摘要
目的探讨成人胸内淋巴结结核的多层CT(MSCT)表现,及与病理、临床的关系。资料与方法回顾性分析42例成人胸内淋巴结结核的MSCT表现,包括淋巴结的部位、数量、形态、边缘、平扫密度及增强表现,并与病理(n=37)、临床表现进行对照。结果185个淋巴结主要位于4R区、2R区、7区和10R区,8例累及1个区淋巴结,34例累及2个以上区淋巴结。145个淋巴结平扫密度基本均匀,40个不均匀。37例进行病理对照的169个淋巴结中,122个未融合者呈卵圆形或圆形,边缘清楚;47个融合者呈分叶状或不规则形,边缘欠清楚或模糊。共有7种强化形式:12个淋巴结均匀强化无中心低密度区,病理上呈结核性增生,无干酪样坏死及临床表现;22个不均匀强化中心有小的低密度区,结核性肉芽肿多,中心小量干酪样坏死,轻度临床表现;52个周边不规则厚壁强化中心无强化,结核性肉芽肿构成强化厚壁,中心干酪样坏死,轻度临床表现;36个周边薄环状强化中心无强化,强化环为小量结核性肉芽肿,中心大量干酪样坏死,中度临床表现;4个周边不规则强化中心无强化区延伸至淋巴结外,干酪样坏死物质破溃到淋巴结包膜外,重度临床表现;40个周边不规则环状强化中心分隔状强化,多个含有干酪样坏死的淋巴结融合,结核性肉芽肿构成强化环及分隔,重度临床表现;3个无明显强化,基本上为干酪样坏死,重度临床表现。11例显示为单一强化形式,26例为2～4种强化形式。结论成人胸内淋巴结结核的MSCT表现主要为多区淋巴结受累,呈卵圆形或圆形,边缘清楚,平扫密度基本均匀,周边不规则厚壁强化中心无强化、周边不规则环状强化中心分隔状强化、周边薄环状强化中心无强化等多种强化形式。MSCT表现能够反映其病理改变,并且与临床表现密切相关。
Objective To investigate muhislice CT （MSCT） appearances of intrathoracic tuberculous lymphadenitis in adults, and the correlation with pathologic and clinical findings. Materials and Methods MSCT images of 42 consecutive adult patients with intratboracic tuberculous lympbadenitis were analyzed retrospectively. The MSCT appearances including location, number, shape, margin, density on precontrast and postcontrast images were analyzed and compared with pathologic （n = 37 ） and clinical findings. Results One hundred and eighty-five intrathoracic tuberculous lymphadenitis distributed mainly in regions of 4R,2R,7 and 10R. Among them, intratboracic tuberculous lymphadenitis involved 1 region in 8 patients,more than 2 regions in 42 patients. On precoutrast images, density of lymph nodes showed homogenous and heteromogenous in 145 nodes and 40 nodes. Among 169 lymph nodes correlated with pathologic findings in 37 patients, 122 nodes without fused had oval or round shape with clear margin ,47 fused nodes had lobulated or irregular shape with unclear or hazy margin. Seven enhancement patterns were demonstrated ： （ 1 ） homogeneous enhancement pattern （ n = 12）. The corresponding pathologic findings were tuberculous hyperplasia without caseous necrosis. These patients had silent clinical symptom;（2） heterogeneous enhancement pattern. MSCT showed small no enhancement area in center （n = 20） and the correspording pathologic findings were tuberculous granuloma with small amounts of caseous necrosis in center. These patients had mild clinical symptom ; （ 3 ） peripheral irregular thick wall enhancement with central no enhancement area （ n =52 ）, the wall was composed of tuberculous granuloma with some caseous necrosis in center. The patients had mild clinical findings ; （4） peripheral thin rim enhancement with central no enhancement area （ n = 36 ）, the rim was composed of a little tuberculous granuloma with a great quantity of caseous necrosis in center. The patients had moderate clinical findings; （5） peripheral irregular enhancement with central no enhancement area which extended out of the nodes （ n = 4）. Caseous necrosis ruptured from capsule. The patients had severe clinical findings ; （ 6 ） peripheral irregular rim enhancement with central separate enhancement （n = 40 ）. Multiple lymph nodes with caseous necrosis were confluented. The rim and separation were formed by tuberculous granuloma. Tha patients had severe clinical findings ; （7） No obvious enhancement （ n = 3 ）, The lymph nodes were basically caseous necrosis with little tuberculous granuloma. The clinical findings were severe . Single en- hancement pattern was showed in 11 patients, 24 patterns in 26 patients. Conclusion Main appearances of tuberculous lymphadenitis in adults on MSCT showeded as multiregional lymph nodes with oval or round shape and clear margin, basi- cally homogenous density on precontrast scan, multiple enhancement patterns. MSCT findings could reveal its pathological changes, and correlate closely with clinical findings.
出处
《临床放射学杂志》
CSCD
北大核心
2009年第3期338-342,共5页
Journal of Clinical Radiology
关键词
肺门
纵隔
结核
淋巴结
体层摄影术
X线计算机
Hilum of lung Mediastinum Tuberculosis,lymph node Tomography,X-ray computed
