniques, film-reading it carefully is another important factor.
Lower lobe of suspected pulmonary atelectasis may increase oblique chest X-ray film; suspected when peripheral cancer took part in the under fluoroscopic spot film. This helps to separate the mass and overlap the ribs, and whether the observed tumor calcification and peritumoral structures, but also help to biopsy or pleural effusion drainage positioning.
Traditional X-Tomography, including tracheal bifurcation layer, the lateral pipe layer, the physical layer and after the oblique body layer, localized disease, due to the limitations of density resolution, and many of the senior cadres of the V-ray film that combined CT scanning can replace traditional X ray tomography.
Orthotopic tracheal bifurcation tomography can display a narrow trachea and major bronchi, truncated, but not the tumor extended to the mediastinum and mediastinal lymph node lesions. Lateral tracheal tomography can show the posterior wall of the trachea before or near the tumor mass and the bulge. For some strange wheezing patients, particularly when in a particular position in patients with dyspnea and wheezing to remission in the absence of conditions for the CT scan and tomography is not yet found in the bifurcation lesion, the lateral should be taken Tracheal tomography.
After the oblique (55 ~ 65 ) tomography contribute to the observed suspicious hilar mass, identification is due to bulging of the hilar lymph nodes or blood vessels caused by shadow, the sensitivity was about 70%. After oblique tomography can clearly indicate the upper lobe anterior tongue segment, dorsal middle and lower bronchi segmental bronchi, tracheal bifurcation is an important supplement to the body layer.
Localized disease, the projection position of the body layer should be chosen to focus as much as possible separated from the adjacent structure. For example, paragraph or under the dorsal heart and great vessels with lesions overlapping the lateral lesions tomography should be used. Tomography may help differentiate lesions ribs, pleural disease, and whether the calcified lesions observed or empty, whether the observed tumor drainage blood vessels, to identify whether the lungs of arteriovenous malformations.
(C) CT scan
Good contrast CT scan, a higher spatial resolution, no image overlap is in addition to conventional chest outside the lung tumors check the preferred method to solve difficult problems. Detailed scan is the key to improving diagnostic accuracy. Enhanced scans should be used to identify blood vessels and lymph nodes. Thin layer of the lesion plus scanning technology can provide more valuable information.
(1) CT scan can show the heart of conventional chest X-ray before the area is difficult to show, spine next to the ditch, azygos vein esophageal nest, after the ribs every hidden corner and close to the pleural lesions.
(2) to show by a large number of pleural effusion or pleural thickening of the pulmonary lesion masked.
(3) thin high-resolution CT scan can show lung mass within the cavity, calcification or fat, tumor and vascular, bronchial and chest wall between the effects of more traditional CT scans better.
Sagel so that conventional scanning found that 10% of calcification by CT scan detected thin; CT scan shows tumor cross-section may, in the form of peritumoral changes, useful in differential diagnosis.
(4) can clearly show the tumor within the tracheal system and its growth to the outer wall of the part.
(5) can show enlarged mediastinal lymph nodes, the general diameter of 10mm as the dividing line between normal and abnormal. Moller and other reports, CT showed subcarinal lymphadenopathy, traditional X-ray examination found only 23% had abnormal azygos vein fossa contour, 40% had subcarinal density increased. CT scan showed enlargement of lymph node metastasis is not the same, up to 58% false positive, if necessary, need to be further confirmed by mediastinoscopy and biopsy. Less than 10mm does not mean that there is no lymph node metastasis. Mediastinal CT scan findings can be used as microscopic examination or exploratory thoracotomy when the "roadmap", a destination for sampling inspection. Some people think, T1 if the CT scan of the lung cancer mediastinal lymph node enlargement was not found, you can directly exploratory thoracotomy.
CT scan can still show the tumor and chest wall or mediastinal pleura and large blood vessels adjacent to the relations, which estimate the difficulty of surgery and prognosis of juice, but there are some limitations, should strictly control the diagnostic indications, only able to determine the involvement is absolutely sure to be taken the tissues, organs, involvement of the diagnosis, CT findings can not be easily ruled out based on the resectability of surgical risk. Friedman et al reported 60% false negative, false positive of 33%.
(6) CT scan for the cross section to help set up field radiotherapy, the radiation field with the minimum to achieve the best therapeutic effect, so that the amount of normal lung receiving radiation to a minimum, thereby reducing pulmonary complications of radiotherapy.
The diagnostic accuracy rate of CT scanning technology and have a close relationship. Host scan radiologist to fully understand the patient's condition, chest radiograph performance and the requirements of clinicians, to develop targeted scanning programs, and during the scanning process seen under the scanning make the necessary adjustments. Patients should be trained prior to scanning in a calm breathing breath, each scan as far as possible to maintain similar respiratory status, in order to avoid inconsistency due to respiratory phase missing lesions.
MRI is characterized by a good soft tissue contrast, patients do not have to accept the rays, and to get any axial plane of the image. Because blood flow void, MRI can clearly show blood vessels was no signal area to help identify blood vessels and hilar and mediastinal the masses. At the same time according to Tl, T2-weighted image of the different signals, providing diagnostic information lesion characteristics. But still can not replace the CT scan MRI, the reason as follows: the signal low lung, lung nodules and other pulmonary parenchymal disease detection limited. spatial resolution than CT. not detected calcification. check a long time, breathing exercises, cardiovascular pulsatile motion artifacts such as the clarity of the image affected. instrument development process is still expensive, not popular. MRI can be used to solve the current CT scan can not solve the problem of the special parts, such as: ditch on the lung tumor, MRI can be used for coronal and sagittal scanning, can clearly show the chest wall, such as whether the brachial plexus involvement. central lung cancer can not be enhanced CT scan were, MRI helps to show tumor site. observed from the axial mediastinum, heart, great vessels and large tube, differen
tiating A, B, lung or some help; also help determine the tumor and the central bulge of the distance, thus contributing to consider the possibility of making sleeve resection, or to determine whether surgery. lung cancer patients also found that when the adrenal tumor, MRI in differentiating benign adrenal tumor with metastases have a certain effect. help to identify fiber changes after radiotherapy and local recurrence. obstructive pulmonary atelectasis in high water content, and the tumor is different in the T2-weighted multi-echo sequence as atelectasis may be displayed on the tumor size, thus helping to set up field radiotherapy. MRI and CT is similar, only the size of the current evaluation of lymph node lesions, no tissue specificity.
Lung cancer in Imageology inspection method (e) B scan ultra-
In addition to lesions near the chest wall or diaphragm above, breast cancer patients generally do not make B-scan. B-help in evaluating the tumor near the chest wall is a liquid or solid, whether the encapsulated fluid, which helps B-guided biopsy or drainage; contribute to the observed lung tumor of atelectasis size, to determine the size of the radiation field to avoid being too much normal lung tissue irradiation; following a large areas of dense shadow lung field, B horizontal leap over to show the location, activity, and whether every turn and so on; from the parasternal for B-scanning, contribute to the observed before, during or without mediastinal lymph node enlargement.
CT scan has replaced the brain and liver scintigraphy, as a check for the brain, liver approach, but radionuclide bone scan of bone metastasis is still screening examination method. Thoracic lymph node scintigraphy has some value, but can not distinguish between benign and malignant, and the image less clear.
(Vii) esophageal imaging
Lung cancer patients with swallowing difficulties or symptoms of choking when swallowing, should be considered esophageal tumor invasion or oppression, or produce bronchial – esophageal fistula, need for esophageal imaging.
Mediastinal mass near the CT scan can also be made to swallow a 10% to 30% iodine solution, to show the relationship between tumor and esophagus.
(H) bronchial this video
Has been the traditional tomography, or CT scans are replaced, only occasionally used to identify the chronic inflammatory and obstructive lesions.
(Ix) impact of spinal cord proper
Direct violation of the spine near the spine of lung cancer, spinal cord and spinal metastasis of lung cancer can cause symptoms of nerve compression, spinal cord imaging detection of lesions help of a small spinal metastasis can provide valuable information.
(X) X-ray bones
Radionuclide scanning for the screening checks have a certain false positive, abnormal X-ray film taken after the required verification. MRI can show bone marrow invasion, but can not show the cortical bone, and skeletal X-ray films to be seen with the diagnosis.
Imageology inspection methods of lung cancer (k) angiography of the blood supply of lung cancer, the majority of the bronchial artery, bronchial arteries from the selective injection of contrast agent, can develop tumors and metastatic lymph nodes. However, angiography is an invasive examination, many variations of bronchial arteries, selective bronchial arteriography be difficult, it is less used for diagnosis. For unresectable patients, since the feeding artery infusion chemotherapy have a certain effect.
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