Templeton P A, Caskey C I, Zerhouni E A
Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institutions, Baltimore, Maryland.
Radiol Clin North Am. 1990 May;28(3):631-46.
In 1986, Pearson reported on the lung cancer experience in Toronto over the past 25 years. The number of unresectable operations had decreased from 25 to 5%. Operative mortality was down from 10 to 3% and 5-year survival increased from 23 to 40%. The reason for these statistics, he stated, was not better surgery but better selection of surgical candidates, due to invasive and noninvasive techniques. CT and MR imaging are part of those noninvasive techniques and also play an important role in guiding the invasive techniques. Although controversy exists regarding the proper size criteria and axis length in nodal assessment, and the use of imaging in staging T1N0M0 lung cancer, most clinicians rely on CT scans to evaluate the patient with lung cancer. No other imaging test is as comprehensive in evaluating the patient with lung cancer. The main role of MR imaging at this time is as a problem-solving tool. Focused MR imaging examinations should be used to evaluate or to resolve specific questions related to invasion of the chest wall, vascular structures, or brachial plexus, and adrenal mass characterization. MR imaging is also useful in evaluating the hilum and mediastinum in patients who cannot receive intravenous contrast for CT evaluation. The overall accuracy of CT and MR imaging is disappointing, particularly in crucial areas of determining operability such as distinguishing between patients with Stage IIIA or IIIB disease. It is unlikely that CT diagnosis can significantly improve; however, there is substantial potential for improved diagnostic accuracy with MR imaging as continued research moves this technology forward. The future may bring improved tissue characterization and vascular evaluation. At present, CT remains the procedure of choice in the initial assessment of the patient with lung cancer. The radiologist must be prepared to interpret these imaging studies in light of the specific findings that determine the stage and thus potential resectability of lung cancer.
1986年，皮尔逊报告了多伦多过去25年里肺癌的治疗情况。无法切除手术的比例从25%降至5%。手术死亡率从10%降至3%，5年生存率从23%提高到40%。他指出，这些统计数据改善的原因并非手术技术更好，而是由于有创和无创技术的应用，使得手术候选人的选择更加合理。CT和磁共振成像（MR成像）是这些无创技术的一部分，在指导有创技术方面也发挥着重要作用。尽管在淋巴结评估中合适的大小标准和轴长以及在T1N0M0期肺癌分期中使用成像方面存在争议，但大多数临床医生依靠CT扫描来评估肺癌患者。在评估肺癌患者方面，没有其他成像检查能如此全面。目前MR成像的主要作用是作为一种解决问题的工具。应使用针对性的MR成像检查来评估或解决与胸壁、血管结构或臂丛神经侵犯以及肾上腺肿块特征相关的特定问题。MR成像在评估无法接受静脉造影剂进行CT评估的患者的肺门和纵隔时也很有用。CT和MR成像的总体准确性令人失望，尤其是在确定可切除性的关键区域，如区分IIIA期或IIIB期疾病患者时。CT诊断不太可能有显著改善；然而，随着研究的不断推进，MR成像在提高诊断准确性方面有很大潜力。未来可能会带来更好的组织特征分析和血管评估。目前，CT仍然是肺癌患者初始评估的首选检查方法。放射科医生必须准备好根据确定肺癌分期及潜在可切除性的具体发现来解读这些成像研究。
