螺旋CT,X线胸片和热断层(TTM)对SARS诊断价值的评价

The Diagnostic Value of CT,X-ray and TTM in SARS

为提高SARS的诊断及鉴别诊断水平 ,对螺旋CT(SCT)、X线胸片、热断层 (TTM)诊断SARS进行了对比研究。对临床和实验室检查确诊的 111例SARS患者 ,全部进行X线胸片、SCT(部分高分辨螺旋CT(HRCT) )、TTM检查 ,复查间隔时间 2～ 6天 ,随访时间 80～ 90天。三种检查方法诊断结果分别为 :早期SARS病变多位于肺下野 ,X线胸片多表现为肺内单发或多发局灶性渗出改变 ,占病例总数的 4 8% (5 3/ 111例 ) ;SCT表现为单发或多发小片状影 ,其中以“棉花团”样磨玻璃影为基本影像表现。进展期表现为大片状磨玻璃影或以实变影为主的影像 ;TTM则表现为与CT显示病变部位一致的高热辐射区 ,脾脏较肝脏热辐射增高 ,脊柱热辐射降低。TTM不仅可以反映人体功能影像亦可提示SARS病变形态、部位及病情的变化 ,它与X线胸片、SCT相互结合可明显提高SARS诊断和鉴别诊断水平。因此 ,对于临床疑似SARS的病人应首选X线胸片或TTM检查 ,当X线胸片检查在疾病早期受到一定限度时 ,则应及时应用TTM和SCT检查有助于诊断和鉴别诊断。三种检查方式相互结合应用于SARS的诊断 ,不失为医学影像技术的最佳搭配。

The imaging manifestation of spiral computer tomography(SCT),chest X-ray, and TTM were evaluated to improve the diagnosis of SARS and the ability of differential diagnosis.SCT,chest X-ray, and TTM were performed on 111 SARS patients hospitalized from March 10 to June 18. The interval of re-examination was 2～6 days and the follow-up observation was 80～90 days. The results were as follows: The lesion was located from the low field of the lung in the early stage of SARS. Solitary or multiple focal infiltrative lesions were seen in 48%(53/111) patients by chest X-ray. Imaging manifestation of CT in the initial stage demonstrated solitary or multiple patches of infiltrative density, especially ground-glass-like density, and in the progressive stage demonstrated extensive ground-glass-like density or consolidation. Imaging manifestation of TTM demonstrated high caloradiance in the site consistent with CT. The caloradiance of liver waslower than the spleen and higher than the spine. Chest X-ray is the basic method useful to the diagnosis of SARS. TTM could not only reflect the state of the body's function, but also suggest the lesion's form ,position, and changes of the patient's condition. TTM combined with X-ray or SCT can obviously improve the diagnosis of SARS and the ability of differential diagnosis. Chest X-ray should be examined firstly to suspected SARS patients,but in the early stage in which chest X-ray's role is limited, SCT and TTM should be applied in time to assist the diagnosis and differential diagnosis.Through the comparison, we think CT, X-ray and TTM combined mutually is the optimal application of medical imaging technique which is helpful to the diagnosis of SARS.