初治活动性继发性肺结核的HRCT影像研究  

The High-resolution CT Imaging of Active Secondary Pulmonary Tuberculosis in the Primary Therapy

作　　者：吕岩[1] 李成海[1] 谢汝明[2] 王岳[1] 周震[1] 宁锋钢[1] 周新华[1] 贺伟[1] 

机构地区：[1]首都医科大学附属北京胸科医院医学影像科,北京101149 [2]首都医科大学附属北京地坛医院放射科,北京100015

出　　处：《结核病与胸部肿瘤》2016年第2期113-118,共6页Tuberculosis and Thoracic Tumor

基　　金：首都卫生发展科研专项资助项目（No.2011-2016-01）

摘　　要：目的研究初治活动性继发性肺结核的HRCT影像特征。方法收集首都医科大学附属北京胸科医院收治的323例初治活动性继发性肺结核病例，观察HRCT征象，包括病变分布、形态特点，并将菌阴肺结核与菌阳肺结核两组患者征像比较，采用×。检验及Logistic回归分析。结果本研究323例患者中，病变分布于单叶86例（26．6％），其中单叶单段41例，单叶多段45例；多叶多段237例（734％），其中上叶尖后段及下叶背段分布较多，分别为205例和146例。HRCT征象：小叶中心分布的结节，包括气腔结节或腺泡结节患者282例（70．6％），“树芽征”患者193例（59．8％），其中45例（占全部病例13．9％，占气腔结节或腺泡结节病例的15．6％）患者可见“反晕征”，高密度的壁及其内磨玻璃密度影内均见结节影；小叶性实变及亚段性实变293例（90．7％），段性实变者115例（35．6％），叶性实变者22例（6．8％），密度不均匀者内见散在边缘模糊的斑点及斑片状低密度影，部分病变内另见支气管扩张和空洞。球形病变及团块状影37例（11．5％），短径〉3cm，增强扫描边缘轻度强化或不均匀轻中度强化伴斑片状或不规则低密度区。肺间质改变者123例（38．1％），小叶内间质增厚者105例（85．4％）；小叶间隔增厚者35例（28．5％），边缘大部分模糊；轴心间质增厚86例（69．9％），远心端轴心间质增厚78例（90．7％），主要表现为支气管壁增厚。实质、间质混合病变：磨玻璃密度影131例（40．6％）；伴随征象：空洞112例（34．7％），厚壁空洞74例（66．7％），薄壁空洞29例（25．9％），无壁空洞21例（18．8％）；支气管扩张65例（20．1％），位于实变影内及空洞引流支气管影，管腔不均匀者呈静脉曲张样或局限动脉瘤样。菌阳及菌阴肺结核中HRCT征象比较，两组患者树�Objective To study the high-resolution CT imaging feature of active secondary pulmonary tuberculosis in the primary therapy. Methods High-resolution CT imaging of 323 eases with active secondary pulmonary tuberculosis in the primary therapy in Beijing Chest Hospital, Capital Medical University were collected, and the lesion distribution and morphological characteristics were observed, respectively. The imaging of high-resolution CT in pulmonary tuberculosis of negative and positive sputum for tuberculous bacterium were compared, the difference of count data in two groups were analyzed by Chisquare test and Logistic regression. Results Among the 323 cases, the lesions of 86 （26.6%） eases located in single lung lobe, the lesions of 237 （73.4%） eases located in more lung lobe and more segment, mostly in S 1, $2 and S6. High-resolution CT manifestation： centrilobular nodles, there were alveolar nodules in 282 eases and ＂tree-in-bud＂ sign in 193 cases, 45 eases with ＂reversed halo sign＂ among them, reversed halos with nodular walls and nodules inside the halos were observed. There were 293 （90.7%） lobular and subsegmental consolidation, 115 （35.6%） segmental comsolidation, 22 （6.8%） lobe consolidation, of which, the CT findings showed small patchy low-density areas in the lesions, and with bronchiectasis and cavity in part lesions. There were 37 spherical or mass lesions, 〉 3 cm, the contrast-enhanced CT scanning showed that ring enhancement and uneven enhancement appeared small patchy low-density areas and boundaries were vague. There were 123 interstitial abnormalities, intralobular, include intralobular reticular reticulation with 105 （85.4%） cases, thickened interlobular septum with 35 （28.5%） cases, thickened peribroncho-vascular interstitium with 86 （69.9%） cases, thickening of the airway wall in telecentric end with 78 （90.7%） cases. Lung parenchyma and interstitial lesions： 131 （40.6%） cases with ground-glass opacity. Along with the sign： 112 （34.7%）

关 键 词：肺结核 活动性 X线计算机 体层摄影术 高分辨率 

分 类 号：R816.4[医药卫生—放射医学]