螺旋CT薄层扫描诊断肺真菌病的价值

The Evaluation of Thin-slice Spiral CT Scan for the Diagnosis of Pulmonary Mycosis

目的研究螺旋CT薄层扫描在肺真菌感染诊断中的临床价值。资料与方法对38例肺真菌感染患者的螺旋CT薄层扫描图像进行分析,并结合病理学总结不同真菌的影像特征。结果38例中肺曲霉菌16例,螺旋CT薄层扫描主要表现为软组织密度结节或肿块(14/16),其中7例病灶周围形成浅淡的、"磨玻璃"样晕环;典型肺曲菌球表现为"空气半月征"(5/16)。肺隐球菌10例,CT表现为结节、团块及实变影,内部可见"细支气管充气征"(3/10)。肺白色念珠菌9例,表现为两肺野散在或布满大小不一、密度不均的絮片状影,边缘模糊,伴有大小不等的结节影。肺毛霉菌3例,表现为"磨玻璃"样及结节影。结论螺旋CT薄层扫描可以清晰显示肺内病灶的形态特点,提示"晕征"、"空气半月征"、"洞内球征"、"细支气管充气征"及"树芽征"较特异的征象。不同真菌种类其螺旋CT薄层扫描征象亦有所差别,但最终需结合病理学做出诊断。

Objective To evaluate the thin-slice spiral CT scan for the diagnosis of pulmonary mycosis. Materials and Methods The thin-slice spiral CT images of 38 patients with pulmonary mycosis were studied retrospectively. And to summarize imaging features of different fungous combined with the pathology characters. Results There were 16 cases infected with aspergillus,the major thin-slice spiral CT findings were nodules or masses with soft-tissue density （14/16）.Among them,7 cases with ＂halo sign＂. The typical cases with ＂air crescent sign＂ （5/16）. 10 cases were cryptococcus. CT features were nodules, masses and consolidations. Micro-air bronehogram were found in 3 cases （ 3/10 ）. 9 patients, with candida albicans infected, were shown as muhinodular shadows with vague margin, heterogeneous patchy attenuations in the bilateral lung. There were 3 patients with thread fungus, which showed ground-glass opacity and tubercle. Conclusion Pulmonary fungus of focal morphous feature can be revealed on thin-slice spiral CT scan. Although different fungus have different CT findings,a proper diagnosis should be established on both the appearance and the pathobiology.