肺结核反晕征的CT演变特征

Evolution of CT characteristics of reversed halo sign in pulmonary tuberculosis

目的探讨肺结核"反晕征"的CT演变特征,进一步提高对此征象CT表现的认识。方法回顾性分析河南科技大学第一附属医院2013年8月至2020年4月经临床和病理证实且CT表现为"反晕征"的12例肺结核患者的临床及CT资料,并对其中1例接受手术治疗的患者进行病理和影像对照分析。结果12例表现为"反晕征"的患者中,单肺单发2例,单肺多发2例,双肺多发8例;3例仅见"反晕征",9例同时合并晕征样或均匀样"烟花征"。12例患者于"反晕征"外环均可见"树芽征"。8例接受3次及以上CT复查,其中6例规范抗结核治疗后显示"反晕征"整体密度减低、体积缩小。2例自然病程下,1例病灶整体增大,1例病灶整体密度减低、"反晕征"外环壁变薄。1例手术肺叶切除病理显示,肺实质内可见大小不等含朗格汉斯结节巨细胞的肉芽肿性炎结节,典型的干酪性坏死肉芽肿结节少见。CT上"反晕征"外环朗格汉斯结节密集,中央区稀疏伴纤维组织增生和肺泡壁增厚。结论肺结核"反晕征"外环以"树芽征"为主,中央以细网格影为主,在有效抗结核治疗后"反晕征"整体密度减低、病灶缩小,最终多以细网格影长期存在。

Objective To explore the evolution of CT characteristics of the"reversed halo sign"of pulmonary tuberculosis,and to further improve the recognition of its CT signs.Methods Clinical and CT data of 12 patients with pulmonary tuberculosis who were clinically and pathologically confirmed and accompanied with CT manifestation of"reversed halo sign"in First Affiliated Hospital of Henan University of Science and Technology from August 2013 to April 2020 were analyzed retrospectively.Pathological and imaging contrastl analysis was performed on 1 patient undergoing surgical treatment.Results Among 12 cases with"reversed halo sign",there were 2 cases with single lesion in unilateral lung,2 cases with multiple lesions in unilateral lung,and 8 cases with multiple lesions in bilateral lungs.Three cases showed only"reversed halo sign",9 cases showed both halo-like sign and uniform fireworks sign."Tree-in-bud"sign was found in all 12 patients in the outer ring of the"reversed halo sign".Eight patients received three or more CT examinations,and six of them showed reduction of density and volume of the"reversed halo sign"after standardized anti-tuberculosis treatment.Under the natural course of the disease in two cases,the overall enlargement of the lesion was observed in 1 case,and the overall density of the lesion was reduced and the outer ring wall of the"reversed halo sign"was thinned in 1 case.The pathology of one case after surgical lobectomy showed granulomatous inflammatory nodules of varying sizes containing Langerhans nodule giant cells in the lung parenchyma.The typical caseous necrotic granulomatous nodules were rare here.The"reversed halo sign"showed dense Langerhans nodules in the outer ring,sparse central areas with fibrous hyperplasia and alveolar wall thickening.Conclusions The outer ring of"reversed halo sign"of pulmonary tuberculosis shows as"tree-in-bud"sign,and its center shows as the fine reticulation pattern.After effective anti-tuberculosis treatment,both the overall density of"reversed halo sign"and the lesion size reduced.Finally,the lesions mostly present as as fine grid shadows for a long time.