肺结核合并肺癌的CT表现与鉴别诊断

The characteristics of CT and differential diagnosis in patients with pulmonary tuberculosis complicated by lung cancer

目的探讨肺结核合并肺癌患者CT表现特点以及鉴别诊断方法,以提高临床诊断正确率。方法选择2010年2月至2016年12月诊断肺结核合并肺癌患者84例,患者均给予GE 64排螺旋CT检查,分析CT表现特点,并与同期单纯性肺结核患者90例对照分析,比较2组患者肺部CT表现特点。结果肺结核合并肺癌组中病变发生在同侧肺叶16例,同侧不同肺叶37例,不同侧肺叶31例。中心型肺癌表现38例,周围型肺癌表现46例。<3 cm肺癌诊断23例,初次疑诊肺癌12例,漏诊11例。≥3 cm肺癌61例,漏诊3例。以胸腔积液为首发诊断9例,漏诊2例,纵膈型肺结核3例,初次诊断正确率0例。肺结核伴有肺癌患者中以肺部不规则肿块影,伴有分叶征、毛刺征、棘状突起较为常见。胸膜凹陷征、空泡征不典型。斑片状渗出影、小结节影、空洞影发病率低于单纯肺结核组(P<0.05)。结论单纯肺结核CT影像学表现以新旧病灶不一,病灶分布不均、形态多样为主要特点;肺结核合并肺癌患者CT影像学特点为在陈旧性肺结核影像学表现背景下,出现肺癌的占位性特征,或者二者典型表现同时合并存在。肺结核合并肺癌患者临床发病率不少见,动态分析其肺部CT表现有助于其早期诊断。

Objective To investigate the characteristics of CT and differential diagnosis method in patients with pulmonary tuberculosis complicated by lung cancer in order to improve the accuracy of clinical diagnosis. Methods A total of84 patients with pulmonary tuberculosis complicated by lung cancer who were diagnosed and treated in our hospital from February 2010 to December 2016 were enrolled in the study（ tuberculosis ＋ lung cancer group）,who were examined by 64-slice spiral CT scanner. The characteristics of CT were analyzed and compared with those of 90 patients with simple pulmonary tuberculosis（ control group）. Results In tuberculosis ＋ lung cancer group,16 patients had lesions in the same lobe of the same side of the lung,37 patients had lesions in different lobes of the same lung,and 31 patients had lesions in different lungs.Central lung cancer was found in 38 patients,while 46 patients had peripheral lung cancer lesions. Twenty-three patients were diagnosed with lung lesions 〈 3 cm in size,12 patients were suspected of having lung cancer during preliminary evaluation,and11 cases of lung cancer were not identified（ missed diagnoses）. Moreover 61 patients were diagnosed with lung lesions ≥3 cm in sizes,in whom,3 cases were missed at the preliminary diagnosis and 3 cases had missed diagnoses. Nine cases were initially diagnosed as pleural effusion and 2 cases were missed diagnosis. Three cases were diagnosed as mediastinal tuberculosis,and no cases were correctly diagnosed at the first diagnosis. CT findings in with pulmonary tuberculosis complicated by lung cancer were irregular-shaped mass shadows accompanied by lobulation,speculation,and spinous processes. Pleural indentation and vacuole signs were not typical findings. The incidence rates of patchy exudative shadows,small nodular shadows,or hollow shadows in tuberculosis ＋ lung cancer group were significantly lower than those in control group（ P 〈 0. 05）. Conclusion CT image in patients with simple tuberculosis shows the main features of a distinct and variable morphologic appearance that are different between the old and new lesions,and are unevenly distributed throughout the lungs. CT image in patients with pulmonary tuberculosis complicated by lung cancer shows the main features of space-occupying lung cancer lesions visible on a background of old tuberculosis imaging,the coexistence of typical presentations of both lung cancer and tuberculosis. The clinical incidence rate of tuberculosis complicated by lung cancer is higher,and dynamic analysis of lung CT findings in helpful for the early diagnosis.