侵袭性肺曲霉菌病的影像对比研究

目的：评价MRI和CT对侵袭性肺曲霉菌病诊断的准确性。方法：对38例在普通胸片上表现结节样浸润及临床拟诊侵袭性肺曲霉菌病患的MRI、CT表现进行对比研究。结果：早期病变（临床症状和体征小于10天）CT所见“日晕征”有较高的敏感性（16／22）和特异性（8／8）;而MRI也显示很高的敏感性（22／22）,但特异性很差（0／8）。尽管使用GD－DT－PA增强亦不能提高其特异性。病变后期（临床症状和体征大于10天）,MRI增强扫描T1WI显示边缘强化的靶样小结节的典型表现。结论：在侵袭性肺曲霉菌病早期阶段,MRI表现不如CT的“日晕征”具有特征性。但在病变后期,MRI增强后T1WI边缘明显强化及在T2WI上的“反向日晕征”是诊断侵袭性肺曲霉菌病的有力证据。

The manifestation of Invasive pulmonary aspergillosis in MRI, CT and plain radiographic findings and their contribution for early diagnosis

Objective:To asses the diagnostic of invasive pulmonary aspergillosis(IPA)accuracy of magnetic resonance imaging(MRI)and computed tomography(CT).Methods:A prospective study was conducted in MRI and CT of 28 patients with nodular lesions on plain chest radiographs and clinical suspicion of (IPA).Results:For early diagnosis of IPA(clinical signs and symptoms<10 days),CT scans with demonstration of the halo sign had a high sensitivity(16/22) and specificity(8/8).Magnetic resonance imaging performedat the same time revealed a relatively higher sensitivity(22/22),butaverypoor specificity(0/8).Gd-DTPA enhanced images did not improve specificity.In the later course of infection(clinical signs and symptoms >10 days).MRIs showed typical nodular target-like lesions with Gd-DTPA enhancement of the rim area.Conclusion:MRI findingsarenot as characteristic as the CT halo sign in diagnosing IPA in the early course thedisease,but the MRI taret sign with Gd-DTPA enhancementoftherim area and the "reverse target" on T 2-weighted images are strongly suggestive of IPA at a later stag of the disease.