電腦斷層報告分析：從檢查結果看肺癌病變進展與治療效果-胸腔內科

電腦斷層報告？

以下是今年3月剛確診肺腺癌3B電腦斷層報告(有打顯影劑)
Imaging findings： CT of the Chest: The non-enhanced axial and reformatted images are obtained by MDCT. Irregular poor-enhanced mass lesions (~5.8cm @ Se/Im:7/20) (~4.8cm @ Se/Im:3/56) in the right lower lobe with invasion to the right hilum and mediastinum. There are enlarged lymph nodes in the right hilum and mediastinum. Interstitial thickening and ground glass opacity in the right lower lobe of the lung. There is a cystic lesion without significant enhancement in the right kidney. Small hypodense lesions are noted in the liver.Impression： 1) Suspect bronchogenic carcinoma (~5.8cm @ Se/Im:7/20) (~4.8cm @ Se/Im:3/56) in the right lower lobe with invasion to the right hilum and mediastinum. Differential diagnosis: tuberculosis. 2) Suspect metastatic lymphadenopathy in the right hilum and mediastinum. 3) Suspect lymphangetic carcinomatosis in the right lower lobe of the lung. 4) A right renal cyst, Bosniak Classification category I. 5) Small hepatic cysts. ============＜＜ Uniform Cancer Staging Format for Lung Cancer ＞＞============= TNMStage: T4N2M0 (according to AJCC cancer staging 8th ed., 2016) AJCC prognostic stage group: IIIB ================================================================= 1.Imaging date Date of examination (Y/M/D): 2022/03/22 Imaging modality Imaging byCT scan 2.Tumor Location: (TumorLocation) ■Right lower lobe Tumor Size: (TumorSize) Nodule/lesion feature: ■Solid (Se/Im:7/20) ■Size of solid part: 5.8 cm (greatest dimension) 3.Tumor invasion: (TumorCharacteristics ＆ OtherOrganInvasion) ■Invades hilar fat ■Separate tumor nodule(s) in the same lobe as the primary ■Invades mediastinum or mediastinal fat 4.Regional nodal metastasis: (LymphNode) ■Suspicious nodal metastatic location(s): ■ipsilateral hilar ■ipsilateral mediastinal 5.Distant metastasis: (MetastaticOrgan) ■No distant metastasis

以下是6月電腦斷層報告(沒有打顯影劑)
CT of chest without contrast enhancement shows: Techniques: From lower neck to the renal level in 3-mm contiguous section for non-enhanced CT studyCoronal (3mm) and sagittal (5mm) reconstruction performedImaging findings: Some small lymph nodes at left supraclavicular region Regressive change of subpleural consolidation in the upper RLL as compared with last imagesObvious regression of the RLL cavitary lesion Ground glass opacity in the medial RLLInfiltration and atelectasis in the RLLStable 4mm nodule in the LLLRegressive change of the enlarged right hilar and mediastinal LN sas compared with last imagesNo definite pneumothorax or pleural effusion No definite pericardial effusion or pneumopericardium A rightrenal cyst No obvious adrenal mass found No definite enlarged lymph nodes noted in the upper retroperitoneum Some small but visible lymph nodes at the upper retroperitoneum Impression: * Some small lymph nodes at left supraclavicular region * Regressive change of subpleural consolidation in the upper RLLas compared with last images* Obvious regression of the RLL cavitary lesion * Ground glass opacity in the medial RLL* Stable 4mm nodule in the LLL* Regressive change of the enlarged right hilar and mediastinal LN

以下是9月照的胸部電腦斷層報告(有打顯影劑)：
Computed Tomography of Chest With and Without Enhancement Shows:Techniques: From lower neck to liver level in 3-mm section for non-contrast CTFrom lower neck to liver level in 3-mm section for contrast CTCoronal (3mm) and sagittal (5mm) reconstructions are also doneThis study has been compared to previous CT study on 20220617Findings:Partial regressive change of subpleural consolidation in the upper RLL as compared with last imagesPartial regressive change of ground glass opacity in the medial RLLStable 4mm nodule in the LLLStable small lymph nodes at left supraclavicular, right hilar and mediastinal regionSome small but visible lymph nodes at the upper retroperitoneum Stable right renal cyst Hypodense lesions without enhancement in right lobe liver, may be cysts No definite pneumothorax.No definite pleural effusion.No definite pericardial effusion.Patent main pulmonary trunk and branches, no obvious thrombus noted.No definite of double lumen, intimal flap or medial displacement of aorta wall suggesting aortic dissection.No definite adrenal mass.No definite hydronephrosis.No definite bone destruction.Kindly note that subtle mucosal lesion could not be well evaluated on routine CTIMP:* Partial regressive change of subpleural consolidation in the upper RLL as compared with last images* Partial regressive change of ground glass opacity in the medial RLL* Stable 4mm nodule in the LLL* Stable small lymph nodes at left supraclavicular, right hilar and mediastinal region

以下是10月照的正子攝影報告：
正子掃瞄: 【 Indication 】: Right lower lung cancer with hilar encasement s/p target therapy. ˉ 【 Procedure 】: The patient was injected intravenously with 376 MBq of F-18-fluorodeoxyglucose( FDG) after fasting. Blood glucose level was 107 mg/dl at the time of injection. Non-contrast-enhanced CT scan was initially and followed by PET scan obtained from the top of the skull to the knees. CT imaging was performed for attenuation correction and anatomic localization only. ˉ 【 Content 】: 1. There is a focal area (about 1.4cm) of increased uptake of radioactivity in right pulmonary hilar region (SUVmax 10.0). 2. Focal areas of mildly-to-moderately increased uptake in the subpleural consolidations over RLL lung (SUVmax ~3.2). 3. Physiological FDG uptake and accumulation in the brain, tonsils, salivary glands, heart, liver, spleen, GI tracts, GU tracts. 4. No definite abnormal FDG uptake can be demonstrated elsewhere. ˉ 【 Impression 】: 1. An FDG-avid lesion in right pulmonary hilar region, residual tumor or LN metastasis. 2. Moderate FDG-avidity in subpleural consolidations over RLL lung, inflammation is likely.

我是今年3月確診為肺腺癌3B，目前在服用安立適治療，請問以下幾個問題：
1.之前沒有照過正子攝影，這次是第1次照正子攝影，請問正子攝影報告上的肺門有亮點，請問是舊的腫瘤癌細胞產生？還是新長的腫瘤癌細胞？如果是舊的，請問為何正子會有亮點？亮點代表？如果是新的腫瘤癌細胞，是不是代表已經抗藥？惡化？轉移了？
2.近期有頭痛情況(不是到是不是心理因素)，也不是很痛，就是不舒服，只有睡眠品質較差頭痛情況會較嚴重，沒有嘔吐，就單純只有頭痛，請問10月剛照正子攝影，是不是可以排除腦轉移？還需要再照腦部MRI嗎？請問腦轉移症狀？頭痛情況是如何疼痛？劇烈疼痛嗎？有哪個時間點會較嚴重嗎？
抱歉問題較多，謝謝醫生的回答

小可，40~49歲女性，詢問日期：2022/10/25

黃伊文醫師回覆-胸腔內科

醫事人員經歷：台灣e院胸腔內科醫事人員

Dear 小可: 肺門縱膈腔淋巴 3 月電腦斷層就有所以後來的正子攝影應該是舊的
正子攝影亮起來因部位不同有不一樣解讀不夠基本上是代表有癌細胞
看起來非新的所以應該沒有惡化
腦部轉移用正子確實比較有缺點建議再照一次腦部MRI確保狀況
腦轉移無法特別用臨床症狀來區分
彰化醫院關心您

回覆日期：2022/10/25
資料來源：台灣e院 - 電腦斷層報告

彙整補充說明

根據您提供的電腦斷層報告和正子攝影結果，您目前的情況顯示出肺腺癌的進展和治療效果的評估。
首先，讓我們針對您的問題進行分析。

1. 正子攝影報告中的亮點解釋：
正子攝影（PET）報告中提到的肺門區域的亮點，通常代表該區域有較高的代謝活性，這可能是由於腫瘤細胞的存在。
這些亮點可能是舊的腫瘤細胞或新的腫瘤細胞。
根據您的報告，右肺門區域的亮點（SUVmax 10.0）可能表示殘餘腫瘤或淋巴結轉移。
若是舊的腫瘤細胞，亮點的存在可能是因為腫瘤仍在活躍代謝，或者是因為周圍的炎症反應。
若是新的腫瘤細胞，則可能代表病情的惡化或抗藥性，這需要進一步的檢查和評估。

2. 頭痛的情況：
您提到的頭痛情況，若是伴隨著睡眠品質差而加重，可能與心理因素有關，但也不排除其他生理因素。
根據10月的正子攝影結果，並未顯示出腦部有明顯的異常代謝活性，這在一定程度上可以排除腦轉移的可能性。
然而，若頭痛持續或加劇，建議進一步進行腦部MRI檢查，以確保沒有潛在的問題。
腦轉移的症狀通常包括持續性頭痛、視力模糊、癲癇發作、認知功能下降等，頭痛的性質可能是鈍痛或劇烈痛，並且可能在早晨或夜間加重。

3. 治療效果的評估：
從您的電腦斷層報告中可以看出，隨著時間的推移，某些病變有明顯的回歸變化，這顯示出治療的效果。
特別是右下肺的空洞性病變和淋巴結的縮小，這都是正面的指標。
然而，仍需密切監測病情的變化，並根據醫生的建議進行定期檢查。

總結來說，您的情況需要持續的關注和評估，特別是對於正子攝影中亮點的意義以及頭痛的原因。
建議您與主治醫師進行詳細討論，並根據醫生的建議進行進一步的檢查和治療。
保持良好的心態，定期回診，並注意身體的變化，這對於您的健康管理是非常重要的。
希望您早日康復！