多层螺旋CT对胸膜结核瘤的诊断价值

Diagnostic value of multi-slice helical computed tomography in pleural tuberculoma

目的探讨多层螺旋CT对胸膜结核瘤的诊断价值,提高对胸膜结核瘤的认识。方法回顾性分析经临床或手术病理证实的胸膜结核瘤13例的多层螺旋CT表现及后处理图像表现。结果单发胸膜结核瘤10例,多发3例,CT表现为紧贴胸膜并突入肺内的乳头状结节5例,圆形、椭圆形结节6例,不规则形结节2例,多数病灶密度均匀,少数可见低密度坏死区或高密度小钙化灶,病灶边缘光整,增强后病灶多数无强化或轻度强化,邻近胸膜多有局限性增厚、黏连和钙化,9例并有胸腔积液,10例伴有肺内结核灶,7例伴有纵隔淋巴结肿大、钙化。多层螺旋CT后处理图像可更全面的、直观的、立体的显示病变特征。结论MSCT后处理技术弥补了轴位CT图像的不足,在诊断胸膜结核瘤中有很高的临床应用价值,可提高胸膜结核瘤的诊断准确性。

Objective To investigate the diagnostic value of multi-slice helical CT（MSCT） in pleural tuberculoma, and to improve the understanding of this disease. Methods We analyzed ret- rospectively the MSCT and post-processing film features in 13 pleural tuberculoma diagnosed by clinic or surgical pathology. Results Single pleural tuberculoma were seen in 10 cases and multiple pleural tuberculomas in 3 cases. The CT scan showed papillary nodules in 5 cases, round or elliptic nodules in 6 cases and irregular nodules in 2 cases. The lesion density was homogeneous in most ca- ses, and calcifications or necrosis in a few cases, and the lesion margin was smooth. No or slight enhancement of the tuberculoma can be seen on contrast CT. The adjacent pleura can be seen thick- ening, adhesion and calcification. There were 9 cases accompanied with hydrothorax, 10 cases with pulmonary tuberculosis and 7 cases with enlarged and calcified mediastinal nodals. The MSCT post- processing images showed the features of pleural tuberculoma completely, intuitionistically and stereoscopically. Conclusions The MSCT post-processing technique could make up for the lack of axial CT scan. It is high valuable to improve the diagnosis accuracy of pleural tuberculoma.