不典型肺结核MSCT影像分析  

Analysis of MSCT findings in patients with atypical pulmonary tuberculosis

作　　者：张倬 凌杰 尹曲华 聂赣娟 ZHANG Zhuo;LING Jie;YIN Quhua;NIE Ganjuan(Department of Radiology,Hunan Chest Hospital,Changsha 410013,China;Department of Pathology,Hunan Chest Hospital,Changsha 410013,China)

机构地区：[1]湖南省胸科医院放射科,湖南长沙410013 [2]湖南省胸科医院病理科,湖南长沙410013

出　　处：《医学影像学杂志》2023年第9期1594-1597,1607,共5页Journal of Medical Imaging

摘　　要：目的 探讨成人不典型肺结核的MSCT影像学特点,以提高对该病的认识。方法 选取450例经CT引导下经皮肺穿刺活检患者,其中符合结核的190例。根据病理证实同时对比CT影像特点,最终选出59例不典型肺结核患者的临床资料及CT影像学资料加以分析。结果 59例患者中疑诊肺恶性病变26例(26/59,44.1%),疑诊肺炎性病变或肺炎性肌纤维母细胞瘤等32例(32/59,54.2%)、疑诊肺梗塞1例(1.7%);结节或肿块型55例、肺炎型4例。结节或肿块型CT表现:病灶密度不均匀(33/55,60.0%)、不均匀强化(34/55,61.8%)、边缘不光滑(50/55,90.9%)、长毛刺(32/55,58.2%)、浅分叶(25/55,45.5%)、平直征(17/55,30.9%)、桃尖征(13/55,23.6%)、胸膜增厚粘连(33/55,60.0%)等征象居多,病灶内钙化(6/55,10.9%)、淋巴结钙化(7/55,12.7%)、树芽征(9/55,16.4%)、卫星灶(12/55,21.8%)、短毛刺(5/55,9.1%)、深分叶(11/55,20.0%)、胸膜凹陷征(4/55,7.3%)相对较少;肺炎实变型CT表现以实变、空气支气管征为主。结论 不典型肺结核CT表现多样,与肺炎性病变或肺炎性肌纤维母细胞瘤、肺癌等难以鉴别。无结核特征性病变者应结合临床资料综合评估,考虑不典型肺结核的可能,必要时及时行CT引导下经皮肺穿刺活检术。Objective To analyze the MSCT findings in adult atypical pulmonary tuberculosis.Methods A retrospective study was conducted on 59 patients with atypical pulmonary tuberculosis confirmed by CT-guided percutaneous lung biopsy.Results 59 cases included 37 males and 22 females,aged from 17 to 73 years old.Among those 59 cases,suspected pulmonary malignant lesions were found in 26 cases(26/59,44.1%),pneumonia or pneumonia myofibroblastoma in 32 cases(32/59,54.2%),and pulmonary infarction in 1 case(1.7%).Of those 59 cases,55 cases were nodules or masses type and 4 cases were pneumonia type.MSCT findings of nodules or masses type were as follows:uneven density(33/55,60.0%),inhomogeneous enhancement(34/55,61.8%),uneven margin(50/55,90.9%),long burrs(32/55,58.2%),shallow lobulation(25/55,45.5%),flat sign(17/55,30.9%),peach tip sign(13/55,23.6%),and pleural thickening and adhesion(33/55,60.0%)were mostly appeared,whereas,intracranial calcification(6/55,10.9%),lymph node calcification(7/55,12.7%),tree bud signs(9/55,16.4%),satellite lesions(12/55,21.8%),short burrs(5/55,9.1%),and deep lobulation(11/55,20.0%).Pleural indentation sign(4/55,7.3%)were relatively rare.The CT manifestations of pneumonia type were mainly consolidation and air bronchogram.Conclusion Atypical pulmonary tuberculosis has various CT findings,which is difficult to distinguish from pulmonary inflammatory lesions,pulmonary inflammatory myofibroblastoma,lung cancer and so on.Patients without characteristic lesions of tuberculosis should be evaluated comprehensively based on clinical data,the possibility of atypical pulmonary tuberculosis should be considered,and CT-guided percutaneous lung tissue biopsy should be performed in time if necessary.

关 键 词：肺结核 体层摄影术 X线计算机 诊断 病理 

分 类 号：R541.5[医药卫生—心血管疾病] R814.4[医药卫生—内科学]