Davis S D
Department of Radiology, New York Hospital-Cornell Medical Center, NY 10021.
Radiology. 1991 Jul;180(1):1-12. doi: 10.1148/radiology.180.1.2052672.
Computed tomography (CT) is clearly more sensitive than chest radiography or conventional linear tomography in the detection of pulmonary metastases. Routine chest CT scans may reveal peripheral nodules as small as 2-3 mm, and high-resolution CT may demonstrate lymphangitic carcinomatosis. Specificity remains a problem, but attention to clinical factors, such as the type of extrathoracic malignancy (ETM), epidemiology, patient age, and prior treatment, should be of assistance. CT is useful in the evaluation of an apparent solitary pulmonary nodule or an equivocal radiographic finding. For single or multiple nodules, CT is essential for planning invasive procedures such as biopsy or surgical resection. Routine CT scanning to screen for occult metastases is indicated only for patients with ETMs that have a high propensity for metastasizing to the lungs and for which detection of pulmonary metastases would influence therapy--bone and soft-tissue sarcomas, most pediatric tumors, choriocarcinoma, nonseminomatous testicular carcinoma, and possibly advanced melanoma. Future large prospective studies evaluating individual malignancies are needed to assess the impact on long-term survival of early detection of pulmonary metastases with CT.
计算机断层扫描（CT）在检测肺转移瘤方面显然比胸部X线摄影或传统线性断层扫描更敏感。常规胸部CT扫描可能发现小至2 - 3毫米的外周结节，高分辨率CT可能显示淋巴管癌病。特异性仍然是一个问题，但关注临床因素，如胸外恶性肿瘤（ETM）的类型、流行病学、患者年龄和既往治疗情况，可能会有所帮助。CT在评估明显的孤立性肺结节或可疑的影像学表现方面很有用。对于单个或多个结节，CT对于规划活检或手术切除等侵入性操作至关重要。仅对有高肺转移倾向且肺转移瘤的检测会影响治疗的ETM患者，才建议进行常规CT扫描以筛查隐匿性转移瘤——骨肉瘤和软组织肉瘤、大多数儿童肿瘤、绒毛膜癌、非精原细胞瘤性睾丸癌，以及可能的晚期黑色素瘤。未来需要进行评估个体恶性肿瘤的大型前瞻性研究，以评估CT早期检测肺转移瘤对长期生存的影响。
