肺部CT表现对结核性咯血责任血管的预测价值  

The predictive value of pulmonary CT findings for the responsible vessels of tuberculosis-related hemoptysis

作　　者：廖志中 文小检 张孟婷 张亚林[1] LIAO Zhizhong;WEN Xiaojian;ZHANG Mengting;ZHANG Yalin(Department of Radiology,Changsha Central Hospital,Changsha 410018,China;Department of Radiology,Hunan Chest Hospital,Changsha 410205,China)

机构地区：[1]长沙市中心医院放射科,湖南长沙410018 [2]湖南省胸科医院放射科,湖南长沙410205

出　　处：《实用放射学杂志》2022年第7期1092-1095,共4页Journal of Practical Radiology

摘　　要：目的探讨结核性咯血的相关肺部CT征象并对咯血责任血管的分布进行预测,为患者介入治疗提供指导作用。方法选取CT、数字减影血管造影(DSA)及临床资料齐全的结核性咯血患者56例,并选择同时期非结核性咯血患者56例作为对照组纳入研究。比较咯血组患者和非咯血组患者的CT表现,找出与咯血相关的肺部CT征象;然后将结核性咯血患者CT征象与DSA发现的责任血管分布进行对照,观察肺部CT表现对咯血责任血管分布的预测价值。结果(1)咯血组患者在空洞、空洞内伴液平面、空洞伴曲菌球、磨玻璃影、支气管扩张、胸膜增厚等CT表现方面所占百分比明显高于非咯血组,统计学有显著性差异(P<0.05);(2)应用上述征象对结核性咯血患者责任血管分布进行预测,结果发现空洞内伴液平面或伴曲菌球预测责任血管的敏感性最高(93.24%),磨玻璃影预测责任血管的特异性最高(82.82%),联合两者预测责任血管的敏感性达到100%。结论结核性咯血患者具有一些特征性CT表现。空洞内液平面或伴曲菌球结合周围磨玻璃影能为结核性咯血患者责任动脉定位提供很好的预测价值,胸膜增厚>3 mm可能提示非支气管动脉体循环动脉(NBSA)侧支供血。Objective To explore the pulmonary CT findings associated with tuberculosis-related hemoptysis and to predict the responsible vessel distribution for hemoptysis in order to provide guidance for interventional therapy.Methods The CT,digital subtraction angiography(DSA)and clinical data of 56 cases with tuberculosis-related hemoptysis were collected,and other 56 cases without tuberculosis-related hemoptysis in the same period were selected as the control group.The pulmonary CT findings of two groups were compared to find out the relevant CT signs related to hemoptysis.These relevant CT signs were then compared with the findings of DSA to assess the predictive value of CT signs for the responsible vessels of tuberculosis-related hemoptysis.Results There were statistical differences in cavity,cavity with liquid level,cavity with aspergilloma,ground-glass shadow,bronchiectasis and pleural thickening between the two groups(P<0.05).The cavity with liquid level or aspergilloma showed the highest sensitivity(93.24%)in predicting the responsible vessels,while the ground-glass shadow showed the highest specificity(82.82%).And the sensitivity to predict the responsible vessels reached by 1o0%when combined these two signs.Conclusion Patients with tuberculosis-related hemoptysis have some characteristic CT findings.And CT features of cavity with liquid level or aspergilloma combined with surrounding ground-glass shadow can provide a good predictive value for the responsible artery of tuberculosis-related hemoptysis.Additionally,it may indicate collateral blood supply occurs in non-bronchial systemic artery(NBSA)when pleural thickening>3 mm.

关 键 词：肺结核 咯血 计算机体层成像 数字减影血管造影 支气管动脉栓塞术 

分 类 号：R521[医药卫生—内科学] R441.7[医药卫生—临床医学] R814.42