肺部弥漫性病变肺结核高分辨率CT征象表现与分析

Performance and Analysis of HRCT Images of Diffuse Pulmonary Lesion Tuberculosis

目的探讨肺部弥漫性病变肺结核患者肺小叶结构异常高分辨率CT(HRCT)征象表现和HRCT在肺部弥漫性病变肺结核中的诊断价值。方法对78例肺部弥漫性病变肺结核患者(其中急性血行播散性肺结核40例,亚慢性血行播散性肺结核21例,支气管播散肺结核17例)行HRCT检查,图像用高分辨重建。结果①小叶间隔异常可见于急性血行播散性肺结核中占62.5%(25/40),亚慢性血行播散性肺结核中占52.4%(11/21),主要表现为小叶间隔呈结节状和串珠状改变;支气管播散肺结核中仅5.9%表现为小叶间隔呈不规则增厚,与两组血行播散性比较差异均有统计学意义(P<0.05)。②支气管播散性肺结核患者中有88.2%(15/17)表现为小叶核心结节和树芽状,血行播散性病变仅可见小叶核结节状增大,支气管播散性肺结核组与两组血行播散性比较差异均有统计学意义(P<0.05)。③小叶实质异常在三组中均表现为小叶实质内散在结节,三组比较差异无统计学意义(P>0.05)。结论HRCT在显示肺小叶结构异常时具有明确的特征性表现,利用HRCT征象分析肺小叶结构异常特点可以提高肺部弥漫结节性病变的诊断和鉴别水平。

Objective To discuss the performance of HRCT images of Iobular structure of lung abnormalities with diffuse pulmonary lesion tuberculosis, and to assess the diagnostic value in diffuse pulmonary lesion tuberculosis by HRCT. Methods Seventy- eight patients, including 40 patients with acute hematogenous disseminated pulmonary tuberculosis, 21 patients with sub - chronic hematogenous disseminated pulmonary tuberculosis, and 17 patients with bronchial tuberculosis disseminated, underwent, high resolution CT（HRCT）scans and the images were reconstructed using high- spatial- resolution algorithms. Results Lobular septal abnormalities seen in acute hematogenous disseminated pulmonary tuberculosis accounted for 62.5 % （2.5/40）, sub- chronic hematogenous disseminated pulmonary tuberculosis accounted for 52.4 % （11/21）, which mainly expressed in Iobular and nbdular interval moniliforme shape change. Only 5, 9% of bronchial disseminated tuber- culosis expressed as Iobular septal thickening irregularly, which were statistically significant different with two hematogenous disseminated groups （P〈 0.05）. 88.2 % patients with bronchial disseminated tuberculosis （5/17） manifested as the core Iob- ular nodules and treelike buds, hemat0genous disseminated lesions were seen only nuclear nodular enlargement; there were statistically significant differences among bronchial disseminated tuberculosis group and two hematogenous disseminated groups （P〈0.05）. Lobular real anomaly in the three groups were manifested as sporadic Iobular parenchymal nodules, there was no statistically significant difference among the three groups（P 〉 0.05）. Conclusions HRCT has the expression of specific characteristics in abnormal pulmonary Iobular structure. Using HRCT images of Iobular structure of lung abnormalities can improve the diagnosis and differential levels in diffuse pulmonary lesion tuberculosis.