肺癌与肺结核致单侧全肺不张的对比增强CT鉴别诊断

Differential Diagnosis of Unilateral Atelectasis Caused by Lung Cancer and Tuberculosis using Contrast Enhanced CT

目的探讨肺癌及肺结核导致单侧全肺不张的对比增强CT表现差异,以提高对两者诊断及鉴别诊断水平。方法回顾性分析42例肺癌及32例肺结核致单侧全肺不张患者的胸部CT图像,分别采用独立样本t检验、非参数检验或卡方检验对比两者CT表现的差异性。结果与肺癌相比,结核组患侧胸廓塌陷更常见(P<0.05),且塌陷程度及纵隔向患侧移位更明显。肺癌组患侧主支气管改变以截断为主(57.1%),肺门部肿块常见(85.7%);而结核组主要表现为管壁增厚、狭窄或闭塞(84.4%),多伴远端支气管扩张(65.6%)。肺癌组中,患侧肺门处肺动脉多表现为不均匀变细或闭塞(64.3%),而结核组无明显变化。肺癌组中,肺门处肺-纵隔脂肪间隙多消失(69.0%),而结核组中多可见(96.9%)。结核组中患侧及健侧肺组织内主要异常为多发钙化灶(75.0%)及结核灶(50%),而肺癌组中健侧肺内可见转移灶(26.2%)。此外,肺癌组较结核组纵隔淋巴结增大更常见(P<0.05),且增大较明显。结论肺癌与肺结核所致单侧全肺不张患者的胸部CT表现具有较明显差异,熟悉两者的差异有助于提高其诊断及鉴别诊断水平。

Objective To improve the diagnosis and differential diagnosis of unilateral atelectasis caused by lung cancer or tuberculosis by analyzing their contrast enhanced CT features. Methods The chest CT images of 42 patients with unilateral atelectasis due to lung cancer and 32 patients with atelectasis from tuberculosis were retrospectively analyzed. Their CT features were compared by using independent sample t test,nonparametric test or chi-square test in order to determine their differences. Results Compared with lung cancer group,thorax collapse was more common in tuberculosis group(96.9% vs. 64.3%,P<0.05),and its degree and mediastinum shifting to the affected side were more obvious. For the main bronchus on the affected side,it mainly manifested as cut off(57.1%) in lung cancer group and hilar mass was very common(85.7%),while wall thicking,narrowing and obstruction(84.4%) as well as distal bronchiectasis(65.6%) were more common in tuberculosis group. The hilar pulmonary arteries in affected side were usually irregularly narrow or obstructed(64.3%) in lung cancer group,while those had no obvious change in tuberculosis group. The interface between involved lung tissue in hilum and mediastinum was usually disappear in lung cancer group(69.0%),while that could usually be detected in tuberculosis group(96.9%). The main abnormalites in affected and normal lung were multiple calcification and tuberculous foci in tuberculosis group,while multiple metastasis could be detected in normal lung in lung cancer group. In addition,compared with tuberculosis group,enlarged lymph nodes in mediastinum were more common(76.2% vs. 34.4%,P<0.05) and bigger in lung cancer group. Conclusion The chest CT manifestations between patients with unilateral pulmonary atelectasis caused by lung cancer and tuberculosis have significant differences,understanding this outcome is helpful for their diagnosis and differential diagnosis.