煤工尘肺胸膜病变的高分辨率CT形态学表现及其诊断价值

The diagnostic value and morphologic manifestation of high resolution computerized tomography in coal miner's pneumoconiosis with pleural pathological changes

目的 通过煤工尘肺胸膜病变的CT和高分辨率CT(HRCT)检查研究煤工尘肺胸膜病变的可靠的诊断技术。方法 煤矿井下采掘混合工煤工尘肺患者 13 1例 (其中 ,0 + 14例、Ⅰ期 46例、Ⅱ期 58例、Ⅲ期 13例 )及对照组 2 0例 (均摄有同期高仟伏胸片 ) ,在胸部常规CT扫描后 ,另在 4个固定水平上及感兴趣区加作HRCT扫描 ,而后进行观察对比研究。结果 参照国家尘肺诊断标准中对胸膜病变 -胸膜斑的判定方法 ,共发现胸膜病变者 68例 (51.91% ) ,其中 ,尘肺Ⅰ期 12例 (17.65% )、Ⅱ期 43例 (63 .2 4% )、Ⅲ期 13例 (19.12 % )。据胸膜病变在HRCT的形态表现可分为 :结节型(73 .3 8% )、扁平型 (18.71% )、不规则型 (7.91% )、混合型 ;病变位于胸壁胸膜者占 65.0 2 %、纵隔面占2 2 .16%、心包占 12 .80 %。本组病例肺尖和肋膈角区均未见受累表现 ,胸膜病变厚度以 5～ 10mm者为多见 (88.17% )。结论 煤矿工人胸膜损害并非罕见。HRCT是显示胸膜病变的可靠检查方法 ,是常规CT的补充手段 ,具有重要的诊断和实用价值 。

ObjectiveTo analyse CT and high resolution computerized tomography(HRCT) diagnostic value and morphologic manifestation in coal miner's pneumoconiosis with pleural pathological changes. Met hodsOne hundred and thirty-one cases of coal miner patients with peumoconiosis(0 + type:14 cases,type Ⅰ:46 cases,type Ⅱ:58 cases,type Ⅲ:13 c ases) and 20 normal people as control group were first examined by routine CT sc an at 4 fixed slices,followed by HRCT examination at the region of interest(ROI ).Meanwhile,all of them had high-kV chest radiography. ResultsAccording to the national standard of the People's Republic of China in t he diagnosis of coal miner's peumoconiosis with pleural plaque,68 cases of pleu ral disease making up 51.91%(68/131) were found(type Ⅰ acounted for 17.65%,type Ⅱ 63.24%,type Ⅲ 19.12%).The morphologic manifestation of pleural pathology by HRCT could be classified into four types:(1)nodular type:73.38%,(2)flat type:18 .71%,(3)irregular type:7.91%,(4)mixed type.The pleural pathological changes were found in thoracic wall pleura(65.02%),surface of mediastinum(22.16%),and perica rdium(12.80%),but not found in the top of lung and costo-phrenic angles.The th ickness of pleura was often about 5～10 mm(88.17%). ConclusionPleural pathological changes were not seldom seen in coal miner's pneu moconiosis.HRCT is a reliable examination method aiding routine CT to show pleur al pathological changes,thus it has a great diagnostic and practical value.It i s necessary to make a further comparison study between pathology and imagology.