肺癌与肺结核致单侧全肺不张的对比增强CT鉴别诊断
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摘要
目的探讨肺癌及肺结核导致单侧全肺不张的对比增强CT表现差异,以提高对两者诊断及鉴别诊断水平。方法回顾性分析42例肺癌及32例肺结核致单侧全肺不张患者的胸部CT图像,分别采用独立样本t检验、非参数检验或卡方检验对比两者CT表现的差异性。结果与肺癌相比,结核组患侧胸廓塌陷更常见(P<0.05),且塌陷程度及纵隔向患侧移位更明显。肺癌组患侧主支气管改变以截断为主(57.1%),肺门部肿块常见(85.7%);而结核组主要表现为管壁增厚、狭窄或闭塞(84.4%),多伴远端支气管扩张(65.6%)。肺癌组中,患侧肺门处肺动脉多表现为不均匀变细或闭塞(64.3%),而结核组无明显变化。肺癌组中,肺门处肺-纵隔脂肪间隙多消失(69.0%),而结核组中多可见(96.9%)。结核组中患侧及健侧肺组织内主要异常为多发钙化灶(75.0%)及结核灶(50%),而肺癌组中健侧肺内可见转移灶(26.2%)。此外,肺癌组较结核组纵隔淋巴结增大更常见(P<0.05),且增大较明显。结论肺癌与肺结核所致单侧全肺不张患者的胸部CT表现具有较明显差异,熟悉两者的差异有助于提高其诊断及鉴别诊断水平。
Objective To improve the diagnosis and differential diagnosis of unilateral atelectasis caused by lung cancer or tuberculosis by analyzing their contrast enhanced CT features. Methods The chest CT images of 42 patients with unilateral atelectasis due to lung cancer and 32 patients with atelectasis from tuberculosis were retrospectively analyzed. Their CT features were compared by using independent sample t test,nonparametric test or chi-square test in order to determine their differences. Results Compared with lung cancer group,thorax collapse was more common in tuberculosis group(96.9% vs. 64.3%,P<0.05),and its degree and mediastinum shifting to the affected side were more obvious. For the main bronchus on the affected side,it mainly manifested as cut off(57.1%) in lung cancer group and hilar mass was very common(85.7%),while wall thicking,narrowing and obstruction(84.4%) as well as distal bronchiectasis(65.6%) were more common in tuberculosis group. The hilar pulmonary arteries in affected side were usually irregularly narrow or obstructed(64.3%) in lung cancer group,while those had no obvious change in tuberculosis group. The interface between involved lung tissue in hilum and mediastinum was usually disappear in lung cancer group(69.0%),while that could usually be detected in tuberculosis group(96.9%). The main abnormalites in affected and normal lung were multiple calcification and tuberculous foci in tuberculosis group,while multiple metastasis could be detected in normal lung in lung cancer group. In addition,compared with tuberculosis group,enlarged lymph nodes in mediastinum were more common(76.2% vs. 34.4%,P<0.05) and bigger in lung cancer group. Conclusion The chest CT manifestations between patients with unilateral pulmonary atelectasis caused by lung cancer and tuberculosis have significant differences,understanding this outcome is helpful for their diagnosis and differential diagnosis.
Objective To improve the diagnosis and differential diagnosis of unilateral atelectasis caused by lung cancer or tuberculosis by analyzing their contrast enhanced CT features. Methods The chest CT images of 42 patients with unilateral atelectasis due to lung cancer and 32 patients with atelectasis from tuberculosis were retrospectively analyzed. Their CT features were compared by using independent sample t test,nonparametric test or chi-square test in order to determine their differences. Results Compared with lung cancer group,thorax collapse was more common in tuberculosis group(96.9% vs. 64.3%,P<0.05),and its degree and mediastinum shifting to the affected side were more obvious. For the main bronchus on the affected side,it mainly manifested as cut off(57.1%) in lung cancer group and hilar mass was very common(85.7%),while wall thicking,narrowing and obstruction(84.4%) as well as distal bronchiectasis(65.6%) were more common in tuberculosis group. The hilar pulmonary arteries in affected side were usually irregularly narrow or obstructed(64.3%) in lung cancer group,while those had no obvious change in tuberculosis group. The interface between involved lung tissue in hilum and mediastinum was usually disappear in lung cancer group(69.0%),while that could usually be detected in tuberculosis group(96.9%). The main abnormalites in affected and normal lung were multiple calcification and tuberculous foci in tuberculosis group,while multiple metastasis could be detected in normal lung in lung cancer group. In addition,compared with tuberculosis group,enlarged lymph nodes in mediastinum were more common(76.2% vs. 34.4%,P<0.05) and bigger in lung cancer group. Conclusion The chest CT manifestations between patients with unilateral pulmonary atelectasis caused by lung cancer and tuberculosis have significant differences,understanding this outcome is helpful for their diagnosis and differential diagnosis.
引文
1 罗凤荣,李雁平.结核性肺不张和癌性肺不张的影像学鉴别诊断[J].华夏医学,2006,19:1176-1177.
2 张建华,方伟军.已致肺不张的支气管内膜结核与中央型肺癌的影像鉴别诊断[J].广东医学,2006,27:529-530.
3 王洪武,李冬妹,蔡存良,等.引起左全肺不张的基底细胞样鳞癌误诊1例分析[J].中国误诊学杂志,2011,11:2849.
4 左竹林,张燕凉.单纯型支气管内膜结核致全肺不张和大咯血1例报告[J].临床荟萃,1999,14:180.
5 潘浩,雷显萍,等.纤维支气管镜检查218例肺不张的经验和结果分析[J].中国内镜杂志,2012,18:657-659.
6 徐家禄,刘德群,等.纤维支气管镜对肺不张病因诊断的临床应用[J].中国当代医药,2014,21:158-160.
7 路晓东,杨学东,王振光,等.成人活动性肺结核的CT表现[J].临床放射学杂志,2003,22:114-117.
8 潘纪戍.成人胸部结核的CT诊断[J].中华放射学杂志,2000,34:583-587.
9 刘扬,龚圣兵,陈严,等.中年人初发活动性肺结核的CT影像特点[J].临床肺科杂志,2017,22:1184-1187.
10 严代全,刘秀华,王新伟,等.45例结核性支气管狭窄肺不张的CT征象[J].临床放射学杂志,2007,26:1211-1214.
11 李琦,黄兴涛,罗天友,等.I期中央型肺癌与支气管播散性肺结核CT树芽征的比较分析[J].中国医学影像学杂志,2016,24:930-933.
2 张建华,方伟军.已致肺不张的支气管内膜结核与中央型肺癌的影像鉴别诊断[J].广东医学,2006,27:529-530.
3 王洪武,李冬妹,蔡存良,等.引起左全肺不张的基底细胞样鳞癌误诊1例分析[J].中国误诊学杂志,2011,11:2849.
4 左竹林,张燕凉.单纯型支气管内膜结核致全肺不张和大咯血1例报告[J].临床荟萃,1999,14:180.
5 潘浩,雷显萍,等.纤维支气管镜检查218例肺不张的经验和结果分析[J].中国内镜杂志,2012,18:657-659.
6 徐家禄,刘德群,等.纤维支气管镜对肺不张病因诊断的临床应用[J].中国当代医药,2014,21:158-160.
7 路晓东,杨学东,王振光,等.成人活动性肺结核的CT表现[J].临床放射学杂志,2003,22:114-117.
8 潘纪戍.成人胸部结核的CT诊断[J].中华放射学杂志,2000,34:583-587.
9 刘扬,龚圣兵,陈严,等.中年人初发活动性肺结核的CT影像特点[J].临床肺科杂志,2017,22:1184-1187.
10 严代全,刘秀华,王新伟,等.45例结核性支气管狭窄肺不张的CT征象[J].临床放射学杂志,2007,26:1211-1214.
11 李琦,黄兴涛,罗天友,等.I期中央型肺癌与支气管播散性肺结核CT树芽征的比较分析[J].中国医学影像学杂志,2016,24:930-933.