胸部CT扫描显示簇状微结节样病灶对肺结核的诊断价值  

Diagnostic Value of Pulmonary Tuberculosis with Cluster-like Micronodule in Chest CT Imaging

作　　者：李芳[1] 吕平欣[1] 贺伟[1] 吕岩[1] 李成海[1] 周新华[1] Li Fang;Lv Pingxin;He Wei;Lv Yan;Li Chenghai;Zhou Xinhua(Department of Radiology,Beijing Chest Hospital,Capital Medical University,Beijing 101149,China)

机构地区：[1]首都医科大学附属北京胸科医院影像科,101149

出　　处：《结核病与胸部肿瘤》2020年第3期234-238,共5页Tuberculosis and Thoracic Tumor

摘　　要：目的探讨胸部CT扫描显示簇状微结节样病灶对肺结核的诊断与鉴别诊断价值。方法回顾性分析2016年1月至2019年8月北京胸科医院行CT扫描表现为簇状微结节样病灶并诊断明确的患者74例。其中70例患者经临床或实验室检查诊断为活动性肺结核,2例诊断为非特异性炎症,2例诊断为结节病。本研究重点分析其中70例诊断为肺结核患者的CT扫描特征,包括簇状微结节样病灶的分布部位、分布方式、形态特征,以及并存的肺内其他形态病变的CT征象。结果70例肺结核患者胸部CT扫描显示,簇状微结节样病灶分布于双肺上叶尖后段49例(70.0%),多发者49例(70.0%)。CT表现为均匀样、晕征样、反晕征样、混合存在等4种表现形式,分别占47.1%(33/70)、25.7%(18/70)、18.6%(13/70)及8.6%(6/70)。病灶内结节大小均匀29例(41.4%),大小不等、有融合41例(58.6%)。肺内族状微结节样病灶之外,伴有其他肺野并存病灶表现为1种形态(实变、空洞、结节样病灶、纤维条索状病灶四种形态之一)者10例(14.3%),2种形态者15例(21.4%),3种形态者16例(22.9%),4种形态者6例(8.6%);纵隔和(或)肺门淋巴结肿大者14例(20.0%),胸腔积液9例(12.9%)。2例结节病和2例非特异性炎症也表现为簇状微结节样病灶,与肺结核的影像特征近似。结论CT扫描表现为簇状微结节样病灶,无论是单发局限性或是多发性分布,均应首先考虑是继发性肺结核的一种较常见的不典型表现形式,值得重视。Objective To investigate the value of diagnosis and differential diagnosis in pulmonary tuberculosis patients with cluster-like micronodular lesions in chest CT imaging.Methods A retrospective analysis was performed in 74 patients with cluster-like micronodule confirmed by CT from January 2016 to August 2019 in Beijing Chest Hospital including 70 patients diagnosed as active tuberculosis by clinical or laboratory examination,two cases diagnosed as non-specific inflammation and two cases diagnosed as sarcoidosis.This study focused on the CT scan features in 70 patients diagnosed as pulmonary tuberculosis including the distribution of cluster-like micronodular lesions,distribution patterns,morphological features,and CT signs of other morphologic lesions coexisting in the lungs.Results The CT scan of 70 patients with pulmonary tuberculosis showed that cluster-like micronodular lesions were distributed in the apicoposterior segment of the upper lobe in both lungs in 49(70.0%)cases and multiple nodules in 49(70.0%)cases.The image features showed in four patterns:homogenous pattern(47.1%,33/70),halo pattern(25.7%,18/70),reversed halo pattern(18.6%,13/70)and mixed pattern(8.6%,6/70).There were 29 cases(41.4%)with uniform nodule size and 41 cases(58.6%)with different sizes which partial focus were fused.Except the cluster-like micronodular lesions,in other parts of lung there were coexisting one morphology lesions showing consolidation-like shadows,cavities,nodular-like lesions or fibrous cord-like lesions in 10 cases(14.3%),two kinds of the forms(as above)in 15 cases(21.4%),three kinds of the forms(as above)in 16 cases(22.9%)and four kinds of the forms(as above)in 6 cases(8.6%).Mediastinal and/or hilar lymphadenopathy occurred in 14 cases(20.0%).There were pleural effusion in 9 cases(12.9%).Sarcoidosis and non-specific inflammation also showed cluster-like micronodular lesions in each two cases which were similar to the imaging features of pulmonary tuberculosis.Conclusion CT scans show cluster-like micronodular lesions

关 键 词：结核 肺 体层摄影术 X线计算机 诊断显像 疾病特征 诊断 鉴别 

分 类 号：R73[医药卫生—肿瘤]