艾滋病合并肺孢子菌肺炎的影像学表现特征及分型

Study of Imaging Features and Classification of Pneumocystis Carinii Pneumonia in AIDS Patients

目的:探讨艾滋病合并肺孢子菌肺炎(PCP)的影像学特征、动态变化及CT影像分型。方法:回顾性分析经临床诊断或病理证实的40例艾滋病合并肺孢子菌肺炎的临床、影像学资料,总结其影像学特征,且按照影像学形态、病理基础及动态变化过程进行分型,并评价其在临床应用中的价值。结果:40例艾滋病合并PCP患者中,表现磨玻璃影22例,肺气囊9例,而且两肺弥漫性表现者占77%以上。依据PCP的CT影像学表现及利于临床诊断与鉴别诊断,将其分为5型,即磨玻璃型、肺气囊型、斑片型、间质型、混合型。影像学动态变化特点:最初小片状渗出、磨玻璃样改变向双肺散在斑片状及弥漫实变过渡,最后常遗留间质性改变。结论:AIDS合并PCP的特征性影像学表现是肺部磨玻璃影及肺气囊。影像学分型在临床诊断及鉴别诊断中具有一定指导意义。

Objective： To evaluate the imaging features,temporal changes and CT classification of AIDS complicated with pneumocystis carinii pneumonia（PCP）.Methods：The clinical and imaging materials of 40 cases with clinical or patho-logy proved AIDS complicated with PCP were retrospectively analyzed.The imaging characteristics were summarized.An imaging based classification was made according to imaging appearances,pathology,and temporal changes.The clinical value of this imaging classification was evaluated.Results：Of the 40 AIDS patients complicated with PCP,the major imaging features were ground-glass opacities（22 cases） and pneumatocele（9 cases）.More than 77% of patients had bilateral diffuse pulmonary involvement based on CT manifestations of PCP,the imaging features were classified into 5 types：ground-glass opacities,pneumatocele,patchy infiltration,interstitial involvement and mixed type.The dynamic imaging manifestations were：patchy exudation and ground-glass opacities initially,then transited to bilateral scattered patchy and diffuse consolidation,finally residual interstitial changes were revealed.Conclusion：Ground glass opacities and pneumatocele were the characteristic imaging manifestations of AIDS complicated with PCP,imaging classification could be a helpful guidance for the clinical diagnosis and differential diagnosis.