肺结核与肺癌并存的CT影像研究

CT imaging of coexisting pulmonary tuberculosis and lung cancer

目的研究肺结核与肺癌并存的CT影像特征。方法搜集经组织学、细胞学及临床综合确诊为肺结核与肺癌并存的患者104例，全部患者均有详细CT影像资料。将先有肺结核后出现肺癌或两者同期发现者定为Ⅰ组；将肺癌化疗期间出现肺结核者定为Ⅱ组；再将Ⅰ组中周围型肺癌定为Ⅰa组，Ⅱ组中周围型肺癌定为Ⅱa组，2组的中心型肺癌分别定为Ⅰb组及Ⅱb组。观察总结肺结核及肺癌病灶的影像特征，并将肺癌及肺结核出现的先后进行χ2和t检验分析。结果104例中Ⅰ组92例（88．5％），Ⅱ组12例（11．5％）。Ⅰ组中肺癌与肺结核同叶者70例（76．1％），不同叶者22例（23．9％）。Ⅰ、Ⅱ组之间肺结核的分布构成差异没有统计学意义（χ2=4．302，P=0．507）。肺结核影像表现中索条影、硬结钙化灶及病灶与胸膜粘连表现2组间比较差异有统计学意义（χ2值分别为22．737、15．193、27．792，P值均〈0．05），而其他征象差异没有统计学意义（P〉0．05）。中心型肺癌33例，Ⅰb组28例，Ⅱb组5例，Ⅰb中2例表现不典型，动态观察病变增大；周围型肺癌71例中，Ⅰa组64例，Ⅱa组7例。Ⅰa组中，表现典型者39例（60．9％），不典型者25例（39．1％），以直径≥3cm病变居多（49例，76．6％），除磨玻璃病变外所有病灶增强扫描均有强化。结论肺癌化疗期间继发肺结核的CT表现与普通活动性肺结核具有同样特征；分析肺结核合并的肺癌病灶，其形态、增强扫描及动态观察等均有助于诊断及鉴别诊断。

Objective To study the CT characteristics of coexisting pulmonary tuberculosis and lung cancer. Methods One hundred and four patients of coexisting pulmonary tuberculosis and lung cancer proved by histology, cytology or clinical underwent CT examination. All patients were divided into two groups, groupⅠ were the patients with the lung cancer after tuberculosis or both found simultaneously （ group Ⅰ a with peripheral lung cancer and group Ⅰ b with central lung cancer）, group Ⅱ with tuberculosis during lung cancer chemotherapy （ group Ⅱ a with peripheral lung cancer and group Ⅱb with central lung cancer）. Imaging characteristics of tuberculosis and lung cancer were compared. X2 test and t test were used for the statistical analysis. Results Of 104 patients,there were 92 patients （88.5%） in group Ⅰ and 12 patients （ 11.5% ） in group Ⅱ. Seventy patients （ 76. 1% ） of lung cancer and tuberculosis were located in the same lobe and 22 patients （23.9%） in the different lobes in group Ⅰ. There was no significant difference in distribution of tuberculosis between group Ⅰ and groupⅡ χ2 = 4. 302, P = 0. 507 ）. The fibrous stripes, nodules of calcification and pleural adhesion of tuberculosis were statistically significant between the two groups （χ2 =22. 737,15. 193,27. 792 ,P 〈 0. 05 ）. There were 33 central lung cancers and 71 peripheral lung cancers. In group Ⅰ a （ 64 patients of peripheral lung cancers ）, 39 patients （ 60. 9% ） had typical manifestations and most of the lesions were ≥ 3 cm （n = 49,76. 6% ）, solid lesions showed variable enhancement. Conclusions Secondary tuberculosis during lung cancer chemotherapy has the same CT characteristics with the common active tuberculosis. The morphology, enhancement pattern of lesion and follow-up are helpful for the diagnosis of lung cancer after tuberculosis.