活动性和非活动性结核的薄层CT特征

Thin-section CT characteristics of active and inactive pulmonary tuberculosis

目的本研究利用薄层CT探讨活动性和非活动性肺结核的影像特征。方法回顾性分析138例可疑肺结核患者的薄层CT。12例患者由于痰涂片/培养阴性或无随访结果或最后诊断为非结核性疾病被排除在本研究外,126例纳入本研究。根据病变的活动性和非活动性,分别评价其薄层CT模式,包括微结节、结节、肿块、实变、空洞、磨玻璃影以及支气管异常。结果 116例肺结核中,活动性91例;非活动性35例。活动性结核最常见的薄层CT表现是小叶中央性微结节模式、支气管扩张、实变、腺泡样微结节、磨玻璃密度影、结节、厚壁空洞、不均匀的支气管管壁增厚伴管腔狭窄或闭塞、肿块和粟粒性微结节。其中实变、磨玻璃密度影、厚壁空洞、不均匀的支气管管壁增厚伴管腔狭窄或闭塞和粟粒性微结节为其特异性表现。非活动性肺结核最常见的薄层CT表现是钙化性结节、不规则线状影、境界清楚的小叶中央性微结节、牵拉性支气管扩张、境界清楚的腺泡样微结节、瘢痕周围肺气肿、肺实质束带影、部分钙化性结节以及均匀的支气管管壁增厚伴管腔狭窄。其中不规则线状影、瘢痕周围肺气肿、肺实质束带影以及均匀的支气管管壁增厚伴管腔狭窄为其特异性表现。结论这些交互影响的薄层CT征象有助于区别活动性和非活动性肺结核。

Objective To evaluate characteristic of active and inactive pulmonary tuberculosis using thin-section CT. Methods Total of 138 patients were reviewed retrospectively using thin-section CT for suspicion of pulmonary tuberculosis.12 patients were excluded due to sputum smear/culture negative or no follow-up results or final diagnosis of non-tuberculous lesions.The results from 126 patients were used for this study.On the basis of disease activity and inactivity,thin-section CT patterns of micronodules,nodules,masses,consolidation,cavity,ground-glass opacity,and bronchial abnormalities were assessed.Results Of the 138 patients included in this study,91 cases were active and 35 cases were inactive.Most common thin-section CT manifestations of active pulmonary tuberculosis were centrilobular micronodules,bronchiectasis,consolidation,acinar micronodules,ground-glass opacity,nodules,thick-walled cavities,bronchial wall thickening with irregular stenosis or occlusion,masses and miliary micro-nodules.Among this,consolidation,ground-glass opacity,thick-walled cavities,bronchial wall thickening with irregular stenosis or occlusion and miliary micronodules were specific performance.Most common thin-section CT manifestations of inactive pulmonary tuberculosis were calcified nodules,irregular linear,defined-well centrilobular micronodules,traction bronchiectasis,defined-well acinar micronodules,pericicatricial emphysema,parenchyma bands,incompletely calcified nodules and bronchial wall thickening with smooth stenosis,of which irregular linear,pericicatricial emphysema,parenchyma bands,and bronchial wall thickening with smooth stenosis were specific performance.Conclusions Interaction of these thin-section CT signs can be helpful in the distinction of active from inactive pulmonary tuberculosis in most cases.