螺旋CT薄层扫描及CT值测定在继发性肺曲菌球诊断中的作用

The evaluation of thin-slice spiral CT scan and CT value measuring for the diagnosis of secondary pulmonary aspergilloma

目的研究螺旋CT薄层扫描及CT值测定在继发性肺曲菌球诊断中的临床价值。方法对57例确诊为继发性肺曲菌球病例的61个肺曲菌球的螺旋CT薄层扫描图像和CT值重新进行分析和测定,并与肺结核和肺癌病灶的CT值进行比较。结果61个肺曲菌球多继发于肺结核空洞内,以双上肺多见,形态多样,不完全填充型较多,占41.0%(25/61),典型的“新月形”改变并不多见,仅占22.9%(14/61);肺曲菌球的密度多数较低,CT值为负值的占52.5%(32/61),CT值小于20HU的占86.9%(53/61),平均CT值为2.56HU。肺结核和肺癌病灶的CT值较高,均大于20HU,平均CT值分别为38.4HU和39.0HU,明显高于肺曲菌球的CT值(P<0.01)。结论螺旋CT薄层扫描可以详细观察肺空洞内病灶的形态特点,发现更多形态不典型的曲菌球,低CT值是曲菌球较特异的征象,两者结合,对绝大多数继发性肺曲菌球可以作出准确的诊断。

Objective To evaluate the thin-slice spiral CT scan and CT valu e measuring for diagonosis of secondary pulmonary aspergilloma. Methods The thin- slice spiral CT scan and CT values of 61 aspergillomas in 57 patients with secon dary pulmonary aspergilloma were studied retrospectively. The CT values of asper gilloma were compared with that of lesions of pulmonary tuberculosis and lung ca ncer. Results Most of the secondary pulmonary aspergillomas were found in caviti es of pulmonary tuberculosis, located in upper lobes, with polymorphic appearanc e. The “incomplete filling”were seen in 41.0%cases (25/61); while typical “c rescent”aspergillomas were revealed only in 22.9%cases (14/61). In most cases of aspergilloma the lesions were hypo-dense, including lesions with negative CT values in 52.5%cases (32/61) and CT values lower than 20HU in 86.9%cases (53/ 61). The average CT values of aspergillomas were 2.56HU, significantly lower tha n that of the tuberculosis or lung cancer (38.4HU and 39.0HU respectively), (P< 0.01). Conclusion Secondary pulmonary aspergilloma within the cavities of the tu berculosis or untypical lesions can be revealed on thin-slice spiral CT scan. The hypo-dense lesion may be characteristic findings of pulmonary aspergilloma. A proper diagnosis should be established on both the appearance and the CT value measuring of the lesion.