粟粒型肺结核与尘肺的螺旋CT鉴别特征

目的探讨粟粒型肺结核与尘肺的螺旋CT表现特征,提高肺部粟粒性病变的影像鉴别诊断水平。方法收集经临床证实的43例粟粒型肺结核和28例尘肺的螺旋CT资料,观察肺粟粒结节的分布、大小,肺内有无毛玻璃征,肺门、纵隔淋巴结增大和钙化,以及肺内并发病灶。结果CT图像上,43例粟粒型肺结核中,结节均匀分布34例（79%）,大小一致31例（72%）,密度均匀31例（72%）以及毛玻璃征32例（74%）。28例尘肺中,粟粒结节均匀分布4例（14%）,大小一致12例（43%）,密度不均匀25例（89%）,毛玻璃征2例（7%）。两者在结节分布、大小、密度均匀性和伴毛玻璃征方面均有统计学差异（P〈0.05）。13例（13/43,30%）结核的肺门和（或）纵隔淋巴结增大;而尘肺有20例（20/28,71%）,其中10例伴钙化;结核性胸腔积液16例（16/43,37%）,尘肺4例（4/28,14%）;胸膜增厚中,尘肺9例（9/28,32%）,肺气肿9例（9/28,32%）。结论粟粒型肺结核与尘肺粟粒结节的分布、大小、均匀度以及密度等CT表现明显不同,这些特征与疾病的病理解剖改变有关。

Differentiation Between Miliary Tuberculosis and Pneumoconiosis by on Hefical CT

Objective:To evaluate the helical CT features of miliary tuberculosis and pneumoconiosis so that improving the correct diagnosis of the miliary lung diseases.Methods:We retrospectively reviewed the helical CT or high-resolution CT features(distribution and size of miliary nodule and attenuation of the lung)of 43 patients with miliary tuberculosis and 28 patients with pneumoconiosis.Results:The uniformly distribution and size of the bilateral lung were observed in 34(34/43,79%)and 31(31/43,72%)cases with miliary tuberculosis and 4(4/28,14%)and 12(12/28,43%)cases with pneumoconiosis(P<0.05).Miliary tuberculosis showed homogeneous nodules in 31(31/43,72%)and ground glass opacity(GGO)in 32(32/43,74%),whereas pneumoconiosis showed heterogeneous nodules in 25(25/28,89%)and GGO in 2(2/28,7%)(P<0.01).There were enlarged lymph nodes of hilar and mediastinum,pleural effusion in 13(30%),16(37%)cases with tuberculosis,respectively, but in 20(71%)and 4(14%)cases with pneumoconiosis,respectively.Otherwise,there were thickened pleura in 9(32%)and emphysema in 9(32%)cases with pneumoconiosis,respectively.Conclusion:Miliary tuberculosis and pneumoconiosis with miliary nodules had the different characteristics of distribution,size and density of the miliary nodules on CT,that were corresponded to their occupations and pathologic findings.