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？

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

小小，40~49歲女性，詢問日期：2022/10/31

楊文達醫師回覆-胸腔內科

醫事人員經歷：衛生福利部臺中醫院胸腔暨重症醫學科主任（原胸腔內科）

您好:
正子攝影報告和電腦斷層差不多, 應該是改善中的右下肺腫瘤和右肺門淋巴結殘餘病灶, 正子攝影可排除腦轉移, 繼續目前治療, 其他後續觀察及計畫可與您的主治醫師詢問!

回覆日期：2022/10/31
資料來源：台灣e院 - 正子攝影和電腦斷層報告

彙整補充說明

根據您提供的報告和問題，以下是針對您情況的詳細解釋與建議：
1. 正子攝影肺門的亮點：在正子攝影中，肺門區域的亮點可能是舊的病灶或新出現的病變。
若該亮點是舊的，這可能表示病情未有改善，且仍然存在活躍的腫瘤或炎症反應。
若是新出現的病灶，則可能表示腫瘤的進展或抗藥性。
這種情況下，建議與主治醫師討論是否需要改變治療方案，例如考慮其他靶向藥物、化療或放療。

2. 顯影劑的影響：在進行電腦斷層掃描時，使用顯影劑可以提高影像的清晰度，幫助醫生更好地判斷病變的性質。
雖然正子攝影本身不需要顯影劑，但如果之前的CT檢查使用了顯影劑，這可能會影響對肺門區的判讀，因為顯影劑的分布可能會影響影像的解讀。

3. 手術建議：是否建議開刀取出主腫瘤和肺門的腫瘤，需根據腫瘤的大小、位置及病人的整體健康狀況來決定。
如果決定手術，通常會在手術中取出腫瘤後進行病理檢查，這樣可以確定腫瘤的性質及是否為新長出來的病變。
病理檢查會根據取出的組織進行，通常會一起檢查，但具體情況需依醫師的判斷。

4. NGS基因檢測：如果懷疑腫瘤已經抗藥，進行NGS基因檢測可以幫助了解腫瘤的基因變異，並指導後續治療。
若未來需要進行檢測，若腫瘤組織不足，可能會影響檢測結果。
因此，建議在手術時儘量保留足夠的腫瘤組織進行檢測。

5. 腫瘤檢體的存放：醫院通常會根據規定保存腫瘤檢體，時間可能從數月到數年不等，具體取決於醫院的政策和檢體的性質。
建議您向醫院的病理科詢問具體的保存期限。

6. 腦轉移的檢查：正子攝影能夠提供有關全身的代謝活動的資訊，但對於腦部的轉移，MRI仍然是更為敏感的檢查方式。
如果您有頭痛和頸部僵硬的症狀，儘管疼痛程度不需要服用藥物，建議還是進行MRI檢查，以排除腦轉移的可能性。
這些症狀可能與心理因素有關，但也不應忽視潛在的病理原因。

總結來說，您的情況需要持續的醫療監測和專業的醫療建議，建議您與主治醫師保持密切的溝通，並根據醫師的建議進行後續的檢查和治療。
希望您早日康復！