多层螺旋CT在肺结核空洞与肺癌空洞鉴别诊断中的临床应用

Clinical application of multi-slice spiral CT for the differential diagnosis of tuberculosis and lung cancer cavities

目的探讨多层螺旋CT(MSCT)对肺结核空洞与肺癌空洞的鉴别诊断价值。方法选取2015年1月至2020年1月间咸丰县人民医院收治的行MSCT检查检出肺部空洞的94例患者,其中肺结核空洞55例,肺癌空洞39例,对两组患者空洞病灶部位(上叶、中叶/舌叶、下叶)、大小(长径、厚壁空洞数)、性质(钙化、结节、分叶、毛刺)和周围组织特征(周围组织炎症、胸膜粘连、淋巴结钙化、周围卫星灶)中各项指标进行比较。结果两组病灶部位比较,在上叶空洞中,肺结核患者比例显著多于肺癌患者,差异有统计学意义(P<0.05);在下叶空段空洞中,肺癌患者比例显著多于肺结核患者,差异有统计学意义(P<0.05);在中叶/舌叶空洞中,两组患者比例比较,差异无统计学意义(P>0.05)。两组病灶大小比较,肺癌组患者空洞长径显著高于肺结核组,且厚壁空洞数量高于肺结核组,差异均有统计学意义(均P<0.05)。两组病灶性质比较,肺结核组钙化发生率显著高于肺癌组,肺癌组结节、分叶、毛刺发生率显著高于肺结核组,差异均有统计学意义(均P<0.05)。两组周围组织特征比较,肺结核组周围组织炎症、淋巴结钙化及周围卫星灶发生率显著高于肺癌组,差异均有统计学意义(均P<0.05),两组患者胸膜粘连发生率比较,差异无统计学意义(P>0.05)。两组病灶形态学分型比较,肺结核组Ⅲ型比例显著高于肺癌组,肺癌组Ⅳ型比例显著高于肺结核组,差异均有统计学意义(均P<0.05),两组患者Ⅰ型及Ⅱ型比例比较,差异无统计学意义(P>0.05)。结论MSCT下肺结核及肺癌来源的空洞在部位、大小、形态、病灶性质及周边组织层面的诸多特性中存在显著性差异,可有效对肺部空洞的来源进行鉴别诊断。

Objective To explore the value of multi-slice spiral CT(MSCT)for the differential diagnosis of tuberculosis and lung cancer cavities.Methods A total of 94 patients confirmed with lung cavities by MSCT at Xianfeng County People’s Hospital from January 2015 to January 2020 were selected,including 55 patients with tuberculosis cavities and 39 patients with lung cancer cavities.The sites(superior lobe,middle lobe/lingual lobe,inferior lobe),size(long diameter,number of thick-walled cavities),properties(calcification,nodule,lobulation,burr)and surrounding tissue characteristics(inflammation of peripheral tissues,pleural adhesion,lymph node calcification,surrounding satellite lesions)of cavities were compared between the two groups.Results In terms of sites of lesions,the proportion of superior lobe cavities was significantly higher in tuberculosis patients than in lung cancer patients(P<0.05),while the proportion of inferior lobe cavities was significantly lower in tuberculosis patients(P<0.05).There was no significant difference in the proportion of middle lobe/lingual lobe cavities between the two groups(P>0.05).In terms of size of lesions,long diameter of cavities in lung cancer group was significantly longer than in tuberculosis group(P<0.05),and number of thick-walled cavities was significantly more than in tuberculosis group(P<0.05).In terms of properties of lesions,the incidence of calcification was significantly higher in tuberculosis group than in lung cancer group(P<0.05),while incidence of nodules,lobulation and burrs was significantly lower in tuberculosis group than in lung cancer group(P<0.05).In terms of the characteristics of surrounding tissues,the incidence of peripheral tissues inflammation,lymph node calcification and surrounding satellite lesions was significantly higher in tuberculosis group than in lung cancer group(P<0.05).There was no significant difference in the incidence of pleural adhesion between the two groups(P>0.05).In terms of morphological classifications of lesions,proportion of typeⅢwas significantly higher in tuberculosis group than in lung cancer group(P<0.05),while proportion of typeⅣwas significantly lower in tuberculosis group than in lung cancer group(P<0.05).There was no significant difference in the proportion of typeⅠorⅡbetween the two groups(P>0.05).Conclusion There are significant differences in the sites,size,morphology,properties and surrounding tissues of cavities between tuberculosis and lung cancer under MSCT.This examination method can effectively differentiate the sources of lung cavities.