胸部X线摄影术与CT诊断胸壁结核的对照研究

Radiological diagnosis of chest wall tuberculosis: CT versus chest radiograph

目的评价胸部X线摄影术及CT在胸壁结核诊断中的价值。方法对21例经手术、穿刺活检证实的胸壁结核作了影像学分析，其中男8例，女13例，年龄在19—84岁，中位年龄34岁；全部病例均作了胸部X线摄影术和CT扫描，9例作了增强CT扫描。结果（1）胸部X线平片仅4例显示骨质破坏。（2）CT平扫则全部可见肋骨旁软组织肿块；16例边缘密度较高，中央密度较低，3例呈较高密度中有多发低密度，2例呈均匀较低密度。5例肋骨破坏，3例为膨胀性溶骨性骨破坏。增强扫描时8例肿块呈边缘强化。（3）21例CT所见的胸壁肿块，胸片均未能发现（X^2=42．000，P〈0．01）；4例CT上可见的4个纵隔及腋窝肿大淋巴结，胸片上均未能见到（X^2=4．421，P〈0．05）；2种影像学检查差异具有统计学意义。结论CT，特别是增强CT扫描是确诊本病的首选方法。

Objective To evaluate the role of CT or Chest radiograph in diagnosis of chest wall tuberculosis. Methods The study population included 21 patients with chest wall tuberculosis confirmed by operation or biopsy. Chest radiograph and plain CT were performed in all cases, while enhanced CT in 9 cases, and all images were reviewed by 2 radiologists. Results Single soft tissue mass of the chest wall was detected in all cases on CT, but not on chest radiograph （ X^2 = 42. 000,P 〈 0. 01 ）. Plain CT showed low attenuation region in the center of masses in 16 cases. Enhanced CT showed an enhanced rim around the soft tissue masses in 8 cases. The chest radiograph showed destruction of ribs in 4 cases. CT demonstrated bone destruction in 5 cases, and three of them were osteolytic expansible lesions. Single enlarged nodes of the mediastinum or axilla were found in 4 cases on CT, but not on chest radiograph （X^2 = 4. 421, P 〈 0.05 ）. Conclusion CT, especially enhanced CT scan is the first choice in the diagnosis of chest wall tuberculosis.