孤立性肺结核球薄层动态CT扫描及病理对照研究

目的　对薄层动态螺旋CT扫描诊断孤立性肺结核球 (SPTM )的价值进行评估。方法　对 2 8例SPTM进行了平扫及薄层动态增强扫描 ,层厚及间距为 2～ 3mm。分析总结了SPTM的强化特点及形态学特点 ,并与病理学改变进行对照研究。结果　 2 8个SPTM主体均无明显强化 ,CT差值均 <2 0Hu ,且无明确强化峰值。病灶环行强化 14例 ,病理显示为干酪病灶周围有肉芽组织包绕 ;索状强化 3例 ,病理为残存的血管强化影 ;轻度强化 1例 ,为结核球坏死不均匀或不彻底则实质内有血供 ;完全无强化 10例 ,病理学显示病灶为干酪坏死。以CT差值小于 2 0Hu为域值 ,敏感性及特异性均为10 0 %。薄层扫描能发现常规扫描未能显示的细小钙化、小空洞及病灶包膜 ,后者具有特异性。结论　薄层动态螺旋CT扫描是诊断SPTM的最敏感和可靠的方法。

Solitary Pulmonary Tuberculoma:Comparative Study of Spiral Dynamic CT of Thin Collimation and Pathological Findings

Objective To assess the evaluation of diagnosis of solitary pulmonary tuberculoma (SPTM) with spiral dynamic CT of thin collimation.Methods Twenty-eight SPTM were performed with non-enhanced and dynamic enhanced CT scan of thin collimation at 2-3mm thickness and interval.The characteristics of SPTM in dynamic scan were analyzed and compared with pathological findings.Results The enhanced CT value in 28 SPTM was less than 20Hu.No peak enhancement was found.Ring enhancement was showed in 14 foci,stripe enhancement in 3,mild enhancement in 1,no enhancement in 10.With 20 Hu as the threshold for a positive test,specificity and sensitivity were 100%.Conclusion Spiral dynamic CT of thin collimation was a sensitive and reliable method to diagnose SPTM.Thin collimation can find mini-calcified lesion?small cavity and capsule of lesion which has the specificity.