Первый слайд презентации: Federal State Autonomous Educational Institution of Higher Education First Moscow State Medical University named after I.M. Sechenov of the Ministry of Health of the Russian Federation ( Sechenov University)
Radiation diagnosis of lung diseases Completed by: student ICM 6 course 33 group Shestopalov N.R.
Lung cancer is a malignant tumor that develops from the epithelium of the bronchi, bronchial glands, or alveoli. Pulmonary carcinoma takes 1st place among malignant neoplasms in men (17.6%) and only 10th place (3.8%) in women. One-year survival rate is around 50%, so early diagnosis and quality treatment is essential for a good prognosis.
Слайд 3: Lung cancer classification
By histological type According to clinical and anatomical characteristics By stages of the tumor process (TNM classification)
Слайд 4: Histological classification of tumors of the lung and pleura (1999)
Epithelial tumors (benign, pre-invasive, malignant) Soft tissue Mesothelial Mixed Lymphoproliferative Disorders Secondary tumors Unclassified tumors Tumor lesions
Слайд 5: Clinical and anatomical classification
Cancer of large bronchi (central) Small bronchial cancer (peripheral) Nodal Cavity Apical Pneumoniae Mediastinal Alveolar and bronchiole cancer ( bronchioloalveolar )
Слайд 6: Forms of central lung cancer
Endobronchial Exobronchial Peribronchially branched
Слайд 8: Forms of bronchioloalveolar cancer (BAC)
Nodal Pneumoniae Disseminated Mixed
Слайд 9: TNM classification
The TNM classification of lung cancer is based on the assessment of three parameters: T is the size and location of the primary tumor, N - involvement of mediastinal lymph nodes, M - the presence of distant metastases to other organs, including another lung.
Слайд 10: TNM classification Classification of primary tumor according to the 8th revision TNM
Tx Primary tumor cannot be assessed or malignant cells are found in sputum or bronchial lavage, but cannot be detected by imaging or bronchoscopy T0 No signs of primary tumor Tis Carcinoma in situ T1 Tumor ≤3 cm in greatest dimension, surrounded by lung tissue or visceral pleura, without visible invasion proximal to the lobar bronchus on bronchoscopy (without affecting the main bronchus ) T1a (mi) Minimally invasive adenocarcinoma T1a Tumor ≤1 cm in largest dimension T1b Tumor> 1 but ≤2 cm in greatest dimension T1c Tumor> 2, but ≤3 cm in greatest dimension T2 Tumor> 3 but ≤5 cm, or tumor with any of the following: The main bronchus is involved, regardless of the distance to the tracheal keel, but without the participation of the latter
Visceral pleura invasion The tumor is associated with atelectasis or obstructive pneumonitis that extends to the root of the lung, involving part or all of the lung T2a Tumor> 3, but ≤4 cm in greatest dimension T2b Tumor> 4, but ≤5 cm in greatest dimension T3 Tumor> 5, but ≤7 cm in greatest dimension, is either associated with a distinct tumor node (s) as the primary tumor, or directly invades any of the following structures: Chest wall (including parietal pleura and superior sulcus tumors) Phrenic nerve Pericardium T4 Tumor> 7 cm in greatest dimension or associated with a separate tumor node (s) in a different ipsilateral lobe than the primary tumor, or invading any of the following structures: Diaphragm, Mediastinum, Heart, Major vessels, Trachea, Recurrent laryngeal nerve, Esophagus, Vertebral body, keel of trachea
NX Regional lymph nodes cannot be assessed N0 No regional lymph node metastases N1 Metastases to ipsilateral peribronchial and / or ipsilateral thoracic lymph nodes and intrapulmonary nodes, including direct tumor spread to lymph nodes N2 Metastases in the ipsilateral mediastinal and / or bifurcated lymph node (s) N3 Metastasis in lymph nodes in the mediastinum or root of the lung on the opposite side, in the prescaled or supraclavicular lymph nodes on the affected or opposite side
In the 8th edition of the TNM system, metastatic cancer is still classified as M1a if it is confined to the chest (single nodules in the contralateral lung, tumor with dissemination along the pleura, malignant or pericardial effusion). The subclassification for distant metastases has changed: unlike the 7th revision system, which provides only stage M1b (other distant metastases), in the 8th revision system, a division into stage M1b (single distant metastasis) and M1c (multiple distant metastases in one or more organ).
Слайд 14: Pancost tumor
A Pancoast tumor, also known as a superior sulcus tumor, is a relatively rare situation in which primary lung cancer occurs at the apex of the lung and affects the surrounding soft tissue. Pancost's syndrome usually occurs, but in fact it occurs in only a quarter of cases.
Слайд 15: X-ray features
Plain X-ray Plain films show the soft tissue opacity at the apex of the lung. Occasionally, rib involvement or distribution into the supraclavicular fossa may be evident.
Слайд 16: CT scan
Although, as with bronchogenic cancers elsewhere, CT is a workhorse for diagnosis, it has low sensitivity (60%) and specificity (65%) for accurate local staging 7. However, it is excellent for detecting bone lesions.
Слайд 17: MRT
MRT is useful in evaluating apical lung tumors due to its excellent demonstration of soft tissue lesions and is much more sensitive (88%) and specific (100%) for local stage 7 determination. A careful assessment of the brachial plexus is important, as lesions greater than the inferior trunk or C8 nerve root are generally considered inoperable 7. Anatomy is particularly well suited for imaging in the coronary and sagittal planes, and sagittal T1 images provide most of the information needed 2.8.
Слайд 18: PET-CT
For bronchogenic carcinoma in general, it is useful for assessing nodular and distant metastases at baseline. In particular, for Pancost, PET-CT allows you to accurately determine the total tumor volume, which will be important for planning radiation therapy.
Слайд 21: Benign lung tumors
Benign lung tumors are a collective concept that includes a large number of tumors of various origins and histological structures, with different localization and features of the clinical course.
Слайд 22: Classification of benign tumors
In accordance with the histological structure, benign tumors are differentiated into 4 types: epithelial (formed from cells of the surface layer - adenomas and papillomas ); neuroectodermal (formed from cells lining the membrane of long processes of neurons, such as neurofibroma ); mesodermal (formed from fatty and connective tissue, such as fibroids, fibroids, and others); dysembryogenetic (congenital benign formations that have elements of the embryo tissue, such as hamartomas and teratomas ).
Слайд 23: Adenomas
All adenomas are epithelial tumors that develop mainly from the glands of the bronchial mucosa. Among all benign lung tumors, adenomas account for 60-65%. In the overwhelming majority of cases (80-90%) they are centrally located.
Adenoma of the bronchus is a collective concept, since the following types of this tumor are distinguished: carcinoid, mucoepidermoid, cylindromatous and mixed. Taking into account the benign nature of the course of most carcinoids, cylinders and mucoepidermoid tumors in clinical practice, it is advisable to consider them as benign tumors with a tendency to malignancy, and on this basis conditionally retain the term "adenomas" for them, which are divided into 4 main types according to their histological structure: carcinoid (carcinoids), mucoepidermoid, cylindromatous ( cylindromas ) and combined adenomas, in which the structure of carcinoids and a cylinder are combined.
Слайд 25: Diagnostics of the bronchial adenoma
In most cases, all bronchial adenomas are rounded pink-red neoplasms, clearly visible during bronchoscopy, usually no more than 2-3 cm in diameter . Inside, they are smooth, sometimes divided into lobules.
Слайд 27: Bronchial carcinoid in a 55-year-old man
Axial (a) and coronal (b) multidetector CT images of the chest (“lung window”) show a circular mass (arrow) in the left main bronchus (c). Bronchoscopy also revealed an oval mass (arrow). Histopathological analysis of the postoperative specimen showed bronchial carcinoid (d). Macrodrug of lung carcinoid tumor.
Слайд 28: Pulmonary hamartomas
Pulmonary hamartomas are benign growths of cartilage, connective tissue, muscle, fat, and bone. The vast majority of pulmonary hamartomas are located peripherally in the lungs (> 90%), with endobronchial hamartomas accounting for only ~ 5% (range 1.4-10%) of such lesions.
Слайд 29: X-ray features
Often found by chance, they usually present as well-defined nodules or masses (usually small) with smooth or lobed edges. About 60% contains fat 7 and about 20-30% is calcified / ossified (like popcorn) 3. Cavitation is not visible. Size varies: they can be large (> 10 cm), but in most cases they are <2.5-4 cm in diameter 10.13. Growth occurs, but very slowly, with a typical volume doubling time of over 400 days 9.
Слайд 30: Plain X-ray
Chest X-ray is nonspecific and shows soft tissue weakness, a well-defined mass with smooth or lobed edges. Calcification (the classic type of popcorn) may be present and may indicate a diagnosis. Fat is difficult to identify with certainty, although the lesion is usually low density for its size.
Слайд 31: CT-scan
CT is far superior to determining fat in the lesion and calcification. The reported prevalence of calcification in hamartomas on CT varies from 5 to 50%, while fat can be found in 60% of hamartomas on CT. Fat components can be localized or spread within the nodule. The presence of fat in a well-circumscribed single pulmonary node that does not show significant growth is inherently pathognomonic for a hamartoma of the lung and no further investigation is required. Calcification is usually dispersed in the form of multiple lumps throughout the lesion in a popcorn configuration.
Слайд 32: MRT
T1: non-uniform signal mostly intermediate signal 8 high signal lesions represent fat low signal areas representing fibrous or calcified material T2: high signal due to fat and cartilage components low signal areas representing fibrous or calcified material T1 C + ( Gd ): Non-uniform gain observed
Слайд 33: Hamartoma
An example of a hamartoma at the root of the right lung on the radiograph (left). On the right - the most typical picture of hamartoma with localization in the left lung (linear tomogram). A rounded shadow is visible in the left pulmonary field, with smooth edges, a heterogeneous structure (with multiple calcifications in the center).
Слайд 34: Sclerosing hemangioma
Pulmonary pneumocytomas, formerly known as pulmonary sclerosing hemangiomas, are rare benign lung neoplasms. Most patients have no symptoms. It is a rare benign tumor that is microscopically characterized by four major histological components (solid, papillary, sclerotic and hemangiomatous ) in varying proportions. A thin fibrous pseudocapsule separates it from the adjacent compressed lung parenchyma.
Слайд 35: X-ray features
lesions are 1 to 8 cm in diameter, although most are <3.5 cm.
Слайд 36: Plain X-ray
they usually tend to manifest as solitary, well-defined nodular lesions (oval to rounded shadow) they sometimes contain areas of calcification a sign of an air meniscus may appear: sickle-shaped enlightenment on the periphery of the pulmonary node
Слайд 37: CT-scan
often manifests as a well-defined intraparesimal nodular mass (often juxta -pleural) areas of calcification may be present may show a radiolucent area around the lesion shows significant but non-uniform gain
Слайд 38: CT image of the formation of the upper lobe of the right lung (frontal reconstruction and axial slices)
Слайд 39: Alveococcosis
Helminthiasis from the cestodosis group, characterized by a severe chronic course, primary tumor-like liver damage, often with metastases to the brain and lungs, as well as to many other organs. The causative agent is the larva ( oncosphere ) of the tapeworm alveococcus. The membrane of the alveococcus consists of one layer, in the section the parasite has a cellular structure, the cells contain a yellowish gelatinous mass. The parasite in the larval stage multiplies according to the type of indomitable division, infiltrating the surrounding tissues, affects almost all organs, but more often the liver and lungs.
Слайд 40: Diagnostics of the alveococcosis
As shown by the analysis of MSCT data, the semiotics of alveococcus is polymorphic, the variants of the lesion can be divided into 3 types - infiltrative, tumor-like, mixed. The formation of different-sized cavities in the affected area is determined in all forms of parasitic damage. On radiography of the lungs and MSCT, the infiltrative form of alveococcus manifested itself in the form of pneumonia-like infiltrates, located mainly in the lower and middle lobes of the lungs with signs of cavities forming against their background.
Слайд 41: Alveococcus of the right lung: a) X-ray of the lung - infiltration of the lower lobe of the right lung;
Слайд 42: b) MSCT - infiltration of lung tissue with the presence of fluid inclusions is determined in the lower lobe of the right lung
Слайд 43: Diagnostics of the alveococcosis
With a tumor-like form, multiple soft-tissue, oval-shaped formations (up to 3-6) with uneven, indistinct, vague contours, sizes from 2 to 6.5 cm in diameter, with a density of 35-53 HU were identified. In the mixed form, there were both infiltrative and focal changes in the lungs with the above-described macrostructure on radiography and MSCT.
Слайд 44: Diagnostics of the alveococcosis
The absence of accumulation of contrast agent in altered tissues on MSCT and paramagnetics on MRT, signs of fluid content in the projection of the zone of changes according to MRT data, in our opinion, are the main symptoms that suggest lung alveococcosis. As with echinococcosis, it is of great importance to identify changes similar to the lungs in the liver and other organs.
Слайд 45: Lung syphilis
Lung syphilis is a manifestation of visceral syphilis. The early forms of visceral syphilis are observed in the early periods (in the first 2-3 years of the disease). Lesions of the respiratory system in early syphilis are rare. Acute syphilitic bronchitis and pneumonia occur. Syphilitic pneumonia in its course is similar to the same forms of tuberculous and nonspecific pneumonia.
Слайд 46: Lung syphilis
Late forms of visceral syphilis develop in the later periods of the disease, no earlier than 3-4 years after infection. Later, syphilitic damage to the lungs is expressed in the formation of individual gummy nodes or diffuse gummy peribronchial infiltration, and can also be represented by scattered small gummy foci. Most often, the process is localized in the lower and middle lobes of the right lung. A more rare lesion, but with more severe consequences is gummy-ulcerative syphilis of the bronchi. Gummas most often affect the trachea and large bronchi. The process is accompanied by deep destruction of the bronchi and the surrounding lung tissue.
Слайд 48: Assman-Redeker hearth
This is a rounded infiltrate in the subclavian region with secondary infiltrative tuberculosis. Infiltrative pulmonary tuberculosis is a secondary form of pulmonary tuberculosis, a widespread lesion of the lungs that occurs against the background of specific hypersensitization of the lung tissue and a significant increase in the exudative tissue reaction in the area of inflammation.
Слайд 49: Variants of infiltrative pulmonary tuberculosis
According to the X-ray picture, there are four main variants of infiltrative pulmonary tuberculosis: 1. Lobular or limited infiltration. 2. Cloudy or round infiltration. 3. Segmental, lobar tuberculous pneumonia. 4. Periscissuritis.
Слайд 50: X-ray diagnostics:
a) broncho -lobular infiltration: limited darkening of the polygonal shape more often in the cortical zone of the I, II, IV segments up to 3 cm, low intensity, blurred contours, elongated towards the root b) rounded: limited darkening of a rounded shape, medium intensity, clear, not sharp contours (in the subclavian region - Assmann-Redeker infiltration); from the medial parts of the darkening to the root, sometimes an inflammatory pathway (with "tennis racket"); when decaying - cavities in the center
Слайд 51: X-ray diagnostics:
c) cloudy - uneven darkening within several segments, contours without clear boundaries ("dissolve" in the surrounding tissue); several decay cavities, rarely one large d) periscissurite : darkening of a triangular shape with a distinct lower border, the base is outward ( Serzhan's triangle) e) lobitis : a syndrome of widespread darkening with accentuated pleural sheets (with a lesion of the middle lobe - triangular darkening with apex outward)
Слайд 54: Idiopathic fibrosing alvelitis (idiopathic pulmonary fibrosis (IPF))
IPF is a special form of chronic progressive fibrosing interstitial pneumonia of unknown etiology, which occurs mainly in older people, affects only the lungs and is associated with the histological and / or radiological pattern of common interstitial pneumonia (CIP ). Common interstitial pneumonia (CIP ) is a histological pattern, the main signs of which are the presence of fibroblastic foci, interstitial chronic inflammation, fibrosis mainly in the zones of bronchiolo -alveolar transitions, in the subpleural / paraseptal zones with the formation of "honeycombs".
Слайд 55: Diagnostics
To assess the condition of the lungs in patients with IPF, so-called high-resolution CT (HRCT) is performed. This technique consists of performing thin, less than 1.5 mm, tomographic slices, and using a high-resolution algorithm for image reconstruction. X-ray and HRCT picture reflects morphological changes in the lungs, which are defined as common interstitial pneumonia (CIP ). The main signs of CIP in HRCT are diffuse bilateral reticular changes; in combination with small subpleural air cysts (cellular lung) and / or traction bronchiectasis; the predominance of changes in the cortical and basal parts of the lungs.