孤立性肺结节：良性与恶性对比

rtly solid nodule containing ground-glass component most likely to be malignant

On the far left a lesion that only has a groundglass appearance and next to it a lesion that has both ground-glass and solid components. The likelihood of malignancy is 1:5 for the lesion on the far left and 2:3 for the lesion with both ground-glass and solid components.
Air Bronchogram sign 空气支气管征


Recent studies have showed that an air bronchogram is more commonly seen in malignant pulmonary nodules. It is most commonly seen in BAC (bronchoalveolar cell carcinoma) and adenocarcinoma. 最近一项研究表明，在恶性结节中经常看 见空气支气管征，主要见于支气管肺泡癌 或腺癌
Solid and Ground-glass components 实性与磨玻璃样

Another result from screening studies is that nodules containing a ground-glass component are more likely to be malignant (5). 另一项研究表明，含有磨玻璃样密度的结节很可能是恶性 结节。 Partly solid lesions with ground-glass components had a malignancy rate of 63%. 部分实性和磨玻璃样密度是恶性结 节的可能性事63% Nonsolid - only ground-glass lesions had a malignancy rate of 18%. 完全磨玻璃样密度结节16%是恶性结节 Only solid lesions had a malignancy rate of only 7%.完全实性结 节是仅7%是恶性结节
Margin 边缘


Corona radiata sign - highly associated with malignancy (figure) 放射冠征 Lobulated or scalloped margins intermediate probability 分叶征和锯齿征


Smooth margins - more likely benign unless metastatic in origin 边缘光滑见于良性结节，除外转移瘤


On the left two solitary pulmonary nodules. Based upon the morphology, which lesion has the most malignant features? 下列两个结节有哪些恶性特征呢

The lesion on the far left has a spicuated margin and has lucencies within it. The lesion next to it is lobulated in contour and has some spicules radiating to the pleura. It is however homogeneous in attenuation. Based on these findings we should be most concerned that the lesion on the far left is malignant. It proved to be an adenocarninoma, while the other one was a fungal infection. The lucencies and frank air bronchograms should not mislead you in thinking that it probably is infection.
CT:良性与恶性



钙化 大小 生长速度 形状 边缘 支气管含气征 实性或磨玻璃样 增强特征
Calcification 钙化

Diffuse, central, laminated or popcorn calcifications are benign patterns of calcification.

The case on the left shows an airbronchogram seen as a linear lucency (broad arrow) and as a more cystic lucency (small arrow) due to the fact that the bronchus is seen en face.
Size 大小



A solitary pulmonary nodule (SPN) is defined as a single intraparenchymal lesion less than 3 cm in size and not associated with atelectasis or lymphadenopathy. A lesion greater than 3 cm in diameter is called a mass. 孤立性结节定义为小于3cm，不伴有肺不张、淋巴 结转移，大于3cm的为肿块 This distinction is made, because lesions greater than 3 cm are usually malignant, while smaller lesions can be either benign or malignant. 以3cm为界，因为大于3cm的通常是恶性的，而小 于3cm的可能是良性或恶性。



LEFT: 1 in 5 malignant 左边图是5个病灶1个为恶性结节 RIGHT: 2 in 3 malignant 右边图是3个病灶2个为恶性结节
Contrast enhancement 对比增强

Contrast enhancement less than 15 HU has a very high predictive value for benignity (99%). After a baseline scan, 4 consecutive scans at 1 minute interval are performed. 对比增强小于15HU是良性病变的可能性 （99%）
Solitary pulmonary nodule: benign versus malignant 孤立性肺结节：良性与恶 性对比



The differential diagnosis of a solitary pulmonary nodule is broad and management depends on whether the lesion is benign or malignant. 孤立性肺结节的鉴别诊断是很多的，处理方法依 赖于该病变是良性还是恶性 In this overview we will discuss some of the new features that can help to differentiate between benign and malignant nodules based upon CT and PET-CT findings. 在此篇文章，我们着重讨论下一些有助于鉴别良 恶性结节的新特征，此特征是基于CT与PET-CT的 检查结果
弥漫性，中心性，分层，爆米花钙化是良性 钙化，


These types of calcification are seen in granulomatous disease and hamartomas
这些形式的钙化最常见于错构瘤、肉芽肿 性病变



The exception to the rule above is when patients are known to have a primary tumor. For instance the diffuse calcification pattern can be seen in patients with osteosarcoma or chondrosarcoma. Similarly the central and popcorn pattern can be seen in patients with GI-tumors and patients who previously had chemotherapy. 一些病人有原发肿瘤病史，可以表现为良性钙化 例如骨肉瘤、软骨肉瘤可以表现弥漫性钙化。 胃肠间质瘤的病人化疗后可以表现为中心性或苞米 花钙化。

The three-dimensional ratio is measured by obtaining the maximal transverse dimension and dividing it by the maximal vertical dimension. A large three-dimensional ratio indicates that the lesion is relatively flat, which is a benign sign.