肺结核,活动性%X线计算机%体层摄影术%高分辨率
肺結覈,活動性%X線計算機%體層攝影術%高分辨率
폐결핵,활동성%X선계산궤%체층섭영술%고분변솔
Active lung tuberculosis%X-ray computer%Tomography%High-resolution
目的 研究初治活动性继发性肺结核的HRCT影像特征.方法 收集首都医科大学附属北京胸科医院收治的323例初治活动性继发性肺结核病例,观察HRCT征象,包括病变分布、形态特点,并将菌阴肺结核与菌阳肺结核两组患者征像比较,采用χ2检验及Logistic回归分析.结果 本研究323例患者中,病变分布于单叶86例(26.6%),其中单叶单段41例,单叶多段45例;多叶多段237例(73.4%),其中上叶尖后段及下叶背段分布较多,分别为205例和146例.HRCT征象:小叶中心分布的结节,包括气腔结节或腺泡结节患者282例(70.6%),"树芽征"患者193例(59.8%),其中45例(占全部病例13.9%,占气腔结节或腺泡结节病例的15.6%)患者可见"反晕征",高密度的壁及其内磨玻璃密度影内均见结节影;小叶性实变及亚段性实变293例(90.7%),段性实变者115例(35.6%),叶性实变者22例(6.8%),密度不均匀者内见散在边缘模糊的斑点及斑片状低密度影,部分病变内另见支气管扩张和空洞.球形病变及团块状影37例(11.5%),短径> 3 cm,增强扫描边缘轻度强化或不均匀轻中度强化伴斑片状或不规则低密度区.肺间质改变者123例(38.1%),小叶内间质增厚者105例(85.4%);小叶间隔增厚者35例(28.5%),边缘大部分模糊;轴心间质增厚86例(69.9%),远心端轴心间质增厚78例(90.7%),主要表现为支气管壁增厚.实质、间质混合病变:磨玻璃密度影131例(40.6%);伴随征象:空洞112例(34.7%),厚壁空洞74例(66.7%),薄壁空洞29例(25.9%),无壁空洞21例(18.8%);支气管扩张65例(20.1%),位于实变影内及空洞引流支气管影,管腔不均匀者呈静脉曲张样或局限动脉瘤样.菌阳及菌阴肺结核中HRCT征象比较,两组患者树芽征、段性实变、叶性实变、间质改变、磨玻璃密度影、空洞和支气管扩张差异具有统计学意义(χ2值分别为27.756、17.332、21.418、8.746、13.784、72.267和58.091,P均< 0.05),多因素Logistic回归分析结果显示,空洞、树芽征及叶性实变与菌阳肺结核具有相关性,间质改变容易出现在菌阴肺结核病变中(P< 0.05).结论 初治活动性继发性肺结核HRCT征象具有特征性和诊断价值.
目的 研究初治活動性繼髮性肺結覈的HRCT影像特徵.方法 收集首都醫科大學附屬北京胸科醫院收治的323例初治活動性繼髮性肺結覈病例,觀察HRCT徵象,包括病變分佈、形態特點,併將菌陰肺結覈與菌暘肺結覈兩組患者徵像比較,採用χ2檢驗及Logistic迴歸分析.結果 本研究323例患者中,病變分佈于單葉86例(26.6%),其中單葉單段41例,單葉多段45例;多葉多段237例(73.4%),其中上葉尖後段及下葉揹段分佈較多,分彆為205例和146例.HRCT徵象:小葉中心分佈的結節,包括氣腔結節或腺泡結節患者282例(70.6%),"樹芽徵"患者193例(59.8%),其中45例(佔全部病例13.9%,佔氣腔結節或腺泡結節病例的15.6%)患者可見"反暈徵",高密度的壁及其內磨玻璃密度影內均見結節影;小葉性實變及亞段性實變293例(90.7%),段性實變者115例(35.6%),葉性實變者22例(6.8%),密度不均勻者內見散在邊緣模糊的斑點及斑片狀低密度影,部分病變內另見支氣管擴張和空洞.毬形病變及糰塊狀影37例(11.5%),短徑> 3 cm,增彊掃描邊緣輕度彊化或不均勻輕中度彊化伴斑片狀或不規則低密度區.肺間質改變者123例(38.1%),小葉內間質增厚者105例(85.4%);小葉間隔增厚者35例(28.5%),邊緣大部分模糊;軸心間質增厚86例(69.9%),遠心耑軸心間質增厚78例(90.7%),主要錶現為支氣管壁增厚.實質、間質混閤病變:磨玻璃密度影131例(40.6%);伴隨徵象:空洞112例(34.7%),厚壁空洞74例(66.7%),薄壁空洞29例(25.9%),無壁空洞21例(18.8%);支氣管擴張65例(20.1%),位于實變影內及空洞引流支氣管影,管腔不均勻者呈靜脈麯張樣或跼限動脈瘤樣.菌暘及菌陰肺結覈中HRCT徵象比較,兩組患者樹芽徵、段性實變、葉性實變、間質改變、磨玻璃密度影、空洞和支氣管擴張差異具有統計學意義(χ2值分彆為27.756、17.332、21.418、8.746、13.784、72.267和58.091,P均< 0.05),多因素Logistic迴歸分析結果顯示,空洞、樹芽徵及葉性實變與菌暘肺結覈具有相關性,間質改變容易齣現在菌陰肺結覈病變中(P< 0.05).結論 初治活動性繼髮性肺結覈HRCT徵象具有特徵性和診斷價值.
목적 연구초치활동성계발성폐결핵적HRCT영상특정.방법 수집수도의과대학부속북경흉과의원수치적323례초치활동성계발성폐결핵병례,관찰HRCT정상,포괄병변분포、형태특점,병장균음폐결핵여균양폐결핵량조환자정상비교,채용χ2검험급Logistic회귀분석.결과 본연구323례환자중,병변분포우단협86례(26.6%),기중단협단단41례,단협다단45례;다협다단237례(73.4%),기중상협첨후단급하협배단분포교다,분별위205례화146례.HRCT정상:소협중심분포적결절,포괄기강결절혹선포결절환자282례(70.6%),"수아정"환자193례(59.8%),기중45례(점전부병례13.9%,점기강결절혹선포결절병례적15.6%)환자가견"반훈정",고밀도적벽급기내마파리밀도영내균견결절영;소협성실변급아단성실변293례(90.7%),단성실변자115례(35.6%),협성실변자22례(6.8%),밀도불균균자내견산재변연모호적반점급반편상저밀도영,부분병변내령견지기관확장화공동.구형병변급단괴상영37례(11.5%),단경> 3 cm,증강소묘변연경도강화혹불균균경중도강화반반편상혹불규칙저밀도구.폐간질개변자123례(38.1%),소협내간질증후자105례(85.4%);소협간격증후자35례(28.5%),변연대부분모호;축심간질증후86례(69.9%),원심단축심간질증후78례(90.7%),주요표현위지기관벽증후.실질、간질혼합병변:마파리밀도영131례(40.6%);반수정상:공동112례(34.7%),후벽공동74례(66.7%),박벽공동29례(25.9%),무벽공동21례(18.8%);지기관확장65례(20.1%),위우실변영내급공동인류지기관영,관강불균균자정정맥곡장양혹국한동맥류양.균양급균음폐결핵중HRCT정상비교,량조환자수아정、단성실변、협성실변、간질개변、마파리밀도영、공동화지기관확장차이구유통계학의의(χ2치분별위27.756、17.332、21.418、8.746、13.784、72.267화58.091,P균< 0.05),다인소Logistic회귀분석결과현시,공동、수아정급협성실변여균양폐결핵구유상관성,간질개변용역출현재균음폐결핵병변중(P< 0.05).결론 초치활동성계발성폐결핵HRCT정상구유특정성화진단개치.
Objective To study the high-resolution CT imaging feature of active secondary pulmonary tuberculosis in the primary therapy.Methods High-resolution CT imaging of 323 cases with active secondary pulmonary tuberculosis in the primary therapy in Beijing Chest Hospital, Capital Medical University were collected, and the lesion distribution and morphological characteristics were observed, respectively. The imaging of high-resolution CT in pulmonary tuberculosis of negative and positive sputum for tuberculous bacterium were compared, the difference of count data in two groups were analyzed by Chi-square test and Logistic regression.Results Among the 323 cases, the lesions of 86 (26.6%) case located in single lung lobe, the lesions of 237 (73.4%) case located in more lung lobe and more segment, mostly in S1, S2 and S6. High-resolution CT manifestation: centrilobular nodles, there were alveolar nodules in 282 case and "tree-in-bud" sign in 193 case, 45 cases with "reversed halo sign" among them, reversed halos with nodular walls and nodules inside the halos were observed. There were 293 (90.7%) lobular and subsegmental consolidation, 115 (35.6%) segmental comsolidation, 22 (6.8%) lobe consolidation , of which, the CT ifndings showed small patchy low-density areas in the lesions, and with bronchiectasis and cavity in part lesions. There were 37 spherical or mass lesions, > 3 cm, the contrast-enhanced CT scanning showed that ring enhancement and uneven enhancement appeared small patchy low-density areas and boundaries were vague. There were 123 interstitial abnormalities, intralobular, include intralobular reticular reticulation with 105 (85.4%) cases, thickened interlobular septum with 35 (28.5%) cases, thickened peribroncho-vascular interstitium with 86 (69.9%) cases, thickening of the airway wall in telecentric end with 78 (90.7%) cases. Lung parenchyma and interstitial lesions: 131 (40.6%) cases with ground-glass opacity. Along with the sign: 112 (34.7%) cases with cavities in consolidation ang node, 74 (66.7%) cases with thick-wall cavities, 29 (25.9%) cases with thin-wall cavities, 21 (18.8%) cases with no wall cavities. There were 65 (20.1%) cases with bronchiectasis, presenting within consolidations and feeding bronchus sign, the shape of the bronchiedtasis was varicose or aneurismal change in uneven bronchial lumen. Compared with high-resolution CT manifestation in pulmonary tuberculosis of negative and positive sputum for tuberculous bacterium, there was signiifcant difference in tree-in-bud sign, subsegmental consolidation lobe consolidation, interstitial abnormality, ground-glass opacity, cavity and bronchiectasis (χ2= 27.756, 17.332, 21.418, 8.746, 13.784, 72.267 and 58.091, respectively;P all < 0.05). Cavity, tree-in-bud sign and lobe consolidation associated with pulmonary tuberculosis with positive sputum, interstitial abnormality easily appeared in pulmonary tuberculosis with negative sputum.Conclusions The high-resolution CT imaging feature of active secondary pulmonary tuberculosis in the primary therapy is characterized and diagnostic value.
