孤立性非干酪性肺结核球的CT表现与鉴别诊断

doi:10.19871/j.cnki.xfcrbzz.2021.01.008

新发传染病电子杂志 ›› 2021, Vol. 6 ›› Issue (1): 35-39.doi: 10.19871/j.cnki.xfcrbzz.2021.01.008

孤立性非干酪性肺结核球的CT表现与鉴别诊断

魏连贵¹, 关春爽¹, 陈步东¹, 吕志彬¹, 薛明¹, 周安¹, 许东海¹, 吕岩², 谢汝明¹

1.首都医科大学附属北京地坛医院放射科,北京 100015;
2.首都医科大学附属北京胸科医院,北京市结核病胸部肿瘤研究所放射科,北京 101149

收稿日期:2020-12-31 出版日期:2021-02-28 发布日期:2021-03-03
通讯作者: 谢汝明,E-mail：mingrux@163.com;吕岩,E-mail：yanlvlv@126.com

CT features of solitary pulmonary non-caseous tuberculoma: diagnosis and differential diagnosis

Wei Liangui¹, Guan Chunshuang¹, Chen Budong¹, Lyu Zhibin¹, Xue Ming¹, Zhou An¹, Xu Donghai¹, Lyu Yan², Xie Ruming¹

1. Department of Radiology, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China;
2. Department of Radiology, Beijing Chest Hospital, Capital Medical University/Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing 101149, China

Received:2020-12-31 Online:2021-02-28 Published:2021-03-03

摘要/Abstract

摘要： 目的回顾性分析孤立性非干酪性肺结核球在CT上的影像表现,并与其他孤立性结节进行鉴别诊断。方法分别收集非干酪性肺结核球28例、周围型肺癌50例、错构瘤16、硬化性血管瘤18例、球形肺炎33例,2位胸部影像医师评估CT影像,对比各组患者病灶大小、分布及卫星病灶、分叶、毛刺、空泡征及强化程度。结果 28例非干酪型肺结核球与周围型肺癌、错构瘤、硬化性血管瘤、球形肺炎在病灶大小及肺叶分布上差异无统计学意义;非干酪性结核球边缘“毛刺征”和“分叶征”与周围型肺癌比较差异无统计学意义,但胸膜凹陷征差异具有统计学意义;只有17.86%的非干酪性肺结核球中出现卫星灶,与球形肺炎卫星灶（90.90%）相比较差异有统计学意义,结核球卫星病灶表现为 “树芽征”,而球形肺炎卫星灶表现为片絮状影;增强扫描后64.29%非干酪性肺结核球不均匀强化,与周围型肺癌和球形肺炎之间差异无统计学意义,但硬化性血管瘤呈均匀强化,可与非干酪性肺结核球相鉴别;71.43%非干酪性肺结核球强化程度在16~20HU之间,与本研究中其他球形病变比较,差异具有统计学意义。结论当肺内孤立结节不均匀强化、CT值增加低于20HU时要高度可疑非干酪性肺结核球。当孤立结节出现空泡征、空洞、脂肪、钙化、毛刺、分叶、胸膜凹陷征时有助于非干酪性肺结核球与其他孤立性结节进行鉴别诊断。

关键词: 结核, 肺, 体层摄影术, X线计算机, 鉴别诊断

Abstract: Objective To retrospectively analyze the imaging features of solitary pulmonary non-caseous tuberculoma (PNCTB) on CT, and to differentiate from other solitary nodules. Methods The twenty-eight cases of PNCTB, 50 cases of peripheral lung cancer, 16 cases of hamartoma, 18 cases of sclerosing hemangioma, and 33 cases of spherical pneumonia were collected. Two chest radiologists evaluated CT images. The evaluation parameters included lesion size, distribution, satellite lesion, lobulated shape, spiculated sign, vacuole sign and enhancement degree. Results The twenty-eight cases of PNCTB showed no statistical difference with peripheral lung cancer, hamartoma, sclerosing hemangioma, or spherical pneumonia in the lesion size and lobe distribution. There was statistical difference between PNCTB and peripheral lung cancer on the " lobulated shape " and " spiculated sign ", but the pleural indentation sign; only 17.86% of PNCTB had satellite lesions, which had statistical significance compared with spherical pneumonia (90.90%). The satellite lesions of PNCTB showed tree-in-bud sign while spherical pneumonia showed patchy shadow. After contrast-enhanced scan, 64.29% of PNCTB showed heterogeneous enhancement, which was not statistically significant with peripheral lung cancer and spherical pneumonia, but sclerosing hemangioma showed homogeneous enhancement, which could be differentiated from PNCTB. 71.43% of PNCTB had enhancement degree with 16-20 HU, which was statistically significant compared with other nodules in this study. Conclusion PNCTB could be highly suspected when solitary pulmonary nodule with inhomogeneous enhancement and CT value below 20 HU. The possibility of PNCTB diagnosis is greatly increased when satellite focus appears. It is helpful to differentiate solitary nodules from other solitary nodules when there are vacuole sign, cavity, fat, calcification, spiculated sign, lobulated shape, or pleural indentation sign.

Key words: Tuberculosis, Lung, Tomography,X-ray computed, Differential diagnosis

魏连贵, 关春爽, 陈步东, 吕志彬, 薛明, 周安, 许东海, 吕岩, 谢汝明. 孤立性非干酪性肺结核球的CT表现与鉴别诊断[J]. 新发传染病电子杂志, 2021, 6(1): 35-39.

Wei Liangui, Guan Chunshuang, Chen Budong, Lyu Zhibin, Xue Ming, Zhou An, Xu Donghai, Lyu Yan, Xie Ruming. CT features of solitary pulmonary non-caseous tuberculoma: diagnosis and differential diagnosis[J]. Electronic Journal of Emerging Infectious Diseases, 2021, 6(1): 35-39.

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孤立性非干酪性肺结核球的CT表现与鉴别诊断

CT features of solitary pulmonary non-caseous tuberculoma: diagnosis and differential diagnosis

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