MSCT后处理技术对真菌性肺炎的诊断及鉴别诊断价值

目的：探讨多层螺旋CT薄层图像与MPR图像在诊断真菌性肺炎中的临床价值，提高对该病的诊断水平。方法：搜集45例具有完整临床、实验室检查、病理组织学及CT检查资料的肺部真菌感染病例，回顾性分析其常规CT图像、薄层图像及MPR图像的CT征象。结果：白色念珠菌感染12例，曲霉菌感染14例，隐球菌感染8例，毛霉菌感染5例，放线菌感染3例，马尔尼菲青霉菌感染3例。肺部真菌感染的CT表现如下：空洞为主型15例，表现为一个或几个肺叶内单发或多发大小不等空洞性病灶，部分空洞周围见“晕征”，部分空洞内呈典型“鸟巢征”；肺炎样实变或支气管肺炎样变16例，呈小片状或大片状阴影，见支气管充气征及周边密度趋淡即“晕征”；结节或肿块8例，结节或肿块可伴有空洞、“晕征”、毛刺或分叶征；曲菌球6例，呈圆形或椭圆形，并可见“新月征”。薄层CT图像结合MPR图像在显示“晕征”、磨玻璃影、网格、线样影及小结节等cT征象明显优于普通cT（P〈0．05），其余征象无明显差异（P〉0．05），但薄层cT结合MPR图像能更清楚地显示病灶范围。结论：多层螺旋CT薄层图像结合MPR图像有助于肺真菌感染的诊断，真菌性肺炎有一定相对特征性改变，掌握真菌性肺炎的CT表现特征，结合临床综合分析，可提高诊断准确性。

Value of MSCT postprocessing techniques in the diagnosis and differential diagnosis of pulmonary mycosis

Objective：To explore the value of thin-section CT findings and MPR findings in the diagnosis of pulmona ry mycosis, and improve the knowledge about the diaease. Methods：45 cases of pulmonary mycosis were collected, which had complete clinical data,pathological features, laboratory examination, the images of routine CT, thin-section CT and MPR, were analyzed retrospectively. Results： The pathogenic fungi included ： candida albicans （n = 12 ）, aspergillus （n =14）, crypto- coccus （n = 8）, mucor （ n = 5 ）, actinomyces （n = 3） and penicillium marneffei （ n = 3）. CT features of pulmonary mycosis in cluded：cavities in 15 cases, with solitary cavity or multiple cavities in one or more lung lobes,accompanied with ＂halo sign＂ or ＂nest sign＂ ;pulmonary consolidation in 16 cases, with patchy shadows, air bronchogram sign and halo sign;nodules or masses in 8 cases, accompanied with cavities and ＂halo sign＂, speculation or lobulated sign; aspergilloma in 6 cases, with round or oval shapes and ＂air crescent signs＂. The manifestations of ＂halo sign＂, ground-glass opacity （GGO）, small nod- ule,net and line sign were better displayed on thin-section CT and MPR images than on routine CT images （P〈0.05） ,and there was no difference between other manifestations （P〈0.05）. Conclusion：Thin-section CT images and MPR images are helpful in the diagnosis of pulmonary mycosis. Since pulmonary mycosis has certain characteristics,its CT findings in combination with clinical history can improve the diagnostic accuracy rate of the disease.