艾滋病合并卡氏肺囊虫肺炎的影像学研究  

Study on imaging findings of AIDS with pneumocystis carinii pneumonitis

作　　者：孟祥 高剑波[2] 赵青霞[3] 孙燕[3] 杨学华[2] 张岩[2] 周志刚[2] 郭华[2] 岳松伟[2] 丁昌懋[2] 

机构地区：[1]商丘市中心医院影像科,河南商丘476000 [2]郑州大学第一附属医院放射科,河南郑州450052 [3]郑州市第六人民医院传染科,河南郑州450052

出　　处：《中国医学影像技术》2008年第5期687-691,共5页Chinese Journal of Medical Imaging Technology

基　　金：河南省卫生厅科技攻关项目计划(2004-13-02)资助

摘　　要：目的探讨艾滋病合并卡氏肺囊虫肺炎(PCP)病人Mcloud分类的影像学特征。方法对42例艾滋病合并PCP病人进行CT平扫及HRCT扫描,扫描结果应用Mcloud分类法分类。结果42例病人中磨玻璃样阴影的7亚类分布和范围显示,呈Ⅳ类分布的有23例病人(54.8%),呈Ⅵ类分布的有19例病人(45.2%)。按肺野分类中,呈M/U分布的7例(16.7%),呈M/L分布的5例(11.9%),呈M/M分布的9例(21.4%),呈BF分布的14例(33.3%),呈B/F分布的7例(16.7%)。磨玻璃样发生率100%;不规则小条状、丝网状影35例(83.3%):呈s1/1样改变的3例(8.6%),s1/2的5例(14.3%),s2/2样改变的10例(28.6%)。st1/2的8例(22.8%),st2/2样改变4例(11.4%),st2/3的5例(14.3%)。网结状影36例(85.7%):x1/2改变2例(5.6%),x2/2改变8例(22.2%),x2/3改变4例(11.1%),xy2/2改变10例(27.7%),xy2/3改变8例(22.2%),xy3/3改变2例(5.6%),xyz2/3改变2例(5.6%)。小圆结节影21例(50.0%):p1/1改变3例(14.3%),p1/2改变2例(9.5%),p2/2改变9例(42.9%),pq1/2改变4例(19.0%),pq2/2改变3例(14.3%)。结论HRCT对PCP的病变特征具有高度敏感性,可发现较细微病变;Mcloud分类法应用的符号和描述把影像学、组织学及病变类型更好地结合起来,适用于不同时期PCP病人的分类;艾滋病合并PCP胸部X线常呈现以肺门为中心或中下肺野为著的弥漫对称逐渐向上、向远侧浸润的磨玻璃样改变、丝网状影或网结状改变的影像学表现。Objective To evaluate the value of Mcloud classification on pneumocystis carinii pneumonia （PCP） with AIDS and the imaging findings. Methods Forty-two AIDS patients with PCP underwent routine CT and HRCT scan. CT scan was performed at the end of the deep inspiration from apex of lung to costo-phrenic angle. The scanning parameter of routine CT as following： collimation was 10 mm, pitch = 1, 120 kV, 200 mA. The scanning parameter of HRCT as following： 140 kV, 280 mAs, collimation was lmm, interval was 5-10 mm, window width was 1000-1500 HU, window level was - 500--700 HU,matrix was 512× 512. We used Mcloud classification to describe PCP. Results One ＂Ground glass＂ opacities were encountered in all PCP （100%） patients. Seven subdivisions according to location and distribution were obained with IV=23（54.8%）and VI=19（45.2%）. With regard to distribution in lung field classification： M/U=7 （16.7%）, M/ L=5 （11.9%）, M/M=9 （21.4%）, BF=14 （33. 3%）, B/F=7 （16.7%）. ＂Small linear or irregular＂ opacities were encountered in 35 eases （83.3 %） patients. With regard to diameter of predominant lesion and profusion： s1/1 = 3 （8.6 %）, sl/2=5 （14.3%）, s2/2=10 （28. 6%）, stl/2=8 （22.8%）, st2/2=4 （11.4%）, st2/3=5 （14.3%）. ＂Reticulonodular＂ pattern 36 eases （85.7%）： xl/2=2 （5.6%）, x2/2=8 （22.2%）, x2/3=4 （11.1%）, xy2/2=10 （27.7%）, xy2/3=8 （22.2%）, xy3/3=2 （5.6%）, xyz2/3=2 （5.6%）. ＂Small rounded （nodular）＂ opacities 21 eases （50. 0%）： pl/1=3 （14.3%）, pl/2=2 （9.5%）, p2/2=9 （42.9%）, pql/2=4 （19.0%）, pq2/2=3 （14.3%）. Conclusion HRCT Provides high sensitivity in detecting the characteristics of PCP. It can detect tiny lesions. Different symbols and discriptions of Mcloud classification which combine imageology, histology and pathology are suitable for classifying different stage of PCP. The typical imaging features of AIDS with PCP include diffuse ground glass opacification, small irregular ch

关 键 词：获得性免疫缺陷病 肺炎 肺囊虫 放射学 

分 类 号：R699.2[医药卫生—泌尿科学] R739.41[医药卫生—外科学]