多层螺旋CT检查肺结核与矽肺的临床价值分析

Analysis of the clinical value of multi-slice spiral CT in the detection of tuberculosis and silicosis

目的探讨肺结核与矽肺患者的CT鉴别诊断。方法回顾性分析临床确诊的肺结核患者37例,矽肺患者35例,均行64排螺旋CT平扫及高分辨率CT(HRCT),分析其影像表现,运用统计学方法进行鉴别诊断。结果肺结核组:37例患者,结节分布双肺上叶及下叶背段29例(78.3%),结节全肺分布11例(29.7%),结节边缘模糊29例(78.4%),纤维斑块12例(32.4%),纤维空洞10例(27.0%),胸膜肥厚36例(97.3%),胸腔积液14例(37.8%),胸膜钙化4例(10.8%),纵隔肺门淋巴结肿大27例(73.0%),纵隔肺门淋巴结钙化10例(27.0%)。结核结节大小约(2.27±0.34)mm。结核纤维灶密度约(35.6±8.4)HU。矽肺组:35例患者,结节分布双肺上叶及下叶背段32例(91.4%),结节全肺分布5例(14.2%),结节边缘模3例(8.5%),纤维斑块15例(42.9%),纤维空洞2例(5.7%),胸膜肥厚25例(71.4%)胸腔积液2例(5.7%),胸膜钙化14例(40.0%%),纵隔肺门淋巴结肿大15例(42.9%),纵隔肺门淋巴结钙化14例(40.0%)。矽肺结节大小约(3.17±0.63)mm。矽肺纤维灶密度约(54.11±1.0)HU。结论矽肺与结核在常规螺旋CT及HRCT上各有异同点,能够为两者鉴别诊断提供非常有价值的信息。

Objective To explore the clinical value of multi-slice spiral CT in differential diagnosis of pulmonary tuberculosis and silicosis. Methods A retrospective analysis was conducted on 37 patients with pulmonary tuberculosis confirmed by the clin-ic and 35 patients with silicosis. All underwent the plain 64-row helical CT scan and high resolution CT （ HRCT） scan. The ima-ging manifestations of those patients were analyzed and the differential diagnosis was performed by use of statistical methods. Re-sults In the group of patients with tuberculosis, the nodules were distributed in the bilaterel superior？ lobe and dorsal segment of lower lobe in 29 cases （78. 3%）, throughout the lungs in 11 cases （29. 7%）. 29 cases （78. 4%） presented with ill-defined nodule margin, 12 cases （32. 4%） with fiber plaques, 10 cases （27. 0%） with fiber cavity, 36 cases （97. 3%） with pleural thickening, 14 cases （37. 8%） with pleural effusion, 4 cases （10. 8%） with pleural calcification, 27 cases （73. 0%） with me-diastinal hilum lymph node enlargement, and 10 cases with mediastinal hilum lymph node calcification （27. 0%）. TB nodule size was about （2. 27 ± 0. 34） mm. Tuberculosis fiber density was about （35. 6 ± 35. 6） HU. In the group of patients with silicosis, the nodules were distributed in the bilaterel superior lobe and dorsal segment of lower lobe in 32 cases （91. 4%）, throughout the lungs in 5 cases （14. 2%）. 3 cases （8. 5%） presented with ill-defined nodule margin, 2 cases （5. 7%） with fiber plaques, 2 cases （5. 7%） with fiber cavity, 25 cases （71. 4%） with pleural thickening, 2 cases （5. 7%） with pleural effusion, 14 cases （40. 0%） with pleural calcification, 14 cases （ 40. 0%） with mediastinal hilum lymph node enlargement, and 15 cases （42. 9%） with mediastinal hilum lymph node calcification. Silicosis nodule size was about （3. 17 ± 0. 63） mm. Silicosis fiber density was about （54. 1 ± 54. 1） HU . Conclusion Silicosis or tuberculosis each exhibits the similarities and differences in rou-tine spiral CT and HRCT, which can provide very valuable information for the differential diagnosis of those two disorders.