薄壁空洞型肺结核和肺癌CT诊断与鉴别诊断  

CT Diagnosis and Differential Diagnosis of Thin Wall Cavity Pulmonary Tuberculosis and Lung Cancer

作　　者：老桂红 李萌[2] Lao Gui-hong;Li Meng(Department of Radiology,Guangdong First Veterans Hospital,Guangzhou 510220,Guangdong Province,China;Department of Radiology,The Second Affiliated Hospital of Guangzhou Medical University,Guangzhou 510260,Guangdong Province,China)

机构地区：[1]广东省第一荣军医院放射科,广东广州510220 [2]广州医科大学第二附属医院放射科,广东广州510260

出　　处：《中国CT和MRI杂志》2023年第11期60-63,共4页Chinese Journal of CT and MRI

摘　　要：目的根据CT影像表现特征,结合γ干扰素释放试验(IGRA)及白细胞介素-6(IL-6),探讨薄壁空洞性肺结核与肺癌诊断与鉴别诊断价值。方法收集2016年2月-2020年2月临床及影像学资料完整的薄壁空洞型病灶73例,其中薄壁囊腔型肺癌组41例,薄壁空洞型肺结核组32例,均经术后病理确诊。对比分析两组病灶的的CT特征、IGRA及IL-6检测水平,并进行统计学分析。结果两组资料在性别、病灶大小及含气腔隙大小上差别不大,无统计学意义P>0.05;而在发病年龄、空洞壁厚较大差异,具有统计学意义P<0.05。结核组病灶的CT特点主要位于上叶尖后段及下叶背段,长毛刺、尖角征、单腔、腔内壁光整、卫星灶等发生率明显高于肺癌组,均有统计学意义P<0.05。肺癌组病灶的CT特点是边缘分叶、短毛刺、多腔、腔内壁不光整、内见分隔及血管穿行、磨玻璃征、蜂窝征等,均有统计学意义P<0.05。结核组IGRA阳性率、IL-6水平均明显高于肺癌组,均有统计学意义P<0.05。CT征象联合IGRA及IL-6,对薄壁空洞型肺结核与肺癌的诊断与鉴别诊断其灵敏度、特异度分别为1.000(41例)、0.875(28例)。结论分析薄壁空洞的CT特征,结合IGRA及IL-6水平,可以明显提高薄壁空洞型肺结核与肺癌的诊断与鉴别诊断,有利于临床制定治疗方案。Objective According to the features of CT images,combined with gamma interferon release test(IGRA)and interleukin-6(IL-6),the value of diagnosis and differential diagnosis of parenchyma cavitary pulmonary tuberculosis and lung cancer was discussed.Methods From February 2016 to February 2020,73 cases with complete clinical and imaging data of parenchyma cavity lesions were collected,including 41 cases in the group of parenchyma cavity lung cancer and 32 cases in the group of parenchyma cavity pulmonary tuberculosis,all of which were confirmed by postoperative pathology.The CT features,IGRA and IL-6 detection levels of the two groups were compared,and statistical analysis was performed.Results There was no significant difference in gender,lesion size and air space size between the two groups(P>0.05).There were significant differences in age of onset and cavity wall thickness(P<0.05).The CT features of the lesions in the tuberculosis group were mainly located in the posterior segment of the upper tip and the dorsal segment of the lower lobe,and the incidence of long burr,sharp Angle,single cavity,cavity wall finishing and satellite foci were significantly higher than those in the lung cancer group,with statistical significance P<0.05.In the lung cancer group,the CT features of the lesions were borderline lobed,short burr,multiple lumen,incomplete lumen wall,internal separation,vascular passage,ground glass sign,honeycomb sign,etc.,all of which were statistically significant(P<0.05).The positive rate of IGRA and IL-6 level in tuberculosis group were significantly higher than those in lung cancer group,with statistical significance(P<0.05).CT signs combined with IGRA and IL-6 have high value in the diagnosis and differential diagnosis of thin-wall cavitary pulmonary tuberculosis and lung cancer,with sensitivity and specificity of 1.000(41 cases)and 0.875(28 cases),respectively.Conclusion The analysis of CT features of thin-walled cavity,combined with IGRA and IL-6 levels,can significantly improve the diagnosis and dif

关 键 词：薄壁空洞 肺结核 空洞型肺癌 CT征象 IGRA IL-6 

分 类 号：R563[医药卫生—呼吸系统] R445.3[医药卫生—内科学]