纵隔淋巴结肿大的影像学特点

THE IMAGE FEATURES OF MEDIASTINAL LYMPHADENECTASIS

目的 :评价X线及CT在纵隔淋巴结肿大定性诊断中的价值 ;方法 :对 6 3例 (其中男 3 9例 ,女 2 4例 )经颈部淋巴结活检、手术病理检查和临床治疗证实纵隔淋巴结肿大作了影像学分析 ,全部病例均作了胸部平片和CT扫描 ,其中 3 5例作了CT增强扫描 ;结果 :6 3例中转移性淋巴结肿大 3 2例 (肺癌 2 3例 ,乳腺癌 9例 ) ,肺结核1 2例 ,恶性淋巴瘤 1 2例 ,结节病 5例 ,坏死性淋巴结炎 2例。胸部平片仅发现 56例纵隔增宽和 42例肺内病灶 ,CT则在 6 3例中均能发现纵隔淋巴结肿大的部位、数目、大小和形态 ,其中 3 5例CT增强扫描 ,转移性淋巴结肿大强化不明显 ,而结核性淋巴结呈环形强化 ,淋巴瘤引起的淋巴结肿大略有强化 ,结节病引起的淋巴结肿大明显强化 ;结论 :CT扫描是诊断纵隔淋巴结肿大的首选方法 ,CT增强扫描结合CT扫描、临床表现。

Objective:To evaluate the effects of X-rays chest films and CT diagnosis on mediastinal lymphadenectasis.Methods:The image findings of mediastinal lymphadenectasis in 63 cases to have been proved pathologically were reviewed retrospectively. All cases, 39 males, 24 females, were performed by chest radiography and CT scan, 35 cases of them were scanned after contrast enhancement.Results:32 cases had metastatic lymphadenectasis from cancers (23 lung cancers, 9 breast cancers). 12 cases with mediastinal lymphadenectasis resulted from pulmonary tuberculosis, 12 from lymphadenoma, 5 from sarcoidosiss and 2 from necrotic lymphadenitis. The all patients showed cleanly the enlarged mediastinal lymphadens, its number, size and shape in CT scan, but the widen mediastinal image (56 cases) and pulmonary lesions (42 cases) were only found in x-ray chest films.Conclusion:CT scan is the most important method for the diagnosis of mediastinal lymphadenectasis.It is more important in diagnosis of mediastinal lymphadenectasis that the CT enhancing scan combine with the clinical sings and laboratory examination.