侵袭型肺曲霉菌病CT影像变化初步研究

目的：探讨侵袭型肺曲霉菌病（IPA）的CT征象演变，提高对侵袭型肺曲霉菌病的认识和早期诊断。方法：回顾分析2，4例经皮肺部穿刺活检病理证实并且行一系列CT复查的侵袭型肺曲霉菌病的CT表现。结果：在IPA诊断第1天，“晕征”的出现率为82．5％；在中位天数3天、7天、14天，“晕征”出现率分别为68％、22％和19％，“新月形空气征”的出现率分别为8％、28％和63％，非特异性肺实变的出现率分别为31％、50％和18％。在IPA诊断后第1—7天（中位天数），病灶体积和数目逐渐增大；7-14天，病灶大小维持相对恒定，而病灶数目则呈下降趋势。结论：“晕征”是IPA早期征象。“新月形空气征”是IPA的晚期征象。“晕征”持续时间较短，对高度怀疑为IPA的患者，胸部CT扫描应及早进行，理想的CT扫描时间应在IPA发病5天以内，在早期积极抗真菌治疗的同时，应注意积极恢复骨髓造血功能。

Preliminary study on the evolution of imaging findings of invasive pulmonary aspergillosis on multiple slice CT

Objective：To investigate the evolution of imaging findings of invasive pulmonary aspergiUosis on multiple slices CT, and to improve its recognition and early diagnosis. Methods：The evolution of imaging findings on multiple slices CT in 24 patients with invasive pulmonary aspergillcsis confirmed by CT-guided percutaneous biopsy were retrospectively analyzed. Results： On the day of IPA diagnosis, a typical CT halo sign was observed in 20 of 24 patients. The halo sign was present in 68%, 22%, and 19% of eases on d 3, d 7, and d 14 respectively. Similarly, the air-crescent sign was seen in 8%, 28%, and 63% of cases on the same days. Otherwise, a nonspeeifie air-space consolidation aspect was seen in 31%, 50%, and 18% of cases on the same days. The analysis of calculated aspergillary volumes and numbers on CT showed that, despite antifungal treatment, the median volume and numbers of lesions increased from d 0 to d 7, whereas, the median volume remained stable and the numbers of lesions dropad from d 7 to d 14. Conclusion：The CT halo sign is an early indicator of IPA and the air-crescent sign is a later indicator of IPA. The duration of the CT halo sign is short, for the highly suspected patient with IPA, CT scan must be performed early in the course of the disease and probably in the first 5 days after the occurrence of the disease. The hematologic response must be actively improved at the same time of antifungal therapy.