肺隐球菌病CT征象的临床分析

Classification of cryptococcus CT features and identification

目的探讨肺隐球菌(PC) CT影像特征。方法对73例PC患者行CT检查后经临床穿刺手术病理证实的CT影像及临床资料进行分析。结果 73例PC按影像分型共分五型:单发结节或肿块型30例,占41. 1%;多发结节或肿块型20例,占27. 4%;肺实变浸润型/肺炎型14例占19. 2%;混合型6例,占8. 2%;非典型(含毛玻璃型、粟粒型及其他非典型影像表现) 3例,占4. 1%。在73例隐球菌病例中:胸膜下分布占100%,边缘平直征为97%,均匀强化占100%,晕征占63%,气管征占65. 8%,空洞征占15%。多发结节或肿块型,较为特征性的征象—"蘑菇兄弟征",出现率为80%。结论 PC的CT表现具有多样性,胸膜下分布、边缘平直征和均匀强化等几个征象有较高的价值。晕征和支气管征发现率也较高,而空洞出现率相对较少。多发结节或肿块型,较为特征性的征象—"蘑菇兄弟征",有较高的特异性。

Objective To classify 73 cases of cryptococcus pneumoniae （PC） collected by many hospitals, to study the image features and differential diagnosis of each type of classification in order to improve the diagnostic level of PC. Methods CT images and clinical data of 73 patients with PC confirmed by puncture or surgical pathology were retrospectively analyzed. Results 73 PCs were divided into five types according to imaging classification： 30 cases with single nodules or masses, accounting for 41.1%; 20 cases with multiple nodules or masses, accounting for 27.4%; lung consolidation/pneumonia cases accounted for 19.2%; mixed cases were found in 6 cases, accounting for 8.2%, and atypical type （including diffuse GGO and other atypical imaging manifestations） in 3 cases, accounting for 4.1%. Among the 73 cases of PC, 100% of cases presented with subpleural distribution, 97% with marginal straight sign, 100% of cases with uniform enhancement, 63%with halo sign, 65.8% with trachea sign and 15% with void sign. The probability of different types of signs was different, especially multiple nodules or masses, and the more characteristic sign was the “mushroom brother sign” with an 80% incidence. Conclusion The CT manifestations of PC are diverse. Several signs such as subpleural distribution, borderline sign and uniform enhancement have higher value. The rate of halo sign and bronchogram sign is also high, but the incidence of voids is relatively small. The probability of different types of signs appears differently, especially multiple nodules or masses, and the more characteristic sign, “Mushroom brother sign”, has higher specificity. Therefore, it is necessary to first classify the sign, then to make a corresponding differential diagnosis.