结节或包块型不典型肺结核与肺癌的CT鉴别诊断

NODULAR OR MASS ATYPICAL PULMONARY TUBERCULOSIS AND LUNG CANCER:CT DIFFERENTIAL DIAGNOSIS

目的对比肺癌的CT表现,分析结节或包块型不典型肺结核的CT征象,以提高对不典型肺结核的认识,降低误诊率。方法经病理证实为结节或包块型不典型肺结核病人116例,肺癌病人158例,分析两组病变的部位、形态、大小、边缘、密度、病灶内部结构、邻近结构改变、增强等CT征象,并进行比较。结果 116例结节或包块型肺结核与158例肺癌比较,分叶征、深分叶征、毛刺征、短毛刺征、支气管充气征、空泡征、胸膜凹陷征、卫星灶及血管集束征构成比比较差异有显著性（t=5.64~36.12,P〈0.05）。两组轻度强化及显著强化构成比比较差异有显著性（t=16.47、25.47,P〈0.05）。结论结节或包块型不典型肺结核主要表现为无分叶或浅分叶、无毛刺或长毛刺、卫星灶轻度强化或无强化,不具备周围型肺癌的典型征象。

Objective To compare and analyze the CT findings of lung cancer and atypical pulmonary tuberculosis （PTB） presenting as nodular or mass, so as to improve the understanding of atypical PTB and reduce its misdiagnosis rate. Methods A total of 116 patients with nodule-or lump-type atypical PTB and 158 patients with pulmonary cancer （LC） confirmed by pathology were enrolled in this study. The CT findings such as site, appearance, size, margin, density, internal structure, adjacent structure changes and enhancement of the lesion in the two groups were compared and analyzed. Results A comparison between LC group and PTB group showed that the differences in sign of lobulation, sign of deep lobulation, spicule sign, short spicule sign, air bronchogram, vscuole sign, pleural indentation sign, satellite focus and composition ratio of vascular bundle were significant （t= 5.64-36.12, P 〈0.05）, and the differences in composition ratio of slight enhancement and significant enhancement were significant as well （t=16.47,25.47;P〈0.05）. Conclusion The main manifestations of nodule-or lump-type atypical pulmonary are not lo- bulated or superficially lobulated, without spicule or long spicule, mild enhancement or with no enhancement of satellite focus, all these features do not have the typical signs of peripheral lung cancer.