颈部淋巴结结核的CT影像表现

目的:探讨颈部淋巴结结核的CT影像表现及评价CT检查对颈部淋巴结结核疾病的诊断价值。材料与方法:回顾性分析90例颈部淋巴结结核的CT影像表现,40例行细针穿刺针吸活检确诊,43例行手术病灶清除病理检查确诊,另7病例经抗结核一年治疗治愈而证实。其中男54例,女36例,年龄1~74岁。所有的病例均行CT平扫,其中的67例做了增强检查。结果:颈部淋巴结结核的CT征象根据病理可分为四型:Ⅰ型:结核结节和肉芽肿形成,本组为12例;Ⅱ型:受累的淋巴结干酪样坏死,本组为21例;Ⅲ型:淋巴结包膜坏死,淋巴结互相黏连伴有淋巴结周围炎,本组为41例;Ⅳ型:干酪样物质破溃进入周围组织,形成脓腔,最终可通过窦道引流至皮肤表面,本组为16例,其中8例溃破形成窦道。以2~4型居多,约占87%。增强检查CT表现可以分为四型;1:均匀强化;2:边缘细环状强化;3:花环样强化;4:不均匀强化;各种增强类型可同时存在。病理分型与CT增强分型是对应的。结论:CT检查对面颈部淋巴结结核的诊断以及明确病灶范围具有重要的价值。

CT Findings of the Cervical Tuberculous Lymphadenitis (CTBL)

Purpose:To investigate the CT findings of the cervical tuberculous lymphadenitis(CTBL),and to evaluate the value of CT in demonstrating the cervical tuberculous lymphadenitis.Materials and Methods:CT findings of the cervical tuberculous lymphadenitis in 90 cases was analyzed retropectively.of which 40 patients were diagnosed definitely by fine needle aspirationcytology,43 patients were diagnosed definitely by cured after getting general antituberculosis chemotherapy for one year.of al patients,54 cases were males,36 cases were females,with age from 1 to 74 years.All patients were underwent CT native scan,and enhanced CT scan were performed on 67 of them.Results:The corresponded pathologic findings of the cervical tuberculous lymphadenitis(CTBL) can be classified into four types:1 tuberculous granulomas in lymph nodes,with or without minimal necrosis;2 tuberculous granulomas with central caseation necrosis 3.multiple lymph onodes with caseation necrosis and tuberculous granulomas confluent or adjacent to each other,accompanied by involved surroundings tructures.Lymph node structure disappeared.4.if tuberculous abscess repture,sinus shape.The enhanced patterns on CT scan were divided into Four types:Type l:isodensity enhancement;Type 2:Thin rim enhancement;Type 3:Corolla like enhancement;Type 4:Heterogeneous enhancement.Various combinations of these types occurred in our patients.Pathologic classification correspond to classification of the CT findings.Conclusion:CT well demonstrated the number,location and enhancement feature of CTBL.CT manifestations may leflect various pathological characteristics in the different stages of CTBL and lead to a correct diagnosis in most cases.