无钙化肺结核球CT动态增强扫描与病理对照研究

Dynamic contrast-enhanced CT patterns and pathologies of noncalcified pulmonary tuberculomas

目的探讨无钙化肺结核球的CT增强特征及其病理基础。方法分别对56例孤立性无钙化性肺结核球(直径1.1～4.2cm)进行2～3mm薄层CT平扫和动态增强扫描,重点观察病灶的强化特征并进行CT-病理对照研究。结果56例结核球中45例无强化;7例呈薄层环状强化;4例呈厚环状强化。病理切片显示:无强化区主要是干酪样坏死组织,少数为液化性坏死。边缘强化部分是类上皮肉芽组织或纤维疤痕组织。结论结核球主要为干酪坏死组织组成,增强扫描大多无强化,少数呈不同程度的环状强化,藉此能将绝大部分结核球与周围型肺癌相鉴别,CT增强扫描是诊断不典型结核球的非常有价值的方法。

Objective To analyze characteristic CT enhancement patterns of noncalcified pulmonary tuberculomas and their pathological basis. Methods Fifty-six patients with noncalcified pulmonary tuberculomas underwent surgical resection of the tuberculomas. Enhanced CT images of these tuberculomas were reviewed and analyzed in relation to the histological findings. Results Of the 56 patients, 45 showed no enhancement in the tuberculomas, which were histologically characterized by central caseous necrosis and a poorly vascularized peripheral fibrotic zone. Eleven patients showed ring-like or eggshell enhancement, and the central low density region was histologically confirmed to be caused by caseous or liquefied necrosis, while the ring enhancement resulted pathologically from moderately or well vascularized peripheral fibrotic or granulomatous tissues. Conclusion Pulmonary tuberculomas consists mainly of caseous necrotic tissues characterized by no enhancement and ring or eggshell enhancement on dynamic contrast-enhanced CT.