肺结核与周围型肺癌空洞的CT鉴别诊断

目的探讨肺结核与周围型肺癌空洞的CT表现，评价CT对其鉴别诊断的价值。方法搜集经手术病理或临床追踪证实的肺结核空洞32例和周围型肺癌空洞46例，78例均作螺旋CT平扫及增强扫描。回顾性分析其CT表现。结果肺结核空洞常位于上叶尖后段，以薄壁相对多见，洞壁厚薄较均匀，周围常有卫星灶，纵膈肿大的淋巴结增强扫描呈环形强化以肺结核最常见。而癌性空洞一般为位于上叶前段，厚壁，内缘凹凸不平，有壁结节，分叶及胸膜凹陷征多见，纵膈肿大淋巴结平扫有中心坏死。结论空洞的部位，空洞壁的厚薄及其是否有壁结节，周围有无卫星灶、空洞外缘分叶的深浅、空洞壁CT强化的幅度、胸膜凹陷征及纵膈淋巴结情况是其鉴别的要点。

CT in the Differential Diagnosis of Pulmonary Tuberculosis and Cavities of Peripheral Lung Cancer

Objective To examine the CT appearances of both pulmonary tuberculosis and cavities of peripheral lung cancer, and to assess the CT value in the differential diagnosis of both of them. Methods Seventy-eight patients, comprising 32 cases of pulmonary tuberculosis and 46 cavities of peripheral lung cancer all confirmed by surgery, pathology, and clinical follow-up, were collected for undergoing plain scan and enhancement scanning of spiral CT, and all CT appearances were retrospectively analyzed. Results Pulmonary tuberculosis cavities were frequently localized in apicoposterior segment of lobus superior pulmonis, in which thin wall was seen relatively and commonly, cavity wall was uniform in thickness in the presence of surrounding satellite lesions. And the enhancement scanning of intumescent mediastinal lymph node associated with pulmonary tuberculosis presented with circular enhancement was most frequently seen. And whereas carcinomatous cavity was usually situated in anterior segment of lobus superior pulmonis, with thick wall, uneven inner margin, wall nodule, and sublobe and pleural indentation commonly seen, and also plain scan of intumescent mediastinal lymph node revealed a central necrosis. Conclusion The differentiating highlights of both two cavities involve the cavity location, wall in thickness, whether in the presence of wall nodules and surrounding satellite lesions or not, sublobe shade of exterior margin in cavity, CT enhancement argument on cavity wall, pleural indentation sign, and mediastinal lymph node, as well as mediastinal lymph node status.