肺侵袭性曲霉菌感染的HRCT影像表现及其动态变化

目的 探讨侵袭性肺曲霉菌肺炎(IPA)的HRCT影像表现及治疗前后的影像动态变化规律。 方法 回顾性分析2014年1月-2017年12月安徽医科大学第二附属医院经痰培养或活组织病理学确诊的56例侵袭性肺曲霉菌患者临床资料,并探讨侵袭性肺曲霉菌初诊HRCT表现及抗真菌治疗前后CT表现动态变化特征。 结果 本组42例(75.0%)表现为斑片影;33例(58.9%)表现为肺内结节,其中69.7%(23/33)表现为结节伴"晕圈征";15例(26.8%)出现"空气新月征",其中60.0%(9/15)出现在随访第3周左右;抗真菌治疗后第1~4周临床症状好转组与未好转组影像变化的P值分别为0.162、0.289、0.010、0.006。4组临床症状好转组中,有29例(29/38,76.3%)影像进展出现在抗真菌治疗后的第2周,其中有15例(15/29,51.7%)部分病灶内在抗真菌治疗后出现点状气体影,且后期会形成典型的空气半月征或病变范围进而缩小、消失。 结论 侵袭性肺曲霉菌肺炎典型HRCT影像表现为肺内单发或多发斑片结节影、曲菌球及"空气新月征",出现结节伴"晕圈征"和"空气新月征"时,则高度提示侵袭性肺曲霉菌病,且"晕圈征"提示为IPA早期;"空气新月征"多出现在患病第3周左右,提示为IPA中晚期;建议抗真菌治疗后第3周及第4周复查CT,抗真菌治疗后的第2周左右,临床症状好转组会出现肺部病灶体积或数量暂时性增加及点状气体影,此时应结合临床客观评价抗真菌治疗效果,不能仅通过影像学评价抗真菌治疗是否有效。 

HRCT imaging findings and dynamic changes of invasive pulmonary aspergillosis

Objective To investigate HRCT image findings of Invasive Pulmonary Aspergillosis (IPA) and the dynamic changes of the image before and after treatment. Methods Clinical data of 56 patients with invasive pulmonary aspergillosis confirmed by sputum culture or histopathological examination in our hospital from January 2014 to December 2017 were retrospectively analyzed. To investigate the HRCT findings of IPA and the dynamic changes of CT before and after anti-fungal therapy. Results In this group, 42 cases (75.0%) presented as patch shadow, 33 cases (58.9%) presented as pulmonary nodules, and 23 cases (23/33, 69.7%) presented as nodules with "halo" sign, 15 cases (26.8%) had "Air Crescent", 9 cases (9/15, 60%) occurred in about 3 th week. After anti-fungal therapy, the imaging changes of the clinical symptoms improvement group and the unimproved group at 1 th-4 th week after anti-fungal treatment were 0.162, 0.289, 0.010, 0.006, 29 cases (29/38, 76.3%) of the 4 groups with improved clinical symptoms presented imaging progression at 2 th week, among the 29 patients, there were 15 cases (15/29, 51.7%) with puncture gas shadow, after further treatment, the point gas will form typical "Air Crescent" signs or disappear. Conclusion Typical HRCT images of IPA showed single or multiple plaques, nodules, aspergilloma and "Air Crescent" in the lungs, while the occurrence of nodules and air crescent highly suggest IPA, most of "Air Crescent" occurred in about 3 th week, which prompts terminal IPA. CT examination is recommended at 3 th and 4 th week after anti-fungal therapy. About the 2 th week after anti-fungal therapy, the volume or number of pulmonary lesions will increase, and the puncture gas shadow will appear, at this point, the efficacy of anti-fungal therapy should be evaluated in combination with clinical objective evaluation.