成人纵隔肺门淋巴结结核的多层螺旋CT特点分析

Characteristic analysis of MSCT in diagnosis of adult mediastinal lymph tuberculosis

目的：分析成人纵隔淋巴结结核的多层螺旋CT（MSCT）特点以提高诊断水平。方法：回顾性分析经临床病理证实的42例成人纵隔型淋巴结结核的MSCT表现并进行总结。结果：①部位：42例CT共见淋巴结肿大185个，淋巴结主要位于4R区、2R区，8例累及1个区淋巴结，34例累及2个以上区；②大小：短轴直径范围10～54mm，加权平均（18±6）mm.长轴直径范围1O～68mm，加权平均（26±11）mm；③形态：37例进行病理对照的169个淋巴结中，122个（72.189％）未融合的淋巴结呈卵圆形或圆形，47个（27.811％）融合的淋巴结呈分叶状或不规则形；④边缘：122个（72.189％）未融合的淋巴结边缘光滑、清楚。47个（27.811％）淋巴结干酪样坏死，边缘欠清楚；⑤密度：145个（78.378％）淋巴结平扫密度基本均匀，CT值40～60HU。40个（21.622％）淋巴结平扫密度不均匀，中央部分CT值16～37HU，平均25.2HU；32个淋巴结内或周边有斑点状钙化。⑥增强表现：169个淋巴结表现为7种强化形式。a.均匀强化（12个）；b.不均匀强化、中心低强化有小的低密度区（22个）；C.周边不规则厚壁强化、中心无强化（52个）；d.周边薄环状强化、中心无强化（36个）.e.周边不规则强化、中心无强化区延伸至淋巴结外（4个）；f.周边不规则环状强化、中心分隔状强化（40个）；g.无明显强化（3个）；⑦肺内结核：8例（19.048％）肺内有结核病灶，其中6例为非活动性条索状影及钙化灶，2例为斑片状活动性结核。结论：MSCT对成人纵隔淋巴结结核具有重要诊断价值。

Objective： To improve the diagnosis of adult mediastinal lymph tuberculosis by analysing the characteristics of multislice CT （MSCT）. Methods： MSCT findings of 42 cases of adult-type mediastinal lymph node tuberculosis clinicopathological confirmed were retrospectively analysed and summed up. Results： ①Site： 185 swollen lymph nodes were found in 42 cases by CT , mainly in 4R, 2R district, of which 1 lymph node area was involved in 8 cases, more than 2 lymph nodes area were involved in 34 cases; ②Size：Short-axis diameter range 10 ~ 54 mm with the weighted average of 18 ~ 6mm, long-axis diameter range 10 ~ 68 mm with the weighted average of 26 ~ 11mm; ③Morphology：Of the 169 lymph nodesin 37 cases pathological confirmed, 122 （72.189%） were round or oval without integration, 47 （27.811%） integrated manifesting lobulated or irregu lar; ④Edge： 122 （72.189%） lymph nodes without integration were smooth and well-margined. 47 （27. 811~/00） lymph node with cheese necrosis manifested an obscure boundary. ⑤Density： Plain density of 145 （78.378 % ） lymph nodes was found ho mogenous, with the CT value of 40 ~ 60 HU,while that of another 40 （21. 622~） lymph nodes were inhomogenous, the central CT value was 16 ~ 37 HU, with an average of 25.2 HU;⑥Enhanced findings： 7 kinds of enhancement were found in 169 lymph nodes, a. homogenous enhancement （12）; b.inhomogenous enchancement with small areas of low density in the center （22）; c.peripheral enhancement with irregular thick wall , while the center area was unenhanced （52） ; d.peripheral enhance ment with thin annular wall,while the center area was unenhanced （36）; e. irregular peripheral enhancement with the unen hanced central area extending to the outside of lymph nodes （4） ; f. irregular peripheral ring-like enhancement with the enhanced strip separating the center area（40） ; g. no significant enhancement （3） ;⑦Pulmonary tuberculosis：8 （19.048%） cases had pul monary tuberculosis, of which 6 had non-active cord-like lesions and calcified lesions, 2 had active tuberculosis patchy. Conclusion： MSCT is very valuable in diagnosis of adult mediastinal lymph node tuberculosis.