新發現的胸部影像學檢查結果：正子攝影和電腦斷層報告-胸腔內科

正子攝影和電腦斷層報告？

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以下是今年3月份剛確診的電腦斷層報告(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月份電腦斷層報告(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月份電腦斷層報告(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.請問正子攝影肺門的亮點是原本舊的？
還是新長出來的？
如果是舊的是不是表示症狀沒有改善？
為何還會有亮點？
請問要如何處理？
如果是新長出來的，是不是表示已經抗藥了？
要如何處理？
改其他藥物嗎？
還是化療？
放療？
2.有沒有打顯影劑會影響肺門區的判讀嗎？
3.建議開刀取出主腫瘤和肺門的腫瘤嗎？
如果開刀，會重新化驗嗎？
是全部一起化驗？
還是主腫瘤和肺門分開化驗，化驗就可以知道肺門腫瘤是新長出來？
還是舊的嗎？
4.需要再次做NGS基因檢測嗎？
如果沒做真的抗藥了，會不會以後沒有腫瘤檢體可以化驗？
5.請問醫院開刀取下腫瘤檢體會存放多久？
6.已經做過正子攝影，是不是可以排除腦轉移？
還是要做MRI才能確認？
近期有頭痛和頸部僵硬疼痛，但疼痛程度不需要服用藥物，請問這樣需要照MRI嗎？
還是心理因素造成？
抱歉報告和問題較多，謝謝醫生的回答

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小小，40~49歲女性，詢問日期：2022/10/31