非结核分枝杆菌肺病与耐多药肺结核的CT影像对比分析

Comparative analysis of CT images of non-tuberculous mycobacterium tuberculosis and multidrug-resistant pulmonary tuberculosis

目的探讨非结核分枝杆菌(NTM)肺病以及耐多药肺结核(MDR-TB)的CT影像学表现特点,提高对该病的鉴别诊断水平。方法选取我院2010年1月—2015年12月确诊为NTM肺病的67例患者(NTM肺病组)及同期103例MDR-TB患者(MDR-TB组)的CT影像资料,比较2组影像学表现及病变部位的差异。结果 NTM肺病病灶好发双肺上叶尖后段及下叶背段内(Ⅰ区),呈簇状聚集的小叶中心性结节,并伴有支气管扩张以及胸膜下的薄壁空洞,少见支气管播散灶。MDR-TB病灶好发于右肺中叶及左肺上叶舌段(Ⅱ区),双肺上叶呈斑片、结节及干酪样病变,内伴厚壁空洞以及肺内慢性炎症;表现为厚壁空洞、肺实变、肺不张、钙化(肺内)、肺门纵隔淋巴结钙化、肺体积缩小、胸膜增厚和胸腔积液等。结论 NTM肺病与MDR-TB的胸部CT影像表现相似,但亦存在差异,细致分析影像特征可为临床鉴别诊断提供一定的依据。

Objective To study the computed tomograhpy(CT)features of non-tuberculous mycobacteria(NTM)andmultidrug-resistant pulmonary tuberculosis(MDR-TB),and to improve the differential diagnosis of the disease.MethodsThe CT imaging data of67patients diagnosed with NTM pulmonary disease(NTM lung disease group)and103patients withMDR-TB(MDR-TB group)were selected from January2010to December2015in our hospital.The imaging findings anddifferences in lesion location were compared between two groups.Results Lesions of NTM lung disease occurred in theposterior segment of the posterior and posterior lumbar dorsal(Ⅰarea),clustered lobular central nodules,accompanied bybronchiectasis and subpleural thin wall empty,rare bronchial foci.MDR-TB lesions occurred in the middle lobe of the rightlung and the upper lobe of the left lung(Ⅱarea).The upper lung of the lungs were patch,nodules and caseous lesions,withthick wall and chronic lung inflammation,showing thick wall empty,pulmonary consolidation,atelectasis,calcification(lung),hilar mediastinal lymph node calcification,lung volume reduction,pleural thickening and pleural effusion.Conclusion Chest CT images are similar in NTM lung disease and MDR-TB,but there are differences.The detailedanalysis of image features can provide a basis for clinical differential diagnosis.