肺曲菌病的MSCT表现和诊断价值

MSCT appearance and diagnosis of the aspergillosis

目的探讨肺曲菌病的MSCT表现和诊断价值。方法本组病例收集于2002年12月至2006年12月,分别经手术病理和治疗随访证实,男性4例,女性3例,年龄44～83岁,平均51岁。5例有轻重不一的发热、咳嗽、胸痛、铁锈色痰或血丝痰,2例无任何症状和体征。采用SIEMENSSENSATION4层或16层螺旋CT,3例仅平扫,4例平扫+增强。增强用非离子碘对比剂80～100ml,经肘静脉自动高压注射器给予,流率2～3ml/s。常规摄横断面片,肺窗:WW1500HU,WC-500HU;纵隔窗:WW400HU,WC40HU。4例加行多方位图像重建(MPR)。结果病灶位于右肺3例,左肺4例。3例表现为孤立性实质性结节,直径8mm～27mm,类圆形,边缘可见棘突及"晕影"。4例为空洞性结节,直径17mm～110mm,其中2例具有"新月"征,2例具有"滚珠"征。结论肺曲菌病早期影像表现缺乏特征性,当病变局限形成曲菌球尤其具备"新月征"和"滚珠征"者是CT诊断的可靠依据。

Objective To evaluate the CT appearance and diagnosis of the aspergillosis. Methods Seven patients with aspergillosis confirmed by operative pathology or therapeutic following-up were retrospectively analyzed .The patients with age from 44 to 83 years old（average 51years old） respectively underwent CT examination in 2002-2006 years.CT images were reviewed by three experienced radiologist and a physician. Results The seven lesions with the longest dimention from 8mm-110mm were respectively located at the right lung （n=3cases） and left lung（n=4cases）.The appearances of the pulmonary aspergillosis were followed as a solitary pulmonary nodule with the “hole sign” （n= 3cases） and a hollow lesion with the “meniscus sign” or “rolling ball sign” （n =4cases）. Conclusion There is no diagnostic specificity of the imaging appearances in early phase of the aspergillosis.The aspergilloma is the special CT signs while with the “meniscus sign” or “roiling ball sign”.