成人纵隔淋巴结结核动态CT值与病理对照分析

Medisastinal tuberculous lymphadenitis in adult:dynamic CT-value and pathologic analysis

目的评价纵隔淋巴结结核在多层螺旋CT检查中动态CT值与病理的关系。方法收集2005年8月至2009年6月经纵隔镜活检、手术、锁骨上淋巴结活检、诊断性治疗确诊的8例纵隔淋巴结结核,5例平扫,3例平扫后增强,记录平扫肿大淋巴结数量、大小、位置,测量兴趣淋巴结中心、次中心、边缘部平扫及注药后18s、50s、70s、120s、180s的CT值。结果平扫病例:纵隔及肺门共检测出肿大淋巴结67个,大小为1.0～3.2cm;肿大淋巴结分布在纵隔2区或2区以上,2R及4R区39%,7R区12%,2L区7%,5区及10R区分别5%;CT值均数(47.5±12.13)Hu。增强病例:共发现强化淋巴结19个,选择7个兴趣淋巴结,测得注药18s、50s、70s、120s、180s的CT值均数分别为(76.30±18.09)Hu、(73.76±15.27)Hu、(78.30±18.81)Hu、(75.42±17.95)Hu、(71.30±19.21)Hu。结论纵隔淋巴结结核动态CT值表明动脉期明显强化,静脉期及延时扫描强化维持在动脉期水平呈平台样改变,反映了淋巴结结核慢性感染的病理状态。

Objective To evaluate the relationship between dynamic CT-value and pathology of mediastinal tuberculous lymphadenitis in adult.Methods 8 cases with mediastinal tuberculous lymphadenitis comfirmed by mediastinoscopy,operation,biopsy and anti-tuberculous therapy were restrospectively collected,including five cases of plain and 3 plain after the enhanced scan.The number,size and location of lymph nodes were recorded,and CT value of centers and sub-centers and edge of interest lymph nodes was measured.Results Plain cases：mediastinal and hilar lymph nodes were detected in 67,with the size of 1.0~3.2 cm.Enlarged mediastinal lymph nodes were found in Zone 2 or more（2R and 4R district 39%,7R district 12%,2L district 7%,district 5 and district 10R 5%）.CT mean value was（47.5±12.13） Hu.Enhanced case：there were 19 enhanced lymph nodes.CT values from selected interesting 7 was measured respectively,including injection 180 seconds,50 seconds,70 seconds,120 seconds and 180 seconds.They were（76.3±18.09）Hu,（73.76±15.27）Hu,（78.3±18.81）Hu,（75.42±17.95）Hu,（71.3±19.21）Hu.Conclusion Arterial phase dynamic CT was obviously enhanced,and delayed venous phase enhanced scanning was maintained at the level of arterial platform like change,reflecting the pathological lymph node tuberculosis chronic infection state.