肺弥漫性粟粒样病变的CT鉴别特征

目的探讨粟粒性肺结核、弥漫性细支气管肺泡癌和粟粒性肺转移瘤的螺旋CT表现特征,提高肺弥漫性粟粒样病变的影像鉴别诊断水平。方法回顾性分析经临床证实的40例粟粒性肺结核、32例弥漫性细支气管肺泡癌、33例粟粒性肺转移瘤的螺旋CT图像资料,观察肺粟粒结节的形态、分布、大小、密度及伴随征象。结果 CT图像上,40例粟粒性肺结核中,结节均匀分布34例（85.0%）,大小一致35例（87.5%）,密度均匀33例（82.5%）,磨玻璃征31例（77.5%）;32例弥漫性细支气管肺泡癌中,中下肺分布27例（84.4%）,大小不一致23例（71.9%）,密度不均匀26例（81.3%）,支气管充气征13例（40.6%）;33例粟粒性肺转移瘤中,中下肺分布29例（87.9%）,大小不一致28例（84.8%）,密度不均匀29例（87.9%）,克氏线19例（57.6%）。结论粟粒性肺结核、弥漫性细支气管肺泡癌和粟粒性肺转移瘤在结节分布、大小、密度等方面螺旋CT表现特征明显不同,在诊断和鉴别诊断这三种疾病中具有重要价值。

CT features of diffuse miliary lung lesions

Objective To investigate spiral CT features of miliary tuberculosis,diffuse bronchiole alveolar carcinoma and miliary lung metastases,thus to improve imaging differential diagnosis of diffuse miliary lung lesions.Methods Spiral CT image data of 40 cases of clinically proven miliary tuberculosis,32 cases of diffuse bronchiole alveolar carcinoma and 33 cases of miliary pulmonary metastases were retrospectively analyzed for the morphology,distribution,size,density and concurrent signs of miliary nodules.Results Among 40 cases of miliary tuberculosis,CT images demonstrated uniformly distributed nodules in 34 patients(85.0%),nodules of the same size in 35 cases(87.5%),nodules of the same density in 33 cases(82.5%) and ground-glass sign in 31 cases(77.5%);among the 32 cases of diffuse bronchiole alveolar carcinoma,CT images demonstrated lower lung distribution in 27 cases(84.4%),size of inconsistencies in 23 cases(71.9%),uneven density in 26 cases(81.3%),and air bronchogram in 13 cases(40.6%);among the 33 cases of miliary pulmonary metastases,CT images demonstrated lower lung distribution in 29 cases(87.9%),size of inconsistencies in 28 cases(84.8%),uneven density in 29 cases(87.9%) and gram’s line in 19 cases(57.6%).Conclusion Miliary tuberculosis,diffuse bronchiole alveolar carcinoma and lung metastases show significantly different miliary nodules distribution,size and density features in spiral CT images,which is important for the differential diagnosis of the three diseases.