肿瘤型肺结核的CT影像学表现及误诊分析

CT Imaging Findings and Misdiagnostic Causes of Tumor-type Pulmonary Tuberculosis

目的分析肿瘤型肺结核的CT影像学特征,评价CT在肿瘤型肺结核诊断中的应用价值;分析误诊原因,提高对肿瘤型肺结核诊断的准确率。方法对43例经临床或病理证实的肿瘤型肺结核患者行CT扫描,所采集数据进行后处理,总结其CT影像学特征。结果 43例肿瘤型肺结核患者按其CT影像学特征分型:肺部团块型23例(53.5%),肺部单发或多发结节型6例(14.0%),肺部空洞型5例(11.6%),纵隔肺门团块型5例(11.6%),支气管腔内结节、团块型4例(9.3%)。32例行CT增强扫描,表现为不均匀强化18例,环形强化4例,周边强化2例,整体均匀强化4例,不强化4例。43例误诊为肺癌36例,误诊率83.7%。结论肿瘤型肺结核因其CT影像特点不典型,误诊肺癌较多,CT显示其影像特点有一定的优势,结合实验室检查、随访或穿刺活检,可以提高诊断准确率。

Objective To investigate the CT imaging findings of tumor-type pulmonary tuberculosis and the value of CT in diagnosing tumor-type pulmonary tuberculosis,and to analyze the causes of misdiagnosis to improve the accuracy of diagnosis.Methods CT scan was performed in 43 patients with clinically or pathologically confirmed tumor-type pulmonary tuberculosis.Image data were analyzed retrospectively on Toshiba workstation and CT imaging characteristics were summarized.Results Among the 43 patients,lung mass type tuberculosis was found in 23（53.5%）,single or multiple pulmonary nodule type tuberculosis in 6（14.0%）,cavity type tuberculosis in 5（11.6%）,mediastinal and lung hilum mass type tuberculosis in 5（11.6%）,and intra-lumen nodule and mass type tuberculosis in 4（9.3%）.Among the 32 patients who underwent enhancement scan,uneven enhancement was observed in 18,ring-shaped enhancement in 4,peripheral enhancement in 2,whole even enhancement in 4,and no enhancement in 4.Tumor-type pulmonary tuberculosis was misdiagnosed as lung cancer in 36 patients（83.7%）.Conclusion Tumor-type pulmonary tuberculosis is easily misdiagnosed as lung cancer because of untypical CT findings.CT scan is predominant in displaying image features and can improve the accuracy of diagnosis of tumor-type pulmonary tuberculosis by combining laboratory test,follow-up or biopsy.