血行播散型与非血行播散型结核累及腹部淋巴结的CT强化表现及其解剖、病理基础

目的观察血行播散型与非血行播散型结核累及腹部淋巴结的CT强化特征及其优势解剖分布.方法回顾性观察46例腹部淋巴结结核(其中血行播散型13例、非血行播散型33例)的CT强化表现(病灶大小、形态、强化类型)及其解剖分布.血行播散型结核合并有肺部粟粒型肺结核.结果血行播散型与非血行播散型结核常优势地累及网膜、肠系膜、胰周及腹主动脉周围上部淋巴结,但腹主动脉周围下部淋巴结受累常见于血行播散型结核(69.2%),而少见于非血行播散型结核(6.1%,P＜0.01).血行播散型与非血行播散型结核淋巴结CT强化特征无差别,97%病例淋巴结增大呈周边强化,常伴"多房样"征象.结合上述CT征象,诊断腹部淋巴结结核的正确率90%,敏感度93%,特异度89%.全部血行播散型病例肝脏、脾脏增大,肝脏多数呈均匀密度,而脾脏有散在低密度灶,46%血行播散型病例肾脏有低密度灶.结论血行播散型与非血行播散型结核累及腹部淋巴结及淋巴结外器官存在一定的优势解剖分布,这与淋巴结结核的感染途径存在一定相关性.

Disseminated versus non-disseminated tuberculosis involving abdominal lymph nodes: evaluation with contrast enhanced CT

Objective To clarify the anatomic distribution and CT manifestation of disseminated tuberculosis (DTB) and non-disseminated tuberculosis (NDTB) involving abdominal lymph nodes so as to improve the imaging diagnosis. Methods Contrast-enhanced CT findings of 46 patients with documented abdominal tuberculous lymphadenitis, involved by DTB (n=13) and NDTB (n=33), were retrospectively evaluated in a blind review for the enhancement criteria of location, morphology and density of the foci. DTB had miliary pulmonary tuberculosis. Results Both DTB and NDTB involved dominantly omentum , mesenteric, peripancreatic and upper paraaortic lymph nodes, but lower paraaortic lymph nodes were involved more often in DTB (69.2%) than in NDTB (6.1%) (P<0.01). The enhancement pattern of lymphadenopathy of DTB was not different from that of NDTB. 97% patients had peripheral rim enhancement, frequently with a multilocular appearance. Combining all criteria, the diagnostic accuracy of abdominal tuberculosis is 90%, with specificity of 89% and sensitivity of 93%. 100% patients of DTB had homogeneous hepatomegaly and inhomogeneous splenomegaly with multiple low densities, 46 % patients of DTB had inhomogeneous kidney with multiple low densities. Conclusion Anatomic distribution of DTB is different from that of NDTB in lower retroperitoneal lymph nodes, spleen, liver and kidney, which was closely related to the infection routes of abdominal TB.