The Value Of CT In Brain Metastasis And Bone Metastasis Of Small Cell Lung Cancer

Part I CT features of small cell lung cancer and its predictive value for brain metastasisObjective To analyze the characteristic CT signs of small cell lung cancer(SCLC)and its correlation with the occurrence of brain metastasis.Materials and methods A total of 118 patients with SCLC confirmed by pathology from June 2015 to December 2018 were enrolled in the study,including 49 patients of brain metastases and 69 of non-brain metastases.The clinical data and chest CT images of all 118 patients with SCLC were retrospectively analyzed.The correlation between chest CT signs and SCLC brain metastasis was further analyzed by univariate and multivariate logistic regression analysis.Results Of the 118 patients with primary SCLC,108 patients were men and 10 were women,52 cases were ?60 years old,and 66 were >60 years old.There were 84 cases in the central type and 34 cases in the surrounding type.The size of the primary tumor(the longest diameter of the primary lesion)? 3cm was 17 cases(14.4%),> 3cm and ? 5cm for 44 cases(37.3%),> 5cm and ? 7cm for 31 cases(26.3%)and > 7cm It was 26 cases(22.0%).There were 15 cases in CT-T1,18 cases in T2 stage,11 cases in T3 stage and 74 cases in T4 stage.The CT-N0 was 10,the N1 was 15,the N2 was 59,and the N3 was 34.70 cases were involved in mediastinal large vessels,including the pulmonary artery or superior vena cava.Pleural condition: pleural effusion and/or pleural nodules or thickening in 24 cases.Univariate analysis(Chi-square test)showed that age,primary tumor location,size,CT-T,CT-N stage,and mediastinal macrovascular disease were the relevant factors for brain metastasis in primary SCLC(P<0.05).Binary logistic regression analysis showed that age(>60 years),primary tumor site(the central type),size(>7cm),CT-T4,CT-N3 phase and macrovascular invasion were associated with brain metastasis(P <0.05),which were risk factors for brain metastasis.There were no significant difference between gender,pleural condition and SCLC brain metastasis(P>0.05).Conclusion 1.The CT of primary SCLC have certain characteristics,mostly central type and CT-T4,N2 stage.The easy invasion of mediastinal large vessels is a characteristic CT feature of SCLC.The final diagnosis still requires pathological examination.2.Partial CT signs of primary SCLC have certain clinical value for the prediction of SCLC brain metastasis,including primary tumor site(central type),size(>7cm),CT-T4,CT-N3 phase and mediastinal large vessels invasion are risk factor for SCLC brain metastasis.Part 2 The relationship between post-chemotherapy osteosclerotic changes and chemotherapy response in small cell lung cancer with bone metastases: a preliminary studyObjectives To explore the relationship between osteosclerotic changes and chemotherapy response in SCLC patients with bone metastases.Materials and methods Thirty-two SCLC patients confirmed by pathological and bone metastasis confirmed by clinical follow-up were enrolled.All patients were the first to receive platinum combination chemotherapy,According to RECITST1.1,lung cancer was divided into effective group(CR+PR)and ineffective group(PD+SD).All bone metastases were divided into osteosclerosis group and non-osteosclerosis group according to their CT imaging features before and after chemotherapy.The relationship between the osteosclerotic changes and the SCLC chemotherapy response in bone metastases was analyzed by chi-square test.Result After two chemotherapy cycles of 32 SCLC patients,26 cases in effective group and 6 cases in ineffective group;there were 22 cases in osteosclerosis group and 10 cases in the non-osteosclerosis group.In the 22 cases of osteosclerosis group,there were 21 cases in in effective group,only 1 case was ineffective,and the 10 patients with non-osteosclerosis group was equally split between invalid and effective group.The incidence of osteosclerosis in bone metastases after all two cycles of effective chemotherapy was significantly higher than that of the ineffective chemotherapy group(p<0.01).Conclusion The osteosclerotic change of bone metastases may be regarded as a imaging index to evaluate the effect of SCLC chemotherapy,which is of importance in clinical practice.