肺结核患者肺部局灶性磨玻璃样病灶的CT征象分析

Analysis of CT imaging findings appearing as focal ground glass opacity in patients with pulmonary tuberculosis

目的探讨肺结核患者肺部局灶性磨玻璃样(focal ground-glass opacity,fGGO)病灶的CT特征,以提高对肺结核少见征象的认识。方法收集2009-2019年北京胸科医院确诊的11例具有fGGO病灶的肺结核患者(肺结核组,11个fGGO病灶),其中7例经临床综合诊断、3例经手术组织标本病理检查证实、1例经皮肺穿刺活检病理证实。同期按照1:4比例选取经我院手术病理证实的44例具有fGGO病灶的肺癌患者(肺癌组,44个fGGO病灶)。分析两组患者fGGO病灶的CT扫描特征。结果肺结核组和肺癌组患者fGGO病灶分布在上叶[分别为63.6%(7/11)和65.9%(29/44)]、中叶[分别为9.1%(1/11)和11.4%(5/44)]、下叶[分别为27.3%(3/11)和22.7%(10/44)]的差异无统计学意义(χ~2=2.608,P=0.106)。肺结核组fGGO病灶呈圆或椭圆形[36.4%(4/11)]、边缘与肺交界面清晰[9.1%(1/11)]、有分叶[0.0%(0/11)]的比例均明显低于肺癌组[77.3%(34/44)、93.2%(41/44)、43.2%(19/44)](χ~2=5.114,P=0.024;χ~2=29.974,P=0.000;χ~2=5.473,P=0.019)。肺结核组fGGO病灶内部密度均匀[9.1%(1/11)]、有支气管影或空泡[0.0%(0/11)]、出现增粗或扭曲血管影[0.0%(0/11)]的比率均明显低于肺癌组[分别为54.5%(24/44)、38.6%(17/44)、77.3%(34/44)](χ~2=7.333,P=0.007;χ~2=4.475,P=0.034;χ~2=19.108,P=0.000),而多发结节样病灶[90.9%(10/11)]的比率高于肺癌组[0.0%(0/44)](χ~2=42.969,P=0.000)。结论肺结核fGGO病灶分布与肺癌无特异性差别;依据fGGO边缘模糊、无分叶、无胸膜凹陷征、病灶内部密度不均匀、无支气管影或空泡、无增粗或扭曲血管影、多发簇状分布结节样病灶的CT表现,在与肺癌鉴别诊断时有一定的参考价值。

Objective To investigate the characteristics of CT images of focal ground glass opacity(fGGO)in patients with pulmonary tuberculosis in order to improve the understanding of rare signs.Methods Eleven cases of pulmonary tuberculosis admitted in Beijing Chest Hospital from 2009 to 2019 were collected as pulmonary tuberculosis group(totally 11 fGGO lesions)including 7 cases by composite reference standard(CRS),3 cases by surgical pathology and 1 case by percutaneous lung puncture.According to the ratio of 1:4,44 cases with lung cancer confirmed by surgical pathology in our hospital during the same period were selected as the lung cancer group(totally 44 fGGO lesions).The CT image characteristics of fGGO lesions in the two groups were analyzed.Results The fGGO lesions in patients with pulmonary tuberculosis and lung cancer were distributed in the upper lobe(63.6%(7/11)vs.65.9%(29/44)),the middle lobe(9.1%(1/11)vs.11.4%(5/44)),and the lower lobe(27.3%(3/11)vs.22.7%(10/44))without statistically significant difference(χ2=2.608,P=0.106).The characteristics of fGGO imaging with round or oval(36.4%(4/11)),clear interface between lesion and lung tissue(9.1%(1/11)),and the lobulation sign(0.0%(0/11))in the pulmonary tuberculosis group were significantly lower than those(77.3%(34/44),93.2%(41/44),43.2%(19/44))in the lung cancer group with statistically significant differences(χ2=5.114,P=0.024;χ2=29.974,P=0.000;χ2=5.473,P=0.019).The features of fGGO imaging with internal homogeneous density(9.1%(1/11)),bronchial shadow or vacuoles(0.0%(0/11)),thickened or twisted vessels(0.0%(0/11))in the pulmonary tuberculosis group were significantly lower than those(54.5%(24/44),38.6%(17/44)and 77.3%(34/44))in the lung cancer group with statistically significant differences(χ2=7.333,P=0.007;χ2=4.475,P=0.034;χ=19.108,P=0.000).However,the frequency of the multiple nodular lesions(90.9%(10/11))in the pulmonary tuberculosis group were significantly higher than that(0.0%(0/44))in the lung cancer group with statistically significant difference(χ2=42.969,P=0.000).Conclusion The distribution of fGGO lesions is not specifically different in two groups.But the characteristic of fGG()imaging with blurred edges,no lobulation sign,no pleural depression,internal inhomogeneous density inside the lesion,no bronchial shadow or vacuoles,no thickened or twisted vessels,and multiple cluster-like noduleshave certain reference value for differential diagnosis in pulmonary tuberculosis from lung cancer.