结核与尘肺所致的纤维素性纵隔炎CT征象鉴别  

Different CTS igns of Fibrosing Mediastinitis Caused by Tuberculosis and Pneumoconiosis

作　　者：蓝海龙 黎昌霖 邓宇[2] 肖叶玉 LAN Hai-long;LI Chang-lin;DENG Yu;XIAO Ye-yu(Department of Medical Imaging,Wuchuan People's Hospital,Zhanjiang 524500,GuangdongProvince,China;Department of Radiology,the First Affiliated Hospital of Guangzhou Medical University,Guangzhou 510120,Guangdong Province,China;Department of Medical Imaging,Guangzhou Hospital of Integrated Traditional and WesternMedicine,Guangzhou 510800,Guangdong Province,China)

机构地区：[1]吴川市人民医院影像科,广东湛江524500 [2]广州医科大学附属第一医院放射科,广东广州510120 [3]广州市中西医结合医院影像中心,广东广州510800

出　　处：《中国CT和MRI杂志》2024年第9期67-69,152,共4页Chinese Journal of CT and MRI

基　　金：广东省中医药局科研项目(20202141);湛江市科技计划项目(2022B101);广州市花都区基础与应用基础研究区院联合资助项目(23HDQYLH16)。

摘　　要：目的分析结核与尘肺所致纤维素性纵隔炎(fibrosing mediastinitis,FM)的CT影像学特征,旨在探索CT征象在鉴别两种病因相关FM的价值。方法统计分析结核组(24例)、尘肺组(22例)病人的以下六组CT特征:1.中央气道表现,包括主气管狭窄、一级支气管狭窄、二级支气管狭窄;2.肺动脉表现,包括肺动脉与主动脉直径比值、肺动脉一级分支狭窄、肺动脉二级分支狭窄、是否继发肺动脉栓塞;3.肺静脉表现,包括肺静脉干狭窄;4.上腔静脉表现,包括上腔静脉狭窄;5.淋巴结表现,包括是否伴随淋巴钙化、测量淋巴结非钙化区CT值;6.其他表现,包括纤维增殖灶是否呈弥漫分布以及是否呈轻度均匀强化、是否合并心包积液、食道是否受压或粘连性狭窄、是否伴随类似恶性侵袭。结果肺动脉二级分支狭窄(结核4/24、尘肺12/22)、上腔静脉狭窄(结核4/24、尘肺11/22)、淋巴结钙化(结核7/24、尘肺18/22)、淋巴结非钙化区CT值(结核44.0±15.8HU、71.1±16.6HU)有统计学意义,P<0.05;其他指标无统计学意义。结论与结核组相比,尘肺组更易致肺动脉二级分支及上腔静脉狭窄,其淋巴结钙化率及非钙化区域CT值较高。Objective To explore the value of CT features in differentiating fibrosing mediastinitis(FM)caused by tuberculosis and pneumoconiosis through analyzing the CT imaging features of FM related to two etiologies.Methods The following CT features of tuberculosis group(24 cases)and pneumoconiosis group(22 cases)were statistically analyzed:1.Central airway manifestations,including stenosis of trachea,main bronchi and segmental bronchi;2.Pulmonary artery manifestations,including the ratio of main pulmonary artery to aorta diameter,stenosis of the left/right pulmonary artery,stenosis of the lobar pulmonary artery,and secondary pulmonary embolism;3.Pulmonary vein manifestations,including stenosis of the common pulmonary vein;4.Manifestations of superior vena cava,including stenosis of superior vena cava;5.Lymph node manifestations,including lymph node calcifications and CT attenuation value of non-calcified area of lymph nodes s;6.Other manifestations,including whether the fibroproliferative foci were diffusely distributed and mild homogeneous enhanced,whether they were combined with pericardial effusion,whether esophagus stenosis caused by compression or adhesion was presented,and whether they were accompanied by signs similar to malignant invasion.Results There were statistically significant difference(P<0.05)of the following features between two group of patients:stenosis of the lobar pulmonary artery(tuberculosis 4/24,pneumoconiosis 12/22),superior vena cava stenosis(tuberculosis 4/24,pneumoconiosis 11/22),lymph node calcification(tuberculosis 7/24,pneumoconiosis 18/22),and CT attenuation value of noncalcified area of lymph nodes(tuberculosis 44.0±15.8HU,71.1±16.6HU).There was not statistically significant difference for other features.Conclusion Compared with the tuberculosis group,the pneumoconiosis group was more likely to cause stenosis of the lobar pulmonary artery and superior vena cava,and the calcification rate of lymph nodes and the CT value of non-calcified area were higher.

关 键 词：纤维素性纵隔炎 结核 尘肺 鉴别 淋巴结 上腔静脉 

分 类 号：R814.42[医药卫生—影像医学与核医学] R445.3[医药卫生—放射医学]