摘要
目的分析肺内多发空洞病变的CT影像表现，探讨其特点与鉴别要点。方法收集2012年1月至2015年12月期间CT影像表现为肺内多发空洞病变39例共计130个空洞，其中继发性肺结核17例，肺内多发转移癌13例，肺隐球菌病6例，肺脓肿3例；男25例，女14例，年龄16-73岁，中位年龄41岁。分析病灶内空洞的形态、密度及周围病灶影像特点。全部患者均行胸部CT平扫及增强扫描。计数资料采用χ^2检验，P〈0．05为差异有统计学意义。结果（1）空洞形态特点：肺结核空洞55个，以裂隙状及新月形多见，占69．1％（38／55）；洞壁厚薄不匀，内壁规则51个（92．7％，51／55），空洞外壁大部分清楚35个（63．6％，35／55），39个可见引流支气管影（70．9％，39／55），增强扫描洞壁多无明显强化；肺转移癌空洞44个，以厚壁（75．0％）多见，内壁不规则30个（68．2％，30／44），洞壁强化明显39个（88．6％，39／44）；肺隐球菌病空洞20个，多为厚壁（95．0％，19／20），内壁轻度不规整16个（80．0％，16／20），周围多伴有磨玻璃状片影；肺脓肿空洞11个，全部为厚壁，内壁规则10个（10／11），外壁模糊10个（10／11），伴有液平9个（9／11），全部出现周围渗出性阴影（11／11），洞壁强化明显（11／11）。肺结核与肺转移癌空洞内壁规则状况差异有统计学意义（χ^2=40．218，P=0．000）；肺结核与肺转移癌空洞洞壁强化程度差异有统计学意义（χ^2=76．517，P=0．000）。（2）伴随病变影像征象：肺结核空洞的伴随病变主要是微小结节及树芽征，分别占60．0％（33／55）和30．9％（17／55）；肺转移癌的多发空洞周围主要为斑片及磨玻璃状影，分别占2．3％（1／44）和31．8％（14／44）。肺结核与肺转移癌伴随空洞出现微小结节的比率两者差异有统计学意义（χ^2=39．600，P=0．000），出现实变斑片状影的比率两者差异无统计学意义（χ^2=1．274，P=0．259），出现磨玻璃状密度影的比率两者差异有统计学意义（χ^2=20．382，P=0.000），出现树芽征的比率两者差异有统计学意义（χ^2=16．420，P=0．000）。肺隐球菌病的空洞周围主要为磨玻璃状影（85．0％，17／20），而肺脓肿空洞周围主要为炎性浸润的片状阴影（1000,6，11／11），这两种征象与肺转移癌空洞组明显不同（χ^2值分别为15．571、49．271．P值均=0．000）。结论肺部空洞病变的内外壁状况、强化程度及周围伴随病变等CT表现具有一定特征性，进行综合分析，有助于对肺部多发性空洞性病变的诊断与鉴别。
Objective To analyzed CT imaging features of multiple cavity of lung and explore its characteristics and differential diagnosis. Methods Total 130 cavities in 39 cases including 17 cases with secondary pulmonary tuberculosis, 13 cases with multiple lung metastasis, 6 cases with pulmonary streptococcus disease, 3 cases with pulmonary abscess were collected during Jan. 2012 to Dec. 2015. There were 25 cases male and 14 cases female, median age 41 years old ranged from 16 to 73. The morphology, density and imaging features of peripheral lesions were analyzed. All patients were performed chest CT scan and enhanced scan. Enumeration data was tested by Chi square and P〈0. 05 was considered difference statistically. Results （1） The morphological characteristics of cavity ： tuberculous cavities were 55 and 38 cavities were fracture and crescent （69.1%）. Cavity wall uneven and inner wall regular were 51 （92.7%）. The outer of wall was clear in 35 cavities （63.6%）. Drainage bronchial shadow was seen in 39 cavities （70.9%）. Enhanced CT scan showed without apparent enhancement. Lung metastasis cavity were 44 with thick wall in 33 （75.0%）, inner wall irregular in 30 （68.2%） and cavity wall enhanced apparently in 39 （88.6%）. Pulmonary streptococcus cavity were 20 with thick wall in 19 （95.0%）, inner wall irregular slightly in 16 （80. 0%） surrounded by ground glass. Pulmonary abscess cavities were 11 with thick wall, enhanced apparently and surrounded exudative shadow in all cases, inner wall regular in 10 （10/11）, outer wall fuzzy in 10 （10/11）, and liquid level in 9 （9/11）. The differences of inner wall iregular and cavity wall enhancement in pulmonary tuberculosis and lung metastasis cavity were significant difference statistically （ χ^2=40.218,P=0.000 and χ^2=76.517, P=0.000）. （2） The imaging signs of concomitant lesions： the concomitant lesions of pulmonary tuberculosis cavity were mainly small nodules and tree bud sign accounting for 60. 0% （33/55） and 30. 9% （17/55）. Multiple metastasis cavities were surrounded by patch and ground glass accounting for 2.3% （1/44） and 31.8% （14/44）. The difference of cavity surrounded by small nodules, ground glass and tree-in-bud in pulmonary tuberculosis and lung metastasis cavity were significant difference statistically （χ^2= 39.600, P=0.000; χ^2 = 20.382, P=0.000, and χ^2=16.420, P=0.000）, however the patches surrounded were no difference （ χ^2= 1.274, P=0.259）. Pulmonary streptococcus cavities were surrounded by ground glass （85.0%, 17/20） and pulmonary abscess cavities were surrounded by patchy shadow of inflammatory infiltration （100%, 11/11）. They were significant difference compared with the sign surrounded by lung metastasis cavity （χ^2 were 15.571 and 49.271, P values were 0.000）. Conelus｜on Pulmonary cavities have characteristics in inner and outer wall, degree of enhancement and lesions surrounded. It can help to diagnose and differential diagnose when analyzed these features synthetically.
出处
《结核病与胸部肿瘤》
2016年第3期194-199,共6页
Tuberculosis and Thoracic Tumor
关键词
结核
肺/诊断
肺肿瘤
肺隐球菌病
空洞
X线计算机
体层摄影术
Pulmonary tuberculosis/diagnosis
Lung metastasis
Pulmonary cryptococcosis
Cavity
X-ray computed, tomography
