甲状腺疾病影像学检查方法及临床应用

甲状腺非侵入性检查手段包括超声、核素显像(单光子显像和正电子断层显像)、CT以及MRI.超声是一种无损伤、操作简便、价格低廉的检查方法,因而是甲状腺疾病尤其是甲状腺结节的首选影像检查方法,彩色多普勒血流成像(CDFI)和超声指导下的细针穿刺活检的应用,为甲状腺结节良、恶性的鉴别诊断提供了可能.核素显像(包括SPECT和PET)是一种功能显像.99mTcO4-是最常用的功能显像剂,131I主要用于分化型甲状腺癌.FDG PET一般不用于甲状腺疾病术前,但甲状腺癌术后考虑转移而131I扫描结果阴性时,可以考虑应用.临床上,CT常作为甲状腺疾病的第二线影像学检查方法.MRI技术本身有许多特点,但在甲状腺疾病而言,并不比CT优越.     

肺气肿合并结核临床和影像学特征分析

目的 探讨肺气肿合并结核临床和影像学特征,提高对不典型影像表现的识别能力.方法 搜集肺气肿合并结核患者97例为研究对象,按影像学特征分为实变组33例和非实变组64例.对两组临床表现、影像学特征及转归进行观察和比较.结果 在临床表现方面,发热、病原学阳性率、体重下降、耐R率、气肿严重程度分级、血浆白蛋白均值、N/L(比值...     

The risk factors and laboratory diagnostics for post renal transplant tuberculosis: a case-control, country-wide study on definitive cases

Background. Tuberculosis (TB) is an important cause of morbidity and mortality in renal transplant recipients and, because of its infrequency and the lack of medical awareness, it is usually misdiagnosed. This study was carried out to determine frequency and weight of multiple risk factors for post kidney transplantation TB.
Methods. A total of 44 cases (0.3%), out of 12,820 patients from 12 major kidney transplantation centers in Iran from 1984 to 2003, were compared with 184 healthy transplant subjects who were transplanted by the same surgical team.
Results. The mean age of cases and controls was 37.7 (13–63) and 35.6 (8–67) years ( P =0.3), respectively. The mean duration of pre-transplantation hemodialysis was 30.3 (3–168) months in cases and 18.2 (1–180) months in controls ( P =0.03). A positive past history of TB was detected in 2 cases and 1 control ( P =0.3). The mean doses of initial and maintenance immunosuppressive drugs in cases and controls were not significantly different. A total of 25 cases (56.8%) and 60 controls (32.6%) had rejection before diagnosis of TB ( P =0.004; OR=2.7, CI_95%: 1.3–5.6).
Conclusions. To our knowledge, this is the first study that demonstrated an increase in the risk of post-transplant TB by increasing the duration of pre-transplant hemodialysis and the number of post-transplant rejection episodes as 2 immunocompromised states. Further study is needed to clarify our new findings, specifically in relation to different immunosuppressive regimens.     

浸润型肺结核CT与临床疗效对比分析

目的 评价初治浸润型肺结核患者的临床疗效和螺旋CT影像学特点的对比研究。方法 116例浸润型肺结核患者,采用抗结核治疗,分别在1,2,4,8和12个月进行对比研究。结果 在1,2和4个月的对比研究中,螺旋CT影像学表现的好转情况明显低于临床表现（P〈0．05）,而8和12个月对比结果两者表现相同。结论 CT表现晚于临床症状的转归。说明即使临床结核中毒症状好转或消失,也不应该忽视结核的化学治疗。     

Comparison of chest computed tomography features between pulmonary tuberculosis patients with culture-positive and culture-negative sputum for non-mycobacteria: A retrospective observational study

Although complication with non-mycobacterial pneumonia among patients with pulmonary tuberculosis (TB) may lead to poor prognosis, discrimination between TB complicated with and without non-mycobacterial pneumonia using radiological imaging has not been fully elucidated. We aimed to clarify the differences in chest computed tomography (CT) features between pulmonary TB patients with culture-positive and culture-negative sputum for non-mycobacteria.We retrospectively included consecutive patients admitted to our hospital from January 2013 to December 2015 for bacteriologically-confirmed pulmonary TB, who were tested by sputum culture for non-mycobacteria, and who underwent chest CT within 2 weeks before or after admission. Chest CT features were compared between pulmonary TB patients who had positive non-mycobacterial cultures and in those who had not.Of 202 patients with pulmonary TB, 186 (92%) were tested by sputum culture for non-mycobacteria and underwent chest CT. Among these, non-mycobacteria were isolated in 118 patients (63%), while 68 patients (37%) had negative cultures. Patients with a positive culture for non-mycobacteria were significantly older and had lower levels of physical activity and albumin, higher levels of C-reactive protein, and a greater number of respiratory failures. By CT, emphysematous lesions, ground-glass opacities, airspace consolidation, air-bronchogram, interlobular septal thickening, bronchiectasis, pleural effusion, pleural thickening, and lymph node enlargement were more frequently in patients with a positive culture for non-mycobacteria. These chest CT features could be helpful for detecting complication with non-mycobacterial pneumonia in patients with pulmonary TB.     

免疫功能低下疾病患者肺结核的影像分析

目的探讨几种免疫功能低下疾病的肺结核患者的X线和CT所见。方法回顾分析糖尿病患者68例,肾病综合症患者20例,SLE患者12例,8例AIDS患者合并肺结核的X线及胸部CT所见。结果X线和CT表现,糖尿病肺结核:大片浸润病灶45例,浸润病灶内多发空洞40例,散在大小不等浸润病灶可不按肺段分布23例,支气管播散病灶21例;部分病例合并胸水10例。肾病综合症或SLE肺结核:急性血行播散性肺结核15例,大小不等浸润病灶17例,合并肺门及纵膈淋巴结肿大4例;AIDS肺结核:肺内斑片阴影合并有淋巴结肿大5例,急性血行播散性肺结核合并有淋巴结肿大3例。结论免疫功能低下疾病患者的肺结核,肺内结核病灶容易形成大片干酪病灶并合并空洞,结核肺内播散,急性血行播散性肺结核,肺门及纵膈淋巴结肿大及非结核好发部位发生浸润结核灶。     

Kyphotic angle correction and neurological status evaluation after operation in spinal tuberculosis patients: Single center retrospective study

BackgroundPrevious studies have indicated that correction of an established kyphosis in spine tuberculosis is both difficult and hazardous. There has not been any publication about evaluation of surgical correction of spine tuberculosis in Indonesia, despite of high incidence of spine tuberculosis cases. Therefore, we evaluated the outcome of kyphotic angle correction and neurological status after surgery of spinal tuberculosis patients for better understanding.MethodsRetrospectively, 96 patients with spinal tuberculosis that underwent operation in Soeharso Orthopedic Hospital from June 2016 to July 2019 were selected. Operation procedure includes laminectomy, debridement and posterior stabilization. We obtained plain x-ray of spine to evaluate the kyphotic deformity before and after surgery. We also examined neurological status of the patient before and after surgery.ResultsThe average pretreatment kyphotic angle in thoracic tuberculosis was 33.69° (range 8°–86°), which improved into a significant change to 13.27° (range 0°–56°). Correction angle was <25° in 34 people, 25°–50° in 17 people, and >50° in 4 people. While in the lumbar tuberculosis, it was 25.52° (range 6°–80°), and improved into 11.51° (range 2°–48°). Correction angle was <25° in 35 people, 25°–50° in 4 people, and >50° in 2 people. Improved neurological deficit was shown in 12% of patient with lumbar tuberculosis, and the rest had constant neurological deficit. While in thoracic tuberculosis found that 7% have improved neurological deficit and the rest is constant. None of them have worsen neurological status after the surgery.ConclusionsSurgical treatment for kyphotic deformity in patient with thoracolumbar tuberculosis are effective and safe, even in high corrective angle (>50°).     

肺结核合并肺癌89例临床分析

目的　分析肺结核合并肺癌的临床特点和诊治对策。方法 回顾性总结分析1997—2003年收治的89例肺结核合并肺癌患者临床资料。结果 本组89例患者平均年龄61.4岁,肺结核:原发性4例,继发性85例;肺癌:非小细胞肺癌81例,Ⅰ期11例,Ⅱ期4例,Ⅲa期15例,Ⅲb期和Ⅳ期51例;小细胞肺癌8例。全组89例患者中,接受正规抗结核治疗者49例,9例患者放弃治疗;在81例非小细胞肺癌中,有26例患者接受手术治疗;53例为中晚期非小细胞肺癌患者(Ⅲ+Ⅳ期),其中30例接受以化疗为主的综合治疗,23例患者放弃治疗;2例早期肺癌患者因低肺功能,仅行化疗。结论 肺结核与肺癌在临床表现及影像学特点相似,两者并存更易误诊、漏诊,积极完善相关的检查,可提高诊断的准确性。在患者身体状态允许的情况下,选用合理的治疗方式,可以提高患者的生存期,改善预后。     

免疫功能低下疾病患者肺结核的影像分析

目的探讨几种免疫功能低下疾病的肺结核患者的x线和CT所见。方法回顾分析糖尿病患者68例，肾病综合症患者20例，SLE患者12例，8例AIDS患者合并肺结核的x线及胸部cT所见。结果x线和CT表现，糖尿病肺结核：大片浸润病灶45例，浸润病灶内多发空洞40例，散在大小不等浸润病灶可不按肺段分布23例，支气管播散病灶21例；部分病例合并胸水10例。肾病综合症或SLE肺结核：急性血行播散性肺结核15例，大小不等漫润病灶17例，合并肺门及纵膈淋巴结肿大4例；AIDS肺结核：肺内斑片阴影合并有淋巴结肿大5例，急性血行播散性肺结核合并有淋巴结肿大3例。结论免疫功能低下疾病患者的肺结核，肺内结核病灶容易形成大片干酪病灶并合并空洞，结核肺内播散，急性血行播散性肺结核。肺门及纵膈淋巴结肿大及非结核好发部位发生浸润结核灶。     

Miliary tuberculosis: clinical manifestations, diagnosis and outcome in 38 adults

OBJECTIVE: The aim of the study was to determine the clinical, radiographic and laboratory characteristics, diagnostic methods, and prognostic variables in patients with miliary tuberculosis (TB). METHODOLOGY: The records of 38 patients (15 male, 23 female; mean age 41 years, range 16-76 years) with miliary TB from 1978 to 1998 were analyzed. Patients were evaluated also as to whether they presented with a fever of unknown origin (FUO). Criteria for the diagnosis of miliary TB were (i) miliary pattern on chest X-ray or (ii) biopsy or autopsy evidence of miliary organ involvement. Paraffin-embedded tissues with granulomata (n = 15) were re-evaluated for the presence of Mycobacterium tuberculosis DNA by polymerase chain reaction (PCR). RESULTS: Predisposing conditions were present in 24% of the patients. The findings were fever, weakness, night sweats, anorexia/weight loss (100% for each), hepatomegaly (37%), splenomegaly (32%), choroidal tubercles (13%), neck stiffness (11%), altered mental status (8%), anaemia (76%), leukopenia (26%), thrombocytopenia (16%), lymphopenia (76%), pancytopenia (8%) and hypertransaminasemia (55%). Eighteen patients (47%) met the criteria for a FUO. Miliary infiltrates were found on chest X-rays of 32 of 38 cases (84%). In six cases without miliary infiltrates, the diagnosis was made by laparotomy in four cases, and autopsy in two cases. Tuberculin skin test was positive in 32% of cases. Acid-fast bacilli were demonstrated in 37% (16/43), and cultures for M. tuberculosis were positive in 90% (9/10) of tested specimens (predominantly sputum and bronchial lavage). Granulomas were found in 85% (11/13) of lung, 100% (15/15) of liver, and 56% (9/16) of bone marrow tissue specimens. Acid-fast bacilli staining was negative in all (0/21), while PCR was positive in 47% (7/15) of specimens with granulomata. Mortality was 18%. Stepwise logistic regression identified male sex (P = 0.005), non-typical miliary pattern (P = 0.015), altered mental status (P = 0.002) and failure to treat for TB (P = 0.00001) as independent predictors of mortality. CONCLUSIONS: Miliary infiltrates on chest X-ray or FUO should raise the possibility of miliary TB. Therapy should be administered urgently to prevent an otherwise fatal outcome.     

肺结核合并真菌感染58例临床观察

目的通过对58例肺结核合并真菌感染的认识与处理。方法从2004年1月～2006年12月三年间收治的肺结核病例中58例合并真菌感染的资料并进行回顾分析。结果58例真菌感染中自色念珠菌20例（34．5％）;热带念珠菌10例（17．2％）;光滑念珠菌8例（13．8％）;克柔念珠菌7例（12．1％）;曲霉菌12例（20．7％）,季也蒙念珠菌1例（1．7％）。感染的诱发因素多与应用抗生素和激素有关。结论临床医师应加强对结核病合并真菌感染的警惕性;合理应用抗结核药物,加强抗生素及肾上腺皮质激素的规范应用,以减少真菌感染及耐药的发生,有利于结核病控制及减少死亡。     

Expansile pneumonia in children caused by Mycobacterium tuberculosis: clinical, radiological, and bronchoscopic appearances

A cohort of 24 children with expansile pneumonia caused by Mycobacterium tuberculosis is described in mostly HIV-noninfected children (n = 22). The children presented with nonresolving pneumonia and a swinging fever (83%). On chest radiography, they had dense opacification with bulging fissures mainly in the upper lobes (75%). On computed tomography, the lobes are consolidated, with areas of liquefacation. Other features visible are enlarged mediastinal lymph adenopathy with ring enhancement (100%), cavities (63%), and tracheal compression (71%). On bronchoscopy, bronchi were obstructed by more than 75% in 20 (83%) of cases. Lymph gland enucleation was required in 42% of cases. Phrenic nerve palsy was present in 3 children, of whom 2 underwent diaphragmatic plication. The children received standard antituberculous therapy, to which prednisone (2 mg/kg/day) was added for 1 month. The mortality was 4% after 6 months of therapy.     

Multidrug-resistant tuberculosis: Treatment and outcomes of 93 patients

BACKGROUND:Tuberculosis (TB) remains a leading cause of death worldwide and the emergence of multidrug-resistant TB (MDR TB) poses a threat to its control. There is scanty evidence regarding optimal management of MDR TB. The majority of Canadian cases of MDR TB are diagnosed in Ontario; most are managed by the Tuberculosis Service at West Park Healthcare Centre in Toronto. The authors reviewed 93 cases of MDR TB admitted from January 1, 2000 to December 31, 2011.RESULTS:Eighty-nine patients were foreign born. Fifty-six percent had a previous diagnosis of TB and most (70%) had only pulmonary involvement. Symptoms included productive cough, weight loss, fever and malaise. The average length of inpatient stay was 126 days. All patients had a peripherally inserted central catheter for the intensive treatment phase because medications were given intravenously. Treatment lasted for 24 months after bacteriologic conversion, and included a mean (± SD) of 5±1 drugs. A successful outcome at the end of treatment was observed in 84% of patients. Bacteriological conversion was achieved in 98% of patients with initial positive sputum cultures; conversion occurred by four months in 91%.CONCLUSIONS:MDR TB can be controlled with the available anti-TB drugs.     

艾滋病合并肺结核35例CT征象分析

目的 分析艾滋病合并肺结核35例患者的临床资料及CT征象分析,总结其CT影像特点,提高对艾滋病合并肺结核的影像诊断水平.方法 收集35例艾滋病合并肺结核患者的临床资料及CT征象,分析和探讨艾滋病合并肺结核的CT特点.结果 艾滋病合并肺结核患者,其临床症状重,但胸部影像表现多不典型:(1)双肺不典型血播多见,表现为双肺弥漫粟粒结节影并广泛间质增厚,部分融合成小片状.(2)1～2个肺段的片团状实变多见,出现干酪坏死少见.(3)双肺毛玻璃影多见.(4)合并多浆膜腔积液(双侧胸腔积液及心包积液)多见.(5)空洞少见.结论 艾滋病合并肺结核的临床表现不典型,CT表现有一定特点,早期临床医生应该高度重视,提高其诊断率.     

肺吸虫病并发肺结核52例临床分析

目的探讨肺吸虫病并发肺结核的临床表现及治疗,提高对肺吸虫病并发肺结核的认识。方法对1995—2002年收治的52例肺吸虫病并发肺结核患者的临床资料进行回顾性分析。结果肺吸虫病并发肺结核均为青年和成年人,男性(67.3%)多于女性,大多数是在疫区居住的农民(76.9%);临床表现呈复杂性、多样性,误诊11例(21.1%);全部病例在流行区均有食半生石蟹或饮溪流生水史,肺结核和肺吸虫病均通过病原学检查确诊。结论肺吸虫病并发肺结核时,两病的临床症状和体征有许多相似之处,影像学有时也难分辨,必须结合病史及病原学检查可确诊。