活动性肺结核的CT诊断

CT Diagnosis of Active Pulmonary Tuberculosis

目的 :进一步了解活动性肺结核的CT表现及其临床应用价值。材料和方法 :回顾分析经病理和临床证实的32例活动性肺结核CT表现 ,并与20例非活动性肺结核作对照。结果 :有28例活动性肺结核发生在上叶尖后段、下叶背段 ;有20例呈不规则斑片状影 ,边界不清 ,密度不均 ;14例可见病灶钙化 ,其中9例发生在狭窄或阻塞支气管的增厚管壁上 ;11例在实变影中见多发性小空洞 ;病灶周围有支气管播散者15例 ;8例见纵隔淋巴结肿大 ,其中2例直径大于20mm ,增强后可见环状强化。非活动性肺结核CT表现主要为纤维性改变、胸膜增厚和纵隔淋巴结钙化。结论 :CT可提高活动性肺结核的诊断正确率 ,并有助于与非活动性肺结核的鉴别。

Purpose:To further appraise the CT features of active pulmonary tuberculosis(Tb) and their clinical application.Materials and Methods:Retrospectively analyzed the CT findings of 32 cases of active pulmonary tuberculosis, which were proved pathologically or clinically,and compared with that of 20 cases of inactive pulmonary tuberculosis.Results: The lesions occurred in the apical or posterior segment of upper lobe or in the superior segment of lower lobe in 28 cases.Heterogeneous, irregular, and illegille opacities were found in 20 cases.Calcification inside the lesion was found in 14 cases, and among them 9 cases had the calcification in the thickened wall of narrowed or obstructed bronchus. Eleven had multiple small cavifies within area of consolidation. Bronchogenic spread was detected in 15 cases. Mediastinal lymphadenopathy was seen in 8 patients, in 2 of which had nodes greater than 20mm in diameter with peripheral rimlike enhancement after the administration of intravenous contrast material. The main CT findings of inactive tuberculosis were fibrotic changes, pleural thickening and mediastinal nodal calcification.Conclusion:CT images can improve the accuracy in diagnosis of active pulmonary tuberculosis, and is helpful in differentiating inactive one.