以粟粒样结节为主要表现的肺结节病和肺结核的CT鉴别诊断

Differentiation and diagnosis by CT in sarcoidosis and pulmonary tuberculosis with miliary nodules as their main manifestations

目的分析以粟粒样结节为主要表现的肺结节病和肺结核的CT影像学特征,提高CT诊断结节病和肺结核的准确性。方法回顾性分析我院2012年12月至2015年2月肺内以弥漫分布的粟粒样结节为主要病变的患者的临床和影像学资料,所有患者均行胸部多层螺旋CT扫描。其中结节病17例,肺结核21例。结果 2种病例在粟粒样结节的区域分布上,差异无统计学意义(P>0.05);在粟粒样结节的位置分布上:结节病的小结节多沿淋巴管周围分布,肺结核的小结节多随机分布(P<0.05);粟粒样结节若大小均匀,提示肺结核的可能性大(P<0.05),若结节边界清楚、具有融合倾向,提示结节病的可能性大(P<0.05);结节病合并淋巴结肿大、空气潴留征、斑片影、纤维化较肺结核多见,而肺结核合并树芽征、磨玻璃密度影、胸腔积液较结节病多见(P<0.05)。结论以肺内粟粒样小结节为主要病变的结节病和肺结核在小结节的位置分布、小结节的特征及合并征象等方面在螺旋CT表现特征上有明显差异,对其鉴别和诊断有重要价值。

Objective To analyze the photographic CT features of sarcoidosis and pulmonary tuberculosis with miliary nodules as their main manifestations,so as to improve the diagnostic accuracy of sarcoidosis and pulmonary tuberculosis by CT. Methods Retrospective analyses of the clinical and photographic data were made in the patients with miliary nodules in the lungs as the main manifestations. The patients sought medical care in the hospital from December,2012 to February,2015. All the patients underwent multislice spiral CT scanning of the chest. Detection results showed that there were 17 cases of sarcoidosis and 21 cases of tuberculosis.Results There were no significant differences in the regional distribution of miliary nodules between the 2 groups（ P〉0. 05）. As for the distribution of miliary nodules,sarcoidosis nodules were mostly distributed along the lymphatic vessels,while pulmonary tuberculosis nodules were distributed at random（ P〈0. 05）. If miliary nodules were even in size,it might indicate a higher probability of pulmonary tuberculosis（ P〈0. 05）. If the boundaries of nodules were clear and had a fusion tendency,it was highly probable that it was sarcoidosis（ P〈0. 05）. Sarcoidosis combined with lymphadenectasis,air retention,patchy shadow,fibrosis was more common,as compared with pulmonary tuberculosis,however,pulmonary tuberculosis complicated with tree-in-bud tuberculosis,ground glass opacity,pleural dropsy was more frequently seen,as compared with sarcoidosis（ P〈0. 05）. Conclusion For sarcoidosis and pulmonary tuberculosis with miliary nodules in the lungs as the main manifestations,from the spiral CT features,significant differences could be seen in the regional distribution,structural features of nodules and associated signs and symptoms,so it was of important value for the identification and diagnosis of the disorder.