球形肺结核的CT表现(附58例分析)

目的:分析球形肺结核的螺旋CT表现,提高对该病的认识诊断能力.方法:对58例确诊的球形结核进行回顾性分析,评价其临床和CT表现.结果:依据影像学表现、随访结果和病灶的病理改变,将58例球形肺结核分为四种类型:①球形干酪肺炎11例,体积较大(最大直径3～5cm),边缘模糊或毛糙,可见晕征,无强化或环行强化;②结核性肉芽肿19例,软组织密度,形态规则或不规则,边缘清楚或光整,强化模式为均匀强化或厚壁强化;③纤维干酪结节14例,规则球形,边缘光滑锐利,内部密度不均匀,可见钙化,多无强化或薄壁环行强化;④结核空洞14例,干酪空洞或纤维空洞,内壁不光整,可见到引流支气管(2例).结论:球形肺结核CT表现具有一定的特征性,多排螺旋CT规范的扫描及后处理技术对球形肺结核的诊断具有重要的临床价值.     

易误诊为肺癌的不典型肺结核CT诊断

目的 探讨易误诊为肺癌的不典型肺结核的CT表现特点,提高诊断正确率.方法 收集本院35例经临床或病理证实并行CT检查的直径＞3 cm的不典型肺结核,回顾性分析病灶的CT平扫及增强特点.结果 (1) 病灶内部特征:密度不均17例,伴空洞9例,钙化6例,引流支气管5例;(2) 边缘特征及邻近组织改变:边界光整8例,边界模糊3例,分叶征8例,毛刺征5例,尖角样突起10例,卫星灶13例,胸膜增厚及粘连11例,胸膜凹陷征1例,纵隔淋巴结肿大4例.(3) CT增强特点:经增强检查的21例中蜂窝状强化9例,包膜样强化5例,周边强化1例,广泛强化4例,不强化2例.结论 肿块状的不典型肺结核影像学极易误诊为肺癌,CT增强有助于该类病变的正确诊断,但仍有部分病例需要结合临床随访或穿刺活检才能明确诊断.     

支气管内错构瘤的CT诊断及误诊分析

目的：探讨支气管内错构瘤的多层螺旋CT表现,并分析误诊的原因,提高对该病的诊断水平。方法：回顾性分析2008年-2012年的6例被CT误诊后经病理证实的支气管内错构瘤的CT表现。结果：6例支气管内错构瘤病灶均位于大支气管内,其中右侧支气管4例,左侧支气管2例。行增强扫描的4例中未见强化2例,2例轻中度强化。伴阻塞性肺不张5例、钙化2例,均未见脂肪密度。6例支气管内错构瘤误诊为肺癌的4例,误诊为结核1例,误诊为异物1例。结论：支气管内错构瘤CT表现不典型,易致误诊,结合病理检查有助于确诊。     

肺结核性空洞与癌性空洞的CT表现与临床分析

目的探讨肺结核性空洞与肺癌性空洞CT表现。方法分析经病理及临床证实的肺结核性空洞29例及肺癌性空洞31例CT表现及临床资料。结果癌性空洞一般为厚壁,内缘凹凸不平,有壁结节,分叶及胸膜凹陷征多见;而肺结核空洞以薄壁相对多见,周围常有卫星灶。厚壁空洞出现壁结节伴有胸膜凹陷征高度提示肺癌,而薄壁空洞,洞壁厚薄较均匀,周围伴有卫星灶者以肺结核最常见。结论 CT对鉴别肺癌性空洞和肺结核性空洞有较高的价值。     

肺结核抗痨过程中病灶进展的影像学表现及误诊分析

目的 探讨肺结核抗痨过程中病灶进展的影像学表现及误诊原因.方法 回顾性分析在本院登记且资料完整的肺结核患者,并且抗痨过程中病灶进展的56例患者的影像学表现及误诊原因.所有患者均摄胸部X线片和/或胸部CT扫描.结果 56例中耐多药肺结核患者45例、肺癌5例、糖尿病2例、真菌感染2例、炎症1例、阻塞性肺炎1例.耐多药肺结核以累及3个以上肺野、多发空洞、厚壁空洞、支气管扩张、毁损肺、肺门纵隔淋巴结肿大为主要特点.误诊为耐多药肺结核的有3例肺癌、2例糖尿病、1例炎症和1例真菌感染;误诊为肺癌的有4例耐多药肺结核和1例阻塞性肺炎.结论 全面、综合分析肺结核抗痨过程中病灶进展的影像学特征能减少误诊;MSCT在肺结核及并发症的鉴别诊断中具有重要价值.     

肺部癌性空洞的CT特征和鉴别诊断分析

目的：探讨肺癌空洞的CT影像学特征，讨论其鉴别诊断和误诊原因，以期提高对肺部空洞病变的诊断水平。资料和方法：21例经病理证实的肺癌空洞，男13例，女8例，平均年龄49岁。有7例术前误诊为肺结核空洞。全部病例均作了胸部X线平片和CT平扫及增强扫描。CT表现着重分析空洞的大小、部位、形态、边缘轮廓、空洞壁的厚度、密度及空洞周围肺组织改变。结果：21例均为单发结节空洞；空洞平均直径为34．5mm：以类圆形为主，占71％（15／21）；空洞外形以浅分叶为主占69％（14／21）；51％（11／21）是薄壁空洞；79％（17／2）的空洞内外壁均不光整。空洞壁CT增强明显。空洞周围卫里灶不明显。结论：肺癌空洞表现为内外壁不光整的厚薄不均的空洞，鉴别的要点为空洞周围卫星灶程度、空洞外缘分叶的深浅及空洞壁CT强化的程度。     

肺空洞性病变的CT定量分析

目的定量分析不同病理基础肺空洞的CT表现及其鉴别诊断。方法回顾性分析经临床与病理证实的98例各类肺空洞病变的CT资料，其中，肺脓肿17例，肺结核30例，肺霉菌病3例，原发性肺癌37例，转移性肺癌8例，Wegner’s肉芽肿3例。逐例记录病灶大小、形态、边缘、密度，对病灶大小及空洞壁的CT值变化进行测量。比较不同病变空洞壁厚度和CT值强化幅度。t检验及X^2检验统计分析相关数据。结果各组不同病变的空洞其内、外壁不同形态出现率比较及空洞内容物出现率均无显著差异（P〉0．05）；偏心空洞以肺癌为主，占70％，与其他各组比较相差显著（P〈0．01）；肺癌与各组间空洞壁厚度相差显著（P〈0．05），空洞壁CT值强化幅度在肺癌与其他各组比较相差显著（P〈0．05）。结论 肺部空洞性病变有无偏心、空洞壁CT增强幅度及空洞壁厚度对鉴别良、恶性空洞有意义。     

周围型肺癌与肺结核空洞的CT鉴别诊断

目的:研究周围型肺癌空洞与肺结核空洞的CT表现,提高其鉴别诊断水平.材料和方法:回顾性分析周围型肺癌空洞46例和肺结核空洞32例的CT表现.结果:癌性空洞一般为厚壁,内缘凹凸不平,有壁结节,分叶及胸膜凹陷征多见;而肺结核空洞以薄壁相对多见,周围常有卫星灶.厚壁空洞出现壁结节伴有胸膜凹陷征高度提示肺癌,而薄壁空洞,洞壁厚薄较均匀,周围伴有卫星灶者以肺结核最常见.结论:CT可清楚地显示空洞壁的状况及病灶本身的特点,是肺部空洞鉴别诊断的最佳影像学检查方法.     

肺结核球的CT表现

目的探讨肺结核球的CT表现及其鉴别诊断。方法选择40例经临床和病理证实的肺结核球及40例经手术病理证实的周围型肺癌,将其资料进行对比分析。结果结核球好发于背侧肺段;密度大多均匀,边界光整,部分病例可见粗长毛刺;病灶内部常见弥散小钙化点,靠近边缘的弧形钙化,钙化面积大于病灶的10%;薄、厚壁空洞内缘光整或裂隙状空洞;增强扫描病灶不强化或环状强化;病灶周围的卫星病灶及胸膜增厚;肺门、纵隔淋巴结钙化,不肿大。抗结核治疗后复查病变吸收慢或略吸收、不吸收。结论综合分析各种CT征象,结合临床资料其诊断准确率可提高;对一时不能确诊的病例,应做CT引导下穿刺检查。     

多层螺旋CT薄层增强动态扫描在周围型肺癌的应用价值

目的：多层螺旋CT平扫，薄层增强动态扫描的应用，对辨析肺内占位性病变的性质，提高对周围型肿瘤的诊断率，尤其是早期≤3cm的周围型肺癌的诊断。方法：对80例肺内占位性病灶，多层螺旋CT对病灶薄层平扫，感兴趣区以肺三期动态增强扫描，肺动脉期15S，支气管动脉期36S，平稳期病灶90S。结果：（1）肺癌CT肺三期增强强化主要形式为无明显强化，显著强化和中等强化；（2）肺炎性病灶肺三期强化变化主要形式为轻度或中等强化，显著强化和显著强化的特点；（3）肺结核球及转移瘤肺三期强化变化较小；（4）肺癌大多数强化于支气管动脉期见不规则条状，斑点状强化血管影；（5）肺癌空洞的好发部位，分叶，大小，内部结构及壁结节的强化变化具有明显特征；（7）肺结核并发肺癌特征。讨论：多层螺旋CT薄层增强动态扫描对肺内占位病灶的肺三期强化的变化，与支气管动脉期病灶强化血供血管与血管床的面积因素相关，肺结核并发肺癌的诱发因素可能相关，有助提高周围型肺癌的诊断率，尤其对早期肺癌的诊断提供重要价值。     

MSCT在结节或肿块型肺结核中的诊断价值

目的通过对比结节或肿块型不典型肺结核与周围型肺癌的MSCT表现,旨在提高结节或肿块型不典型肺结核诊断及鉴别诊断能力。方法收集我院2015年1月~2018年12月不典型肺结核103例,同期周围型肺癌患者96例,对比分析两组MSCT平扫及强化结果。结果深分叶征、短毛刺征、胸膜凹陷征、血管集束征、空洞内壁不光整、轻-中度或明显强化在周围型肺癌中出现率高,差异有统计学意义(P<0.05)。浅分叶征、长毛刺征、卫星灶、钙化、轻度及环形强化在结节或肿块型肺结核中出现率高,差异有统计学意义(P<0.05)。结论浅分叶征、长毛刺征、卫星灶、钙化、轻度及环形强化是结节或肿块型肺结核较特征性MSCT表现,征象出现越多,越提示结节或肿块型肺结核。     

Helical CT of prostate cancer: early clinical experience

OBJECTIV:. This study was undertaken to determine whether helical CT can reveal carcinoma of the prostate detected at transrectal sonographically guided biopsy. MATERIALS AND METHODS: Helical CT of the prostate was performed in 35 patients: 25 with proven prostate cancer (group I) and 10 without cancer detected at biopsy (group II). All patients in group I had cancer in the peripheral zone, and three of these showed foci of cancer in the transitional zone. All patients of group II had undergone at least two sets of biopsy before CT. In group I, areas of contrast enhancement in the peripheral zone of the prostate were defined as suggestive of cancer and correlated with the histopathologic findings. RESULTS: Helical CT revealed cancer in 22 (88%) of 25 patients with proven prostate cancer. Transrectal sonographically guided biopsy detected 102 cancer sites in the peripheral zone and three in the transitional zone in these 25 patients. Helical CT accurately revealed 59 peripheral zone cancer sites (58%) but did not reveal 43 cancer sites (42%). Abnormal contrast enhancement in the peripheral zone that was not caused by cancer was seen in 10% of suspicious lesions. The three cancer sites in the transitional zone were indistinguishable from benign nodular changes. CONCLUSION: Prostate cancer detected at transrectal sonographically guided biopsy appears on helical CT of the prostate as focal or diffuse areas of contrast enhancement in the peripheral zone. A prospective study has been initiated to determine the accuracy, sensitivity, and specificity.     

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.     

肺腺鳞癌的多层螺旋CT表现(附12例分析)

目的:探讨肺腺鳞癌的多层螺旋CT表现特征,以提高其诊断水平。方法:回顾性分析经手术和病理证实的肺腺鳞癌的多层螺旋CT表现。结果:12例肺腺鳞癌中,周围型9例,中央型3例;肿块直径为(3.3±1.2)cm;均匀密度肿块3例(25%),不均匀密度肿块9例(75%),其中有钙化2例;常见CT征象包括分叶征10例(83%),胸膜凹陷征9例(75%),肿块内坏死7例(58%),厚壁空洞2例(17%),毛刺征9例(75%),2例肿块CT增强扫描,强化程度达(23.5±1.2)HU。结论:多层螺旋CT对于肺腺鳞癌具有一定的诊断价值。     

肺硬化性血管瘤的影像学表现及误诊分析

目的探讨肺硬化性血管瘤的X线、CT表现及误诊原因,提高本病的诊断准确率。方法回顾性分析16例资料完整且经病理证实的肺硬化性血管瘤X线、CT表现。结果左肺8例,右肺8例;均呈圆形或类圆形,边缘光整12例,浅分叶3例,1例边缘不规整;密度均匀12例,CT值约为42HU,点状钙化2例,空气半月征1例,囊变坏死1例,血管贴边征2例;增强10例,明显均匀强化9例,不均匀强化1例。术前误诊8例,误诊为周围型肺癌(n=4),转移瘤(n=2),错构瘤(n=1),曲霉菌球(n=1)。结论 PSH特征性表现为肺内孤立性,圆形或类圆形肿块,边缘光整,明显强化,偶见点状钙化及空气半月征,而对其影像特征及鉴别诊断认识不足是误诊的主要原因。     

Thoracic CT findings of adult T-cell leukemia or lymphoma

OBJECTIVE: The aim of this study was to assess pulmonary CT findings in patients with adult T-cell leukemia or lymphoma. MATERIALS AND METHODS: We retrospectively reviewed CT scans of the lung in 87 patients with adult T-cell leukemia or lymphoma who had undergone chest CT between January 1996 and March 2002 at two institutions. The CT scans were interpreted by two chest radiologists working in consensus. Parenchymal abnormalities (ground-glass attenuation, consolidation, nodules, thickening of bronchovascular bundles, interlobular septal thickening, honeycombing, crazy-paving appearance, and bronchiectasis) were evaluated, as were enlarged lymph nodes, pleural effusion, and pleural thickening. In 46 patients who underwent surgical biopsy or autopsy, CT-pathologic correlation was performed with the actual specimens by a pathologist and two chest radiologists. RESULTS: On the CT scans, abnormal findings were seen in 60 patients (69.0%). CT findings consisted of ground-glass attenuation (n = 37), centrilobular nodules (n = 25), thickening of bronchovascular bundles (n = 22), and consolidation (n = 13). These abnormalities were predominantly seen in the peripheral lung parenchyma (n = 26). Pathologically, these findings corresponded with atypical lymphocyte infiltration along the interstitium and the alveolar spaces. Pleural effusion and enlarged lymph nodes were found in 22 and 27 patients, respectively. CONCLUSION: CT findings in patients with adult T-cell leukemia or lymphoma consisted mainly of ground-glass attenuation, centrilobular nodules, and thickening of the bronchovascular bundles in the peripheral lung. These findings, although nonspecific, are considered suggestive of thoracic involvement in patients with adult T-cell leukemia or lymphoma.     

CT在胰腺结核诊断中的价值

目的：探讨胰腺结核的CT征象及其诊断价值。资料与方法：回顾性分析14例胰腺结核的CT表现及临床资料。结果：胰腺结核表现为3型：（1）局灶型：9例，多位于胰头，表现为低密度肿块伴有周边或蜂房状强化；（2）多结节型：4例，胰腺内多发低密度病变，无强化或轻度强化，胰头病变明显，呈蜂房状强化；（3）弥漫型：1例，表现为胰腺弥漫性肿大，边缘模糊。胰腺结核常伴有胰外结核。胰周淋巴结肿大9例，7例增强，呈花环状或环形强化；肝脏受累3例，脾脏受累4例，表现为肝、脾实质内低密度无强化病灶；胆管梗阻、结核性腹膜炎各3例。结论：胰腺结核CT表现多样，包括胰腺局灶性低密度肿块、多发低密度结节或弥漫性胰腺肿大，但最常见的表现是胰腺内局灶性蜂房状强化的肿块。低密度的胰周和门静脉周围淋巴结肿大伴周边环形强化以及其他播散结核灶是支持胰腺结核诊断的重要辅助征象。     

Pulmonary CT findings in 320 carriers of human T-lymphotropic virus type 1

PURPOSE: To retrospectively evaluate pulmonary computed tomographic (CT) findings in human T-lymphotropic virus type 1 (HTLV-1) carriers, who were characterized by means of polyclonal integration of proviral DNA. MATERIALS AND METHODS: Institutional review board approval was obtained, and informed consent was waived. Chest CT scans obtained between January 1996 and October 2004 in 320 (154 men, 166 women; age range, 31-86 years; mean, 64 years) patients with HTLV-1 were retrospectively evaluated by three chest radiologists. Parenchymal abnormalities (ground-glass opacity, consolidation, centrilobular nodules, thickening of bronchovascular bundles, interlobular septal thickening, and bronchiectasis) were evaluated, along with enlarged lymph nodes and pleural effusion. In 58 patients who underwent surgical biopsy or transbronchial biopsy, comparison of CT images with the actual specimens was performed by a pathologist and three chest radiologists. RESULTS: On CT scans, abnormal findings were seen in 98 (30.1%) patients and consisted of centrilobular nodules (n = 95), thickening of bronchovascular bundles (n = 55), ground-glass opacity (n = 51), bronchiectasis (n = 50), interlobular septal thickening (n = 28), and consolidation (n = 5). These abnormalities were predominantly seen in the peripheral lung parenchyma (n = 70). Pathologically, these findings corresponded to lymphocytic infiltration along respiratory bronchioles and bronchovascular bundles. Pleural effusion and enlarged lymph nodes were found in two and five patients, respectively. CONCLUSION: CT findings in patients with HTLV-1 consisted mainly of centrilobular nodules, ground-glass opacity, and thickening of the bronchovascular bundles in the peripheral lung. These CT findings are considered suggestive of thoracic involvement in patients with HTLV-1.     

多层螺旋CT扫描在肺部恶性肿瘤射频毁损治疗中的价值

目的:评价多层螺旋CT在肺部恶性肿瘤射频毁损治疗中的价值.方法:对20例肺部恶性肿瘤患者(32个病灶)行16层螺旋CT引导下射频毁损治疗.治疗中,利用多层CT软件功能,对病灶处进行二维多层面和三维重组,观察治疗针在病灶所处位置以及与周围组织结构之间的关系.治疗后1月或半年后再行CT扫描复查,评价治疗效果.结果:20例患者中,治疗针在病灶所处位置以及与周围组织结构之间的关系显示明确,特别是利用三维重组技术更能清晰观察针尖所处的位置,病灶毁损较为完全.治疗后即行CT扫描,32个病灶周边都有渗出;有25个病灶密度减低;7个病灶密度变化不大.有18个病灶内部呈单个或多个小气泡影.1月或半年后CT复查显示,有2个病灶完全消失,25个病灶有不同程度的缩小,2个无变化,3个增大.8例有肺部症状及体征者治疗后消失或减轻好转.结论:射频毁损治疗肺部恶性肿瘤有确切疗效,16层螺旋CT二维及三维重组图像能准确引导治疗针进入目的位置,特别是对靠近心脏主动脉等重要器官的病灶射频毁损治疗比普通CT定位更精确、效果更佳.     

浆膜型肝结核的CT表现

目的:探讨浆膜型肝结核的CT表现及诊断价值.方法:回顾性分析经病理证实的8例浆膜型肝结核CT表现,所有病例均行CT平扫及增强检查.结果:本组浆膜型肝结核8例中,6例单发,2例多发,共10个病灶.CT表现为肝包膜区梭形或多发结节性低密度灶,增强扫描后病灶呈环形强化8个,蜂窝状或多环状强化2个;10个病灶中明显强化3个,轻至中度强化7个;病灶边缘或中央见点状或条状钙化3个.累及邻近肝实质2例;伴有少量腹水及后腹膜淋巴结轻度肿大1例.结论:浆膜型肝结核的CT表现有一定的特征,当病灶内发现斑点状或条状钙化或病灶呈多环状强化时结合临床表现及实验室检查可作出提示性诊断.