偶发肺结节病的管理.ppt
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1、Guidelines for Management of Incidental Pulmonary Nodules Detected on CT images:From the Fleischner Society 2017 5/26/20241.The Fleischner Society Since then,new information has become Since then,new information has become available;therefore,the guidelines have been available;therefore,the guidelin
2、es have been revisedrevised to reflect current thinking on nodule to reflect current thinking on nodule management.management.Fewer follow-up examinations ArangeoftimesChangeNot intended forImmunocompromised patientsPrimary cancersYounger than 35 yearsIncrease the minimum threshold size5/26/20242.Th
3、e Guidelines5/26/20243.The Guidelines5/26/20244.General RecommendationsThin sections Coronal Coronal reconstructedreconstructedS Sagittal agittal reconstructedreconstructed5/26/20245.General RecommendationsFigure 1:(a)Transverse 5-mm CT section shows an apparently pure ground-glass nodule in the lef
4、t lower lobe(arrow).(b)Transverse 1-mm CT section at the same level as a reveals that this is a suspicious part-solid nodule with cystic components(arrow).5/26/20246.General RecommendationsFigure 2:(a)Transverse 1-mm CT section shows a nodular opacity adjacent to the minor fissure(arrow).(b)Coronal
5、reconstructed CT image shows that the opacity is a benign linear scar or lymphoid tissue(arrow).5/26/20247.General RecommendationsLow-radiation3mGyDose modulationIterative reconstructionA similar technique be used to perform the follow-upA similar technique be used to perform the follow-upexaminatio
6、n.examination.5/26/20248.General RecommendationsThe average of long-and short-axis diameters.Measurements shouldbe rounded to the nearest millimeter.Volume thresholds of 100and 250 mm 3 are used for volumetryinstead of the 6-and 8-mm.5/26/20249.Recommendations for Solid Lung NodulesThe Guidelines5/2
7、6/202410.Recommendations for Solid Lung NodulesSingle solid noncal-cified nodules(8mm)Tissue samplingAs nodules become larger,their As nodules become larger,their morphologymorphology becomes becomes more distinct,and management should be strongly more distinct,and management should be strongly infl
8、uenced by the appearance of the nodule rather than by influenced by the appearance of the nodule rather than by size alonesize alone.PET/CTOptional CT at 3 monthsMeasurement of attenuationMeasurement of attenuation in solid nodules can be in solid nodules can be helpful to determine the presence of
9、helpful to determine the presence of calcification or fatcalcification or fat,either of whicheither of whichcan have major diagnostic implications.can have major diagnostic implications.5/26/202415.Figure 5:(a)Lung window and(b)soft-tissue window 1-mm transverse CT sections show a smoothly marginate
10、d solid nodule(arrow)with internal fat and calcification,consistent with a hamartoma.No further CT follow-up is recommended for such findings.Recommendations for Solid Lung Nodules5/26/202416.Figure 6:(a)CT image shows a smoothly marginated solid nodule with central calcification,typical of a healed
11、 granuloma.No further CT follow-up is recommended for such nodules.(b)CT image shows a smoothly marginated solid nodule with laminar calcification,typical of a healed granuloma.No further CT follow-up is recommended for such findings.Recommendations for Solid Lung Nodules5/26/202417.Recommendations
12、for Solid Lung Nodules Figure 7:Transverse 1-mm CT section through the left upper lobe shows a suspicious solid spiculated nodule(arrow).Surgery revealed invasive adenocarcinoma.5/26/202418.Recommendations for Solid Lung Nodules Figure 8:Transverse 1-mm CT sections obtained 10 months apart show a hi
13、ghly suspicious pattern of progressive thickening in the wall of a right lower lobe cyst(arrow).Resection revealed invasive adenocarcinoma.5/26/202419.Recommendations for Solid Lung NodulesMultiple solid noncal-cified nodules(6mm)Low riskHigh riskSuspiciousSuspicious morphology morphologyUpper lobeU
14、pper lobe location locationOptional CT Optional CT at at 12 months12 months They most often represent either healed granulomata from a previous infection or intrapulmonary lymph nodes.5/26/202420.Recommendations for Solid Lung NodulesMultiple solid noncal-cified nodulesMetastases remain a leading co
15、nsideration,particularly Metastases remain a leading consideration,particularly when the distribution of nodules has when the distribution of nodules has peripheralperipheral and/or and/or lower zonelower zone predominance,and metastases will grow predominance,and metastases will grow perceptibly pe
16、rceptibly within 3 months.within 3 months.Optional CT at 36 months(At least one nodule 6 mm or(At least one nodule 6 mm orlarger in diameter)larger in diameter)Optional CT at 1824monthsdepend onestimated riskAn increase in risk for primary cancer,as the total nodule An increase in risk for primary c
17、ancer,as the total nodule count increased from count increased from 1 to 41 to 4,but a decrease in risk for those,but a decrease in risk for those with with five or morefive or more nodules,most of which likely resulted nodules,most of which likely resulted from from prior granu-prior granu-lomatous
18、 infectionlomatous infection.5/26/202421.Recommendations for Solid Lung Nodules Figure 9:CT image shows multiple solid nodules of varying size with lowerzone predominance(arrows)secondary to metastatic thyroid carcinoma.5/26/202422.Recommendations for Solitary Subsolid Lung NodulesThe Guidelines5/26
19、/202423.Recommendations for Solitary Subsolid Lung NodulesSolitary pure ground-glass nodules(6mm)5/26/202424.Solitary pure ground-glass nodules(610mm)Optional CT Optional CT at at 612 months612 monthsEvery Every 2 years 2 years thereafter until thereafter until 5 years5 yearsRecommendations for Soli
20、tary Subsolid Lung Nodules5/26/202425.Recommendations for Solitary Subsolid Lung Nodules Figure 10:Transverse 1-mm CT sections through the right lower lobe.(a)A well-defined 6-mm groundglass nodule(arrow)can be seen.(b)Image obtained more than 2 years after a shows a subtle increase in the size of t
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- 偶发 结节 管理
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