82例涂阴培阳肺结核治疗前后MSCT表现及转归

MSCT Manifestations and Outcome of 82 Patients with Negative Smear and Positive Culture Pulmonary Tuberculosis Before and After Treatment

目的探讨涂阴培阳肺结核治疗前后及随访6个月时的MSCT表现及演变规律。方法搜集并筛选2009年6月至2012年1月在本院登记治疗且资料完整的涂阴培阳肺结核82例,由3名有经验的高年资主治以上医师进行阅片,统一意见后逐一记录每个病例的胸部MSCT表现及特点,对比分析治疗前后及随访6个月时的MSCT表现。结果治疗前活动性肺结核MSCT征象中的小叶中心结节、磨玻璃影、腺泡结节、树芽征、边缘模糊的小叶样实变、支气管壁增厚、多发性结节内小空洞、边缘模糊的实变、厚壁空洞检出率分别为78.0%、76.8%、70.7%、50%、45.1%、45.1%、43.9%、19.5%、3.66%;活动性CT征象治疗前后检出率分别为100%、17.1%。治疗后非活动性肺结核MSCT征象中的条索影、边缘清晰高密度结节、肺结构扭曲变形、斑块、钙化、支气管扩张、空腔检出率分别为75.6%、59.8%、41.5%、18.3%、15.9%、12.2%、8.54%;非活动性MSCT征象治疗前后检出率分别为30.5%、90.2%。结论涂阴培阳肺结核MSCT征象及转归和其代表的病变性质有关。疗程结束后病灶进一步吸收,但主要是肺组织自身的重塑过程。

Objective Objective To explore multi-slice CT （MSCT） manifestations of smear-negative and culture-positive pulmonary tuberculosis （TB） before and after treatment as well as at 6-month following-up visit, and to discuss its development pattern. Methods A total of 82 patients with smear-negative and culture-positive pulmonary tuberculosis who registered to receive treatment at authors＇ hospital during the period from June 2009 to January 2012 and had complete clinical materials were enrolled in this study. MSCT imaging findings were analyzed by three experienced high-qualification physicians. MRST manifestations as well as imaging features of each patient were recorded if all the three doctors agreed on the explanations. The results which were obtained from three doctors＇ judgment before treatment, after treatment as well as 6 months after treatment were analyzed and compared between each other. Results Before treatment, the active pulmonary TB made its appearance on MSCT scans as lobular nodules （78.0%）, ground-glass opacity （76.8%）, acinous nodules （70. 7% ）, tree-in-bud sign （50%）, lobular consolidation with fuzzy edge （45. 1%）, thickened bronchial wall （45.1%） , multiple tiny holes within a nodule （43.9%） , consolidation shadow with blurred margin （ 19.5% ） and thickened-wall cavity （3.66%）. In active pulmonary TB, the above manifestations could be detected in 100% of patients before the treatment and in 17.1% of patients after the treatment. After the treatment, the inactive pulmonary TB was characterized by the following signs： fibrous tissue （75.6%）, sharply-bordered high-density nodules （59.8%）, deformation of lung structure （41.5%）, plaques （ 18.3% ）, calcification （ 15.9% ）, bronchiectasis （ 12.2% ） and cavity （ 8.54% ）. The detection rates of inactive pulmonary TB signs before and after the treatment were 30.5% and 90.2% respectively. Conclusion MSCT manifestations of smear-negative and culture-positive pulmonary tuberculosis are related to its pathologic nature. When the therapeutic course finishes, the lesions will be further absorbed with the pulmonary tissue being reshaped.