实变型肺癌与结核性肺实变CT影像对照分析

CT Differentiation of Consolidative Lung Cancer and Tuberculous Consolidation

目的探讨实变型肺癌与肺结核实变的CT影像的差异，减少误诊率。方法回顾性分析1998年1月至2005年8月50例肺叶肺段实变表现的肺癌与同期50例肺结核实变的CT影像资料。分别对两组实变的分布、密度、空洞、支气管充气征、磨玻璃征、血管造影征、叶裂膨出征以及其他肺野不同特点的播散病变进行统计分析并进行卡方检验。结果有显著统计学意义的影像包括，多发肺叶肺段实变（肺癌22例，结核9例）、单发下叶肺实变（肺癌17例，结核10例），均匀肺实变（肺癌36例，结核17例）、实变伴液化（肺癌4例，结核33例）、空洞或囊腔（肺癌10例，结核28例），实变内充气支气管管腔狭窄（肺癌18例，结核7例）、管腔扩张（肺癌4例，结核15例），实变周围边界清楚的磨玻璃征（肺癌7例，结核0）。结论实变的密度、好发部位、病变多叶多段分布、是否易于形成液化空洞、环绕于实变周围分界清楚的磨玻璃征及多种性质弗存的气道播散病变影像等对鉴别诊断有一定价值，但仍需综合各种征象及临床资料进行诊断。

Objective To analyze the CT features of consolidative lung cancer and tubereulosis consolidations for differential diagnosis,Methods The CT scans of 50 patients with consolidative lung cancer and 50 patients with tuberculous consolidation between 1998 and 2005 were reviewed and the following CT signs of two groups were compared, including the location of consolidation, cavity, air brenchogram, ground-glass opacity surrounding the consolidation, bulging of the interlobar fissure, and characteristics of disseminations through the airway. Results Male（cancer group n =24, tuberculosis group n =29） ,female（cancer group n =26, tuberculosis group n = 21 ）, and average age（ cancer group is 50, tuberculosis group is 45 ）. There is a significant difference between two groups in the following signs, such as multi - lobar consolidatiou （ cancer group n = 22, tuberculosis group n = 9）, lower lobe distribution of the isolated consolidation（ cancer group n = 17, tuberculosis group n = 10）, homogenous consolidation （ cancer group n = 36 , tuberculosis group n = 17 ）, liquefaction（ cancer group n = 3 , tuberculosis group n = 33 ）, cavity or syst（ cancer group n = 10 , tuberculosis group n = 28 ）. clear boundary of ground -glass opacity（ cancer group n = 7, tuberculosis group n =0）. Narrowing of the involved bronchi （cancer group n = 18, tuberculosis group n =7 ）, dilatation of the involved bronchi（ cancer group n =4, tuberculosis group n = 15 ）, airway dissemination （cancer group n = 15, tuberculosis group n = 43 ）, and among them various airway dissemination in same patient（ cancer group n = 0, tuberculosis group n = 33 ）. COnclusion The signs are helpful for differential diagnosis, including localities of the consolidations , multi lobar or segmental distribution, density of consolidation, liquefaction, cavity , clear boundary of ground -glass opacity and various airway dissemination in same patient. However, many signs and symptoms should be considered together for diagnosis.