免疫功能正常者马尔尼菲蓝状菌病的胸部CT及PET-CT表现

Chest CT and PET-CT manifestations of Talaromycosis marneffei (TSM) in normal immunocompetent patients

目的:探讨免疫功能正常宿主的马尔尼菲蓝状菌病(TSM)的胸部CT和PET-CT表现。方法:回顾性分析18例免疫功能正常宿主TSM的临床及影像表现,其中16例行胸部CT平扫及增强检查,2例仅行胸部CT平扫检查;5例同期行18 FDG PET-CT检查。结果:所有病例均为两肺多发病灶。主要CT表现:多发粟粒及小结节影7例(38.9%),片状实变影6例(33.3%),肿块及结节影3例(16.7%),斑片及条索影2例(11.1%);伴小叶间隔增厚7例(38.9%),多发厚壁小空洞6例(33.3%),支气管扩张4例(22.2%),支气管血管束增粗2例(11.1%),支气管狭窄1例(5.6%),肺毁损1例(5.6%);胸腔积液8例(44.4%),心包积液4例(22.2%);伴骨质破坏7例(38.9%),其中5例(5/7,71.4%)CT复查出现骨质增生、修复;肺门、纵隔及锁骨上窝淋巴结肿大14例(77.8%)。5例患者的PET-CT显示两肺病灶摄取明显升高,SUVmax 5.8~20.3,平均13.74±6.42。结论:免疫功能正常宿主TSM的胸部CT和PET-CT表现有一定特征性,两者结合可提高诊断准确性。

Objective:To investigate the chest CT and PET-CT characteristics of Talaromycosis marneffei(TSM)in normal immunocompetent patients.Methods:Imaging and clinical data of 18 patients with TSM in normal immunocompetence were retrospectively analyzed.16 out of 18 cases underwent plain and enhanced CT scan,and the other 2 cases only had CT plain scan.Moreover,5 cases in 18 cases also had PET-CT examination.Results:Multiple lesions in bilateral lung were detected in all 18 cases.The main CT features were as follows:miliary or micro nodule in 7 cases(38.9%),patchy consolidation in 6 cases(33.3%),mass or nodule in 3 cases(16.7%),and pachy opacity or fibrous stripe in 2 cases(11.1%).Some accompanied features were also observed,including thickened interlobular septa in 7 cases(38.9%),small cavity with thickened wall in 6 cases(33.3%),bronchiectasis in 4 cases(22.2%),thickened bronchoascular bundles in 2 cases(11.1%),bronchial stenosis in one case(5.6%),and lung devastation in one case(5.6%).Pleural effusion in 8 cases(44.4%)and pericardial effusion in 4 cases(22.2%)were also found.Furthermore,bone destruction was found in 7 cases(38.9%),in which bone hyperplasia and repair were also showed in 5 cases(71.4%).The metastasis of the lymph nodes appeared in hilar,mediastinal and supraclavicular fossa was showed in 14 cases(77.8%).Of the 5 cases who underwent PET-CT examination,the lesions all showed an increased uptake with the maximum SUV of 5.8~20.3,average 13.74±6.42.Conclusion:The CT and PET-CT findings of TSM in normal immunocompetent patients have certain characteristics,the combination of the two methods may improve the diagnostic accuracy.