支气管内膜结核的CT诊断

目的分析支气管内膜结核的CT表现，探讨CT对支气管内膜结核的诊断价值。方法回顾性分析20例经纤支镜活检证实的支气管内膜结核的CT表现。结果20例支气管、叶支气管狭窄，11例锥形狭窄，9例管壁增厚，其中．向心性狭窄5例，偏心性狭窄4例，伴支气管扩张7例，钙化4例。6例继发肺不张，19例患者肺野内均可见不同性质肺结核灶，12例并发胸膜病变。肺门纵隔淋巴结肿大及钙化11例。结论CT是诊断支气管内膜结核的有效方法，其CT表现具有一定的特征性。     

支气管内膜结核的CT诊断

目的探讨支气管内膜结核(endobronchial tuberculosis, EBTB)的CT表现. 材料和方法回顾性分析34例经临床和病理证实的EBTB的CT表现.结果长段支气管管壁增厚和管腔狭窄31例,其中狭窄段管壁光滑14例、不规则狭窄17例,.28例可见肺内播散病灶,狭窄、阻塞支气管远端出现肺叶或肺段不张16例,实变5例. 21例可见肺门/纵隔淋巴结肿大.结论CT检查在EBTB诊断和鉴别诊断中具有重要临床价值.     

支气管内膜结核的CT诊断

目的:探讨支气管内膜结核的CT表现,以提高对该病CT诊断水平。方法:回顾性分析经纤支镜活检证实的19例支气管内膜结核的CT表现。结果:19例累及主支气管或肺叶支气管20处,累及气管1处,均有不同程度狭窄及管壁增厚,无肿块及反S征;伴肺叶或肺段不张13例,其中不张或实变区可见钙化9例,支气管扩张3例;伴胸腔积液和胸膜增厚各2例;伴活动性肺内结核12例。结论:CT在支气管内膜结核的诊断中有重要作用。     

多层螺旋CT仿真支气管镜对气管支气管病变的诊断价值

目的评价多层螺旋CT仿真支气管镜（CTVB）对气管、支气管病变的诊断价值。方法对42例患者进行多层螺旋CT检查，在工作站得到仿真支气管图像，采用螺距1．35，重组间隔1mm，重组层厚1．25mm。其中35例为中央型肺癌、3例支气管内膜结核、3例支气管良性肿瘤经病理证实，1例支气管异物经临床证实。所有图像均经2名熟悉气管支气管解剖的放射科医师进行分析。结果42例中，35例中央型肺癌CTVB表现为气管支气管腔内结节状或丘状隆起者22例，狭窄13例，以上35例中央型肺癌横断面CT均显示病变部位支气管壁呈不同程度增厚。3例支气管内膜结核CTVB均表现为支气管腔狭窄，横断面CT显示管壁增厚，管壁增厚范围长。3例气管支气管良性肿瘤CTVB表现为腔内结节，横断面CT无相邻支气管壁的增厚。另1例支气管腔内异物CTVB表现为支气管腔内隆起性阻塞，横断面CT无相邻支气管壁的增厚。CTVB可以越过狭窄部位对远端支气管进行观察。结论多层螺旋CTVB可以反映气管支气管腔内病变的形态，结合横断面CT对气管支气管病变的诊断具有参考价值。     

多层螺旋CT在支气管内膜结核诊断及治疗评价中的应用价值

目的探讨多层螺旋CT(MSCT)在支气管内膜结核诊断及治疗评价中的应用价值。方法回顾性分析32例经纤维支气管镜证实的支气管内膜结核的CT轴位图像表现,并对在工作站获取的薄层图像分别进行多平面重建(MPR),CT仿真内窥镜(CTVE),表面遮盖(SSD)3种方法后重建。结果共有49处气管受累,主支气管2例,右主支气管4例,左主支气管3例,右肺上叶支气管15例,左肺上叶支气管12例,右中叶支气管4例,右肺下叶支气管5例,左肺下叶支气管4例。CT表现为支气管阻塞12例,支气管腔狭窄18例,支气管壁增厚13例,支气管壁钙化6例,伴肺门及纵隔淋巴结钙化27例。结论多层螺旋CT多种重建方法的结合应用,可以明确显示病变的发生部位及支气管腔狭窄或阻塞,有利于支气管内膜结核的诊断及治疗评价。     

气管支气管结核的CT诊断

目的：分析气管支气管结核病人的ＣＴ表现和特征，探讨ＣＴ诊断该病的可靠性。材料与方法：２３例气管支气管结核病人均做胸部ＣＴ和纤维支气管镜（ＦＯＢ）检查，分析其ＣＴ表现并与ＦＯＢ所见对照。１９例经组织学证实，４例经临床随访证实。结果：（１）两肺上叶及中叶舌叶支气管为结核好发部位。（２）受累支气管病变范围较长，７４％多支受累。（３）主要ＣＴ表现为气管支气管不规则或规则狭窄及梗阻，有时显示管壁增厚及管腔内结节。（４）７８％病例伴肺内结核。（５）大多数由支气管结核引起的肺叶、肺段不张或（和）实变，近肺门层面无肿块及局部外凸。（６）可伴肺门纵隔淋巴结肿大。本组资料ＣＴ征象典型，可明确诊断者占４３％；ＣＴ表现不典型，但提示疑诊者占３０％；２２％ＣＴ表现无特征，不能正确诊断。结论：ＣＴ是诊断气管支气管结核的有效方法。对ＣＴ表现不典型及无特征的病例，结合ＦＯＢ检查可提高诊断准确性     

气管-支气管结核的胸部X线与CT诊断

目的 了解气管-支气管结核的胸部X线与CT征象及其诊断价值。方法 36例气管-支气管结核患，其中临床证实16例，手术病理证实20例，均经胸部X线与CT检查，对全部患的胸部X线与CT表现进行了回顾性分析。结果 36例患中，胸部X线显示肺段叶及全肺不张12例，两肺结核性病灶18例，其中有陈旧性结核灶，粟粒播散灶，浸润灶及肺门淋巴结肿大。病变支气管表现有完全性支气管阻塞10例，支气管肺内结节状突起5例；胸部CT扫描显示支气管管腔变窄伴管壁增厚25例，管腔表面凹凸不平5例。管腔内有结节状突起6例，纵隔淋巴结肿大及钙化15例。结论 对气管-支气管结核的胸部X线与CT表现进行综合分析。大大有助于提高其诊断准确性。     

小气道疾病的影像检查

小气道疾病最有效的影像检查方式是高分辨率CT（HRCT），该病在HRCT上的直接征象是气道壁或腔的改变。异常小气道在HRCT上表现为管状的，给节状的或分枝的线性结构。小气道疾病的间接征象表现为病变小气道远端肺实质的改变，包括气囊，亚段肺不张，小叶中心肺气管和气腔结节。很多不同的炎性和传染性疾病，如阻塞性细支气管炎（BO）、阻塞性细支气管炎合并机化性肺炎（BOOP），与吸烟相关的疾病以及哮喘都影响肺的小气道、在HRCT上，BO的主要改变是气囊和支气管扩张；BOOP的主要改变是实变和毛玻璃样变。HRCT甚至可以显示出现…     

肺曲霉菌病的CT诊断

3　讨论肺曲霉菌病分腐生型、过敏性支气管肺型及侵袭型三型 ,影像学特征性表现为“曲菌球”、“支气管粘液栓塞征”及“日晕征”。3 .1　腐生型　常继发于肺内原有空洞或空腔内 ,如肺结核、慢性肺脓肿空洞、肺癌空洞、支气管扩张及肺囊肿等。本组继发结核空洞 13例 ,先天肺囊肿及肺脓肿各 1例。影像学特征性表现为曲菌球 ,即霉菌在肺原有空洞 (腔 )内生长出一个球状软组织影。洞壁形态因病因而异 ,结核空洞多表现为薄壁空洞 ,一般无液平 ,以两上叶多见。慢性肺脓肿及肺癌为厚壁空洞 ,后者洞壁厚薄不均 ,内壁不规则呈“岛屿状”改变。CT诊…     

成人活动性肺结核的CT表现

目的分析成人活动性肺结核的CT表现，明确其CT特征。资料与方法肺结核组61例，肺炎组40例，均行常规螺旋CT扫描和HRCT扫描。分析各自的影像学表现，并进行统计学分析。结果肺结核组：肺实变影60例(98．4％)；合并空洞21例(34．4％)；小叶中心结节或直径2-4mm分支线样结构(春芽征)42例(68．9％)；直径5-8mm边缘模糊的结节50例(82．0％)；支气管扩张43例(70．5％)；不规则线影49例(80．3％)；疤痕性肺气肿21例(34．4％)；血管束变形40例(65．6％)。肺炎组：肺实变影32例(80．0％)；合并空洞5例(12．5％)；小叶中心结节或直径2—4mm分支线样结构(春芽征)16例(40．0％)；直径5-8mm边缘模糊的结节8例(20．0％)；支气管扩张2例(5．0％)；不规则线影20例(50．0％)；肺气肿4例(10．0％)；血管束变形14例(35．0％)。结论典型的活动性肺结核CT表现有其特点，发生在常见或非常见部位的肺实变影，伴有局限或广泛的支气管播散灶，在HRCT上观察到小叶中心结节或2—4mm分支线样结构(春芽征)和5-8mm边缘模糊的结节影，均应初诊为活动性肺结核；同时出现钙化或纤维化的征象，则强烈支持肺结核的诊断。     

气管、支气管内膜结核HRCT价值及临床意义

目的 :探讨HRCT对气管、支气管内膜结核的诊断价值及临床意义。方法 :对 3 2例诊断明确的住院患者行胸部HRCT扫描 ,结合纤维支气管镜检查情况 ,重点观察病变气道内壁及管腔的形态变化以及其病变远侧肺实质的病变情况。结果 :气管、支气管壁病变检出率为 73 .92 % ,其中管壁轻度增厚 5 4.3 5 % ,明显增厚 19.5 7% ;气道管腔形态改变检出率为 67.3 9% ,其中管腔狭窄 <5 0 % 41.3 0 % ,>5 0 % 19.5 7% ,管腔闭塞 6.5 2 %。同时观察到气管、支气管周围及纵隔淋巴结肿大 7例 ,病变支气管远侧管腔内粘液栓 12例 ,管腔局限性扩张 5例 ,小叶性肺气肿 18例 ,肺不张 2例 ,肺内结核病灶 3 9例。结论 :HRCT作为无创性检查 ,在观察气道病变的部位和范围、气道病变与肺内病变的关系、危重患者纤维支气管镜检查前的定位准备及估计预后均有重要的临床意义。     

不典型肺结核CT诊断

分析不典型肺结核CT表现,并探讨其CT诊断价值.材料和方法:回顾性分析不典型肺结核63例,所有病例均得到证实,CT扫描包括常规层厚和薄层扫描或HRCT扫描,52例行增强扫描.结果:不典型CT表现有6种,粟粒性病变缺乏临床症状8例,肺炎实变型16例,磨玻璃密度阴影4例,气管支气管结核20例,结节或肿块9例,纵隔淋巴结结核6例.结核诊断率39.7%(25例),误为肿瘤19.0%(12例).结论:不典型肺结核CT表现多样,类似肺炎和肺癌,多数诊断困难.     

多层CT容积漫游技术在先天性气管支气管狭窄的诊断价值

目的:探讨多层CT容积漫游技术(VRT)在先天性气管支气管狭窄的诊断价值。方法:搜集经影像学检查及临床病史证实的先天性气管支气管狭窄32例,所有病例均行多层CT薄层扫描及支气管树VRT重建,评价VRT在先天性气管支气管狭窄的诊断优势及不足。结果:VRT立体显示气管、主支气管及叶支气管近端单发或多发狭窄32例,其中环形狭窄8例,不规则狭窄15例,锥形狭窄9例;累及长轴范围最长46mm,最短2mm;轻度狭窄8例,中度狭窄13例,重度狭窄11例。18例阻塞性肺气肿中,VRT清晰显示16例,患侧肺组织体积增大,含气增多,其中6例伴有纵隔疝。结论:多层CT-VRT可立体显示先天性气管支气管狭窄部位、范围、程度及阻塞性肺气肿,弥补了CT轴位长轴范围显示不足,图像不直观的缺点,对临床治疗具有重要指导意义;对叶支气管远端及以下支气管狭窄、局限性肺不张及阻塞性肺炎显示有一定限度,诊断时应结合CT二维图像。     

气管支气管结核的多层CT诊断

分析气管支气管结核的多层CT(MSCT)表现,并探讨其诊断价值.材料和方法:回顾性分析38例(男12例,女26例,年龄14～53岁,中位数33岁)气管支气管结核,23例经组织学证实,15例经痰菌检查结合多种其他方法临床证实.MSCT检查采用5mm、2.5mm或lmm准直螺旋扫描,结合2.5mm或lmm的薄层扫描,22例做了增强扫描,全部病例均完成了至少2种后处理;32例同期完成了纤维支气管镜检查.5例瘢痕狭窄行支架治疗,治疗前后均行CT检查.结果:38例共检出58支病变,多支受累率44.7%(17/38);支气管狭窄44例,狭窄长度2cm以上93.2%(41/44);管壁不规则增厚,有时见腔内结节;多数(35/38)伴肺内结核病灶;可伴肺门纵隔淋巴结肿大.MSCT结合各种后处理技术可以有效显示病变特征,并特别有助于支架治疗前后气道通畅性的判断.结论:MSCT结合后处理技术可以有效显示气管支气管结核的特征,有助于诊断,并特别有助于支架治疗前后气道狭窄的判断.     

Automatic evaluation of total lung capacity and of emphysema involvement with spiral computerized tomography (CT) in obstructive pneumonia

OBJECTIVE: To evaluate, in patients with chronic obstructive lung disease or chronic bronchitis, inspiratory helical CT with 3D postprocessing, to measure lung volumes and the amount of emphysema and to compare these measurements with lung function tests. MATERIAL AND METHODS: Seventeen patients with chronic obstructive lung disease disease or chronic bronchitis underwent pulmonary function tests and helical CT after a full inspiration with 3D postprocessing (lower threshold -1024 HU, upper thresholds -200, -300 and -400 HU). Lung inspiratory volumes (TLC-CT) were determined for each model; the amount of emphysema was evaluated by means of an automatic score and a visual score with HRCT. RESULTS: There is a good correlation between automatic and visual scores (p < 0.001); the automatic score had a good correlation with lung function tests, above all with total lung capacity (r = -0.56; p = 0.01) but the visual score had a much closer correlation with DLCO (r = -0.70; p < 0.001). TLC-CT had a significant correlation with pletismographic TLC (TLC-P); the upper threshold -200 HU was more correct (TLC-P = 8011 cc.; TLC-CT 200 = 7138 cc.; r = 0.83; p < 0.001). The volume change of 3D model was about 230 cc. per 100 HU (p < 0.001) modifying upper thresholds, but no change was observed in the volume occupied by emphysema and the percentage of emphysema presented minimal, clinically non significant modifications. DISCUSSION AND CONCLUSIONS: In emphysematous patients, the helical CT with 3D model construction is a good technique to evaluate lung volumes and to quantify emphysema with automatic score; this one, however, probably underscores the extent of pathology; therefore, the addition of a visual score with HRCT is probably worthwhile.     

High-resolution CT in chronic pulmonary changes after mustard gas exposure

PURPOSE: To identify the findings of high-resolution CT (HRCT) of the lung in patients with previous sulfur mustard gas exposure, and to correlate these findings with clinical and chest X-ray (CXR) results. MATERIAL AND METHODS: 50 consecutive patients were studied prospectively. The clinical data were recorded. Standard p.a. CXR and HRCT of the lung and spirometry were performed. The findings of CXR, HRCT and clinical and spirometry results were scored between 0 and 3 according to the severity of the findings. RESULTS: HRCT abnormality was detected in all 50 patients (100%), while CXR was abnormal in 40 patients (80%). The most common HRCT findings was airway abnormalities (bronchial wall thickening in 100% of cases). Other important findings were suggestive of interstitial lung disease (ILD) (80%), bronchiectasis (26%), and emphysema (24%). A statistically significant correlation was found between the severity of clinical presentation and that of the HCTR scores in patients with bronchiectasis, bronchitis and ILD (p< 0.05), but not with severity scores of HRCT in patients with emphysema. No significant correlation was found between severity scores of CXR findings. HRCT evidence of bronchial wall thickening and with a lower frequency ILD were present despite normal CXR in 20% of the patients. CONCLUSION: The results of this study suggest that bronchial wall thickening, ILD and emphysema are common chronic pulmonary sequelae of sulfur mustard injury. HRCT of the chest should be considered as the imaging modality of choice in chemical war injury.     

Thin-section CT vs spiral CT in candidates for lung volume reduction surgery: a comparison based on radiologists' subjective preferences

The aim of this study was to investigate whether high-resolution (HRCT) or spiral CT was preferred in evaluating severe emphysema in patients undergoing lung volume reduction surgery (LVRS), whether there is any difference in this regard between the cranial and caudal part of the lung, and whether the degree of emphysema has an impact on the radiologists' preference. The study was performed by letting four radiologists compare images obtained with the two techniques (film pairs) and decide which technique they preferred or if the techniques were considered as equal in evaluating emphysema. In evaluation of 188 film pairs, the HRCT images were preferred in 56 %, spiral CT in 19 % and the techniques considered as equal in 25 %. Spiral CT images were preferred more often in the caudal part of the lung and in more advanced emphysema compared with the HRCT images. The study confirms our clinical assumption that use of both CT techniques are valuable in evaluating advanced emphysema and there may be technical as well as histopathological reasons for this. Received: 20 March 2000 Revised: 26 June 2000 Accepted: 28 June 2000     

中央型小细胞肺癌的CT诊断及鉴别诊断

目的:探讨中央型小细胞肺癌(Small Cell Lung Cancer,SCLC)的CT表现特点,并找出与非小细胞肺癌(NSCLC)、肺结核、结节病、纵隔淋巴瘤的鉴别诊断要点。方法:回顾性分析经病理证实的57例中央型SCLC、60例NSCLC,5例肺结核,2例结节病,3例纵隔淋巴病的胸部平片及CT资料,全部病例均行胸部平片和CT平扫、增强检查。结果:57例中央型SCLC,CT主要表现为沿支气管长轴生长的肺内肿块,肺门与纵隔广泛淋巴结肿大,而肺不张相对少见。NSCLC60例主要表现为肺门肿块,支气管阻塞性改变相对多见。5例肺结核表现为肺内结节和肺门、纵隔淋巴结肿大,伴有同侧和/或对侧肺内结核病灶。2例结节病,表现为双侧肺门对称性淋巴结肿大。3例纵隔淋巴病表现为中前纵隔的弥漫性软组织肿块。结论:沿支气管长轴生长的肺内肿块、肺门及纵隔淋巴结肿大。支气管阻塞改变少见,随访1～2个月,肿块体积增大1倍以上,是中央型SCLC的CT诊断要点,据此特征诊断正确率达80％。结合临床与其他检查方法可与NSCLC、肺结核、结节病、纵隔淋巴瘤鉴别。     

支气管肺癌的影像诊断

肺癌的主要影像检查方法为X线胸片、CT、MRI等,其中高电压胸片、高分辨CT是早期发现及鉴别诊断的最重要的方法。螺旋CT的影像重建技术和MRI对于肿瘤的分期有重要价值。中央型肺癌的早期X线表现为支气管的阻塞性改变,HRCT显示支气管狭窄、管壁增厚及管腔结节。周围型肺癌的早期X线表现为肺内结节或小斑片阴影,HRCT显示结节有分叶、空泡或细支气管气像、边缘毛糙及胸膜凹陷征。CT或MRI增强扫描显示肿瘤明显强化。经皮肺穿刺活检是诊断肺癌的重要方法。螺旋CT对于病变的多平面重建、三维重建及仿真支气管内镜可从多个角度显示病变的形态,对病变的鉴别诊断起辅助作用。对于肺癌转移的诊断方面,CT及MRI可较准确地判断淋巴结转移,三维CT血管重建（CAT）及MR血管成像（MRA）可准确地诊断肿瘤对血管的侵犯。MRI是确定胸壁转移的可靠方法。中心型肺癌需与肺结核及慢性肺炎鉴别,周围型肺癌应与结核球、慢性炎性结节等肺内孤立结节病变鉴别。在充分发挥X线胸片及HRCT检查的基础上,有目的地选择其他影像方法进行综合影像诊断,可提高肺癌的早期诊断及鉴别诊断水平。