以纵隔及肺门淋巴结肿大为主要征象几种疾病的CT诊断及鉴别

Investigation of the main CT diagnosis and differential diagnosis signs of hilar and/or mediastinal lymph node enlargement.

目的 探讨以肺门及(或)纵隔淋巴结肿大为主要征象几种疾病的CT诊断及鉴别。方法 选取69例经气管镜、穿刺活检和(或)临床治疗证实的以肺门及纵隔淋巴结肿大患者影像学资料进行分析,全部病例均行胸部CT扫描,其中57例行胸部CT增强扫描。结果 中心型肺癌患者17例易受累部位为中纵隔及双肺门(共计71.29%);淋巴瘤患者11例,易受累部位中纵隔及前纵隔(共计73.34%);淋巴结核患者15例,易受累部位为中纵隔及双肺门(共计73.39%);结节病患者21例,易受累部位为中纵隔及双肺门(共计81.98%)。中心型肺癌、淋巴瘤、淋巴结核、结节病、巨淋巴结增生症、转移性淋巴结癌六种疾病前纵隔、中纵隔、后纵隔及双肺门淋巴结位置分布间差异无统计学意义(P> 0.05)。57例患者行增强扫描,肺癌淋巴结肿大强化不明显;结核性淋巴结肿大呈环形强化;淋巴瘤淋巴结肿大略有强化;结节病淋巴结肿大,大致均匀强化;巨淋巴结增生症淋巴结肿大明显强化。中心型肺癌、淋巴瘤、淋巴结核、结节病、巨淋巴结增生症、转移性淋巴结癌六种疾病之间的淋巴结强化程度分级差异无统计学意义(Fisher’s值=16.215,P=0.242);淋巴结有无融合差异有统计学意义(Fisher’s值=25.261,P <0.05)。27例患者可见肺内表现,其中7例可见双肺内少许斑片及索条,6例可见小叶间隔增厚。结论 胸部CT检查是诊断肺门及纵隔淋巴结病变的首选方法,病灶形态特点、分布、强化及临床表现对诊断及鉴别有重要意义。

Objective To investigate the main CT diagnosis and differential diagnosis signs of hilar and/or mediastinal lymph node enlargement.Methods 69 patients with hilar and mediastinal lymphadenopathy confirmed by tracheoscopy,puncture biopsy and/or clinical treatment were analyzed.All cases were scanned by chest CT,of which 56 cases underwent CT enhancement.Results 17 patients with central lung cancer were easily involved in the middle mediastinum and double hilar(79.12%);11 cases of lymphoma were easily involved in the middle mediastinum and anterior mediastinum(76.74%);In 15 patients with lymph node tuberculosis,the vulnerable sites were middle mediastinum and double hilar(80.00%);In 21 patients with sarcoidosis,the vulnerable sites were middle mediastinum and double hilus(81.98%).Due to the small number of cases,no relevant comparative study was done.There was no significant difference in the location of anterior mediastinum,middle mediastinum,posterior mediastinum and bilateral hilar lymph nodes among central lung cancer,lymphoma,lymph tuberculosis,sarcoidosis,Castleman and metastatic lymph nodes(P>0.05).56 patients underwent enhanced scanning.The enlargement and enhancement of lymph nodes in lung cancer were not obvious;Tuberculous lymphadenopathy showed ring enhancement;Lymphoma lymph node swelling was generally enhanced;The lymph nodes of sarcoidosis were enlarged and enhanced evenly;Lymph node enlargement was significantly enhanced in giant lymph node hyperplasia.There was no significant difference in the grading of lymph node enhancement among central lung cancer,lymphoma,lymph tuberculosis,sarcoidosis,Castleman and metastatic lymph nodes(Fisher's value=16.215,P=0.242);However,there was significant difference in lymph node fusion between them(Fisher's value=25.261,P<0.05).Pulmonary abnormalities were seen in 27 patients,including a few patches and cords in both lungs in 7 cases and interlobular septal thickening in 6 cases.Conclusion Chest CT is the first choice for the diagnosis of hilar and mediastinal lymph node lesions. The morphological characteristics, distribution, enhancement and clinical manifestations of the lesions are of great significance for the diagnosis and differentiation.