胸内结节病的高分辨CT诊断与应用价值

High-resolution computed tomography (HRCT) diagnosis and application of thoracic sarcoidosis

目的:探讨胸内结节病的高分辨CT表现特点。方法:回顾性分析48例经临床和病理确诊的胸内结节病的高分辨CT表现。结果:48例中纵膈及肺门淋巴结均有肿大46例(95.8%);纵膈淋巴结肿大47例,无纵膈淋巴结肿大1例(2.1%);双侧肺门淋巴结肿大42例(87.5%),单侧肺门淋巴结肿大5例(10.4%),无肺门淋结肿大1例(2.1%)。内乳动脉旁淋巴结肿大2例(4.2%),心膈角淋巴结肿大2例(4.2%),两腋窝淋巴结肿大4例(8.3%),淋巴结钙化5例(10.4%)。增强的19例肿大的淋巴结均呈均匀强化。48例中既有淋巴结肿大又伴有肺内浸润改变的44例,支气管血管周围间质增厚17例,沿淋巴管周围间质分布的境界清楚的小结节38例,大结节或实变17例,磨玻璃影12例,纤维化表现18例,支气管狭窄2例,胸膜增厚及胸腔积液各2例。结论:胸内结节病临床表现及实验室检查无特异性,HRCT检查可发现淋巴结肿大,又可显示肺内特征性改变,可提高诊断准确率,并能评估临床疗效和预后,具有重要的指导意义。

Objective：To investigate the features of High-resolution computed tomography（HRCT）in pulmonary sarcoidosis.Methods：48 patients with pulmonary sarcoidosis proved clinically or pathologically were retrospectively analyzed by using HRCT scan.Results：The main HRCT findings of pulmonary sarcoidosis were enlarged intrathoracic lymph nodes（n=48）,in both pulmonary hilum and mediastinum（n=46）;the lymph nodes were enlarged in mediastinum（n=47）,the lymph nodes not were found in mediastinum（n=1）;in bilateral pulmonary hilum（n=42）,in unilateral pulmonary hilum（n=5）,the lymph node were not found in bilateral pulmonary hilum（n=1）.Enlarged para-internal mammary artery nodes were see in 2 cases,cardio-diaphragmatic angle nodes were see in 2 cases,bilateral axillary nodes were see in 4 cases.Calcified lymph nodes were see in 4 cases.All of the lymph nodes in the 19 cases of enhanced HRCT scanning appeared enhancement.In all the 48 cases,enlarged lymph nodes and pulmonary infiltration co-existed in 44 cases.The HRCT findings of pulmonary infiltration included peribronchovascular interstitial thickening（n=17）;small well-defined nodules occurring in perilymphatic distribution（n=38）;large nodules,masses,or areas of consolidation（n=17）;ground-glass opacity（n=12）;parenchymal fibrosis（n=18）;stenosis of bronchus（n=2）;pleural thickening（n=2）;pleural effusion（n=2）.Conclusion：The clinical situation and the laboratory examination of pulmonary sarcoidosis lacking specificity,but there are some specific radiographic features of HRCT scan in finding enlarged lymph nodes,especially in finding pulmonary infiltrations.HRCT scan is helpful to improve correct diagnostic rate,and to evaluate clinical therapeutic effect and prognosis,and to direct clinical treatment.