多层螺旋CT对DR胸片显示孤立病灶菌阴肺结核的诊断价值

Diagnostic value of multi-slice spiral CT(MSCT) for sputum smear-and culture-negative pulmonary tuberculosis with solitary node in chest DR X-ray

目的探讨多层螺旋CT(MSCT)对数字成像(digital radiography,DR)胸片显示孤立病灶菌阴肺结核的诊断价值。方法回顾性对照分析180例经过临床确诊的DR胸片显示孤立病灶菌阴肺结核的MSCT表现,将不同MSCT层厚检测结果与DR胸片进行对比。结果 DR胸片发现空洞6例;5 mm层厚MSCT重建显示15例,1 mm层厚MSCT重建显示16例(DR胸片/5 mm层厚MSCTχ2=4.096,P=0.043;DR胸片/1 mm层厚MSCT2χ=4.841,P=0.028)。5 mm层厚MSCT重建显示周围散在卫星灶50例,1 mm层厚MSCT重建显示周围散在卫星灶55例,DR胸片没有显示,(DR胸片/5 mm层厚MSCT2χ=65.616,P=0.001;DR胸片/1 mm层厚MSCTχ2=68.882,P=0.001)。5 mm层厚MSCT重建及1 mm层厚MSCT重建显示阴影内钙化分别为120例和140例,明显多于DR胸片的20例,(DR胸片/5 mm层厚MSCT2χ=116.883,P=0.001;DR胸片/1 mm层厚MSCTχ2=162.000,P=0.001;5 mm层厚MSCT/1 mm层厚MSCT2χ=5.538,P=0.019)。5 mm层厚MSCT重建及1 mm层厚MSCT重建显示肿大淋巴结30例,DR胸片没有显示肿大淋巴结,(DR胸片/5 mm层厚MSCTχ2=33.750,P=0.001;DR胸片/1 mm层厚MSCT2χ=33.750,P=0.001)。DR胸片没有显示树芽征,1 mm MSCT显示10例(χ2=9.907,P=0.007);DR胸片没显示磨砂玻璃影,1 mm MSCT显示15例(χ2=15.882,P=0.001)。结论多层螺旋CT对DR胸片显示孤立病灶的菌阴肺结核的诊断价值优于DR胸片。

Objective To evaluate the diagnostic value of multi-slice spiral CT（MSCT） for sputum smear-and culture-negative pulmonary tuberculosis with solitary node shown in chest digital radiography（DR） X-ray. Methods Solitary node shown in chest DR X-ray and MSCT among 180 cases with smear-and culture-negative pulmonary tuberculosis were analyzed retrospectively and solitary node shown in different section thickness of MSCT and chest DR X-ray were compared. Results Chest DR X-ray showed cavities in 6 cases and 5 mm section thickness MSCT showed in 15 cases（χ2=4.096,P=0.043） and 1 mm section thickness MSCT in 16 cases（χ2=4.841,P=0.028）.Satellites were seen in 50 cases with 5 mm section thickness MSCT（χ2=65.616,P=0.001） and in 55 cases with 1 mm section thickness MSCT（χ2=68.882,P=0.001）,but no satellite was observed in chest DR X-ray.Calcification was found in shadow among 120 cases with 5 mm section thickness multiplanar reconstruction MSCT（χ2=116.883,P=0.001） and among 140 cases with 1 mm section thickness multiplanar reconstruction MSCT（χ2=162.000,P=0.001）.However,there were only 20 cases found calcification in shadow with chest DR X-ray.There were also statistical differences in calcification of shadow between 5 mm-and 1 mm-section thickness multiplanar reconstruction MSCT（χ2=5.538,P=0.019）.Enlarged lymph nodes were observed in 30 cases with 5 mm（χ2=33.750,P=0.001）or 1 mm（χ2=33.750,P=0.001） section thickness multiplanar reconstruction MSCT.There was no enlarged lymph node observed in Chest DR X-ray.Tree-in-bud sign was not shown with Chest DR X-ray in all patients and was shown with 1 mm MSCT among 10 patients（χ2=9.907,P=0.007）.Ground-glass opacities was not shown with chest DR X-ray in all patients and was shown with 1 mm MSCT among 10 patients（χ2=15.882,P=0.001）. Conclusion MSCT is better in diagnosis of smear-and culture-negative pulmonary tuberculosis with solitary nodes than chest DR X-ray.