免疫正常者实变型肺隐球菌病CT特点分析  

CT Characteristics of Consolidation Type of Pulmonary Cryptococcosis in Immunocompetent Patients

作　　者：鲁兴启 李跃兴[1] 丁建平[1] 邓凯琳 LU Xingqi;LI Yuexing;DING Jianping;DENG Kailin(Department of Radiology,The Affiliated Hospital of Hangzhou Normal University,Hangzhou 310015,China;Department of Pathology,The Affiliated Hospital of Hangzhou Normal University,Hangzhou 310015,China)

机构地区：[1]杭州师范大学附属医院放射科,杭州310015 [2]杭州师范大学附属医院病理科,杭州310015

出　　处：《中国医学科学院学报》2021年第2期216-221,共6页Acta Academiae Medicinae Sinicae

摘　　要：目的分析免疫正常者实变型肺隐球菌病的CT特点,以提高对此类型肺隐球菌病的诊断水平。方法回顾性分析经临床确诊的20例实变型肺隐球菌病的CT表现。患者均行胸部屏气多层螺旋CT检查,其中10例行CT增强扫描。分析病灶数目、分布、病灶密度及增强表现、CT伴随征及预后等。结果20例患者中,病灶多发16例(80.0%),单发4例(20.0%);16例多发病例中,单侧分布9例(56.0%);所有患者共检出可评估病灶76个,以下叶(57/76,75.0%)、胸膜下(54/76,71.1%)多见。10例行胸部CT增强扫描,可评估病灶39个,其中病灶均匀强化31个(79.5%)、中度强化34个(87.2%),且所有病灶内均显示血管造影征。实变型病灶均伴随多种CT征象,其中支气管充气征发生率63.2%(48个),其中Ⅲ型为37个、Ⅳ型11个;其他晕征、空泡或空洞、胸膜增厚、胸腔积液分别为43/76(56.6%)、9/76(11.8%)、14/20(70.0%)、2/20(10.0%)。7例患者经过治疗后病灶基本吸收,最终以纤维化形式存在。结论免疫正常者实变型肺隐球菌病好发于下叶胸膜下,以单侧分布多见,血管造影征、近端空气支气管征及晕征是其特点,有助于定性诊断。Objective To analyze the CT characteristics of consolidation type of pulmonary cryptococcosis in immunocompetent patients,and thus improve the diagnosis of this disease.Methods A total of 20 cases with consolidation-type pulmonary cryptococcosis confirmed by pathological examinations were studied.Each patient underwent breath-hold multislice spiral CT,and 10 patients underwent contrast enhanced CT.The data including lesion number,lesion distribution,lesion density,performance of enhanced CT scan,accompanying signs,and prognosis were analyzed.Results The occurrence rates of single and multiple lesions were 80.0%(n=16)and 20.0%(n=4),respectively.In all the 16 multiple-lesion patients,the occurrence rate of unilateral lobar distribution was 56.0%(n=9).The 76 measurable lesions mainly presented subpleural distribution(71.1%,n=54)and lower pulmonary distribution(75.0%,n=57).A total of 39 lesions were detected in the 10 patients received contrast enhanced CT,in which 31 lesions(79.5%)showed homogeneous enhancement,34 lesions(87.2%)showed moderate enhancement,and all the lesions manifested angiogram sign.Consolidation lesions were accompanied by many CT signs,of which air bronchogram sign had the occurrence rate of 63.2%(n=48),including typesⅢ(n=37)andⅣ(n=11).Other signs included halo signs(43/76,56.6%),vacuoles or cavities(9/76,11.8%),pleural thickening(14/20,70.0%),and pleural effusion(2/20,10.0%).After treatment,the lesions of 7 patients were basically absorbed and eventually existed in the form of fibrosis.Conclusions The lesions in the immunocompetent patients with consolidation type of pulmonary cryptococcosis usually occur in the lower lobe and close to the pleura,mainly presenting unilateral distribution.The CT angiogram signs,proximal air bronchogram signs,and halo signs are the main features of this disease,which contribute to the diagnosis.

关 键 词：肺 隐球菌 X线计算机体层摄影术 

分 类 号：R445.3[医药卫生—影像医学与核医学] R445.4[医药卫生—诊断学]