粟粒性肺结核、尘肺和粟粒性肺转移瘤的HRCT鉴别诊断  

Differentiation of Miliary Nodules on HRCT: Miliary Pulmonary Tuberculosis versus Pneumonoconiosis and Metastatic Tumor in Lung

作　　者：褚志刚[1] 余建群[1] 袁红梅[1] 原珍团[1] 张优仪[1] 

机构地区：[1]四川大学华西医院放射科,四川成都610041

出　　处：《华西医学》2009年第6期1494-1497,共4页West China Medical Journal

摘　　要：目的:探讨粟粒性肺结核、尘肺和粟粒性肺转移瘤的HRCT表现及鉴别特征。方法:回顾性分析经本院临床证实的38例粟粒性肺结核,33例尘肺和41例粟粒性肺转移瘤的常规CT及HRCT资料,观察结节的大小、分布特点,统计分析三者的差异。结果:38例粟粒性肺结核中,结节全肺野和内、中、外带分布均匀者分别为32例(84.2%)和29例(76.3%),33例(86.8%)以全小叶分布为主。33例尘肺中,结节以中、上肺野和内中带分布为主者分别为30例(90.9%)和31例(93.9%),28例(84.8%)以小叶中心分布为主。41例粟粒性肺转移瘤中,结节以中下肺野和中、外带分布为主者分别为37例(90.2%)、34例(82.9%),36例(87.8%)以小叶实质分布为主。结核、尘肺及肿瘤结节大小均匀分别为31例(81.5%)、9例(27.3%)、6例(14.6%);边界清晰者分别为36例(94.7%)、31例(93.9%)、39例(95.1%);合并有磨玻璃征者分别为34例(89.4%)、7例(21.2%)、21例(51.2%)。结论:HRCT能够很好地显示粟粒性肺结核、尘肺及粟粒性肺转移瘤结节的分布特点,在诊断和鉴别诊断这三种粟粒性疾病中具有重要价值。Objective： To evaluate the high-resolution CT features of miliary tuberculosis,pneumoconiosis and pulmonary metastatic.Methods： The CT and HRCT imaging features（the size and distribution of nodules） of 38 miliary tuberculosis,33 pneumoconiosis and 41 miliary metastatic pulmonary nodules were analyzed retrospectively.The differences among them were evaluated by statistics.Results： Of all the 38 miliary pulmonary tuberculosis,nodules of 32（84.2%） and 29（76.3%） cases distributed over whole lung field and inner,median and outer zones uniformly.Of all the 33 pneumonoconiosis,nodules of 30（90.9%） and 31（93.9%） cases distributed over upper and middle lung field and inner,median zones predominantly.Of all the 41 miliary lung metastatic tumor,nodules of 37（90.2%） and 34（82.9%） cases distribute over middle and lower lung field and median and outer zones predominantly.Distribution of nodules in lobular,centrolobular and lobular parenchyma of secondary lobule were seen in 33（86.8%） miliary tuberculosis,28（84.8%） pneumonoconiosis and 36（87.8%） pulmonary metastatic tumor predominantly,respectively.Tuberculosis,pneumonoconiosis and tumor showed homogeneous nodules in 31（81.5%）,9（27.3%）,6（14.6%）,well-defined nodules in 36（94.7%）,31（93.9%）,39（95.1%） and ground glass opacity of the lung in 34（89.4%）,7（21.2%）,21（51.2%）,respectively.Conclusion： HRCT is sensitive for showing the nodules distribution of miliary pulmonary tuberculosis,pneumonoconiosis and metastatic tumor and plays an important role in the diagnosis and differential diagnosis of these three kinds of miliary diseases.

关 键 词：肺 结核 尘肺 转移 体层摄影术 X线计算机 

分 类 号：R521[医药卫生—内科学] R135.2[医药卫生—临床医学] R734.2