活动性肺结核的影像诊断价值探讨

    查期1，张宏1，方筠1，续晋铭2

    1.上海国际旅行卫生保健中心，上海 200335；2.上海杨浦中心医院

   摘要：目的分析活动性肺结核的影像学特征及鉴别诊断方法，提高其影像诊断水平。方法回顾性分析63例经确诊的活动性肺结核的胸部X线平片及CT影像资料，并作对照分析。结果X线胸片及胸部CT提示活动性肺结核好发部位为两肺上叶尖后段、下叶背段(47例)；病灶多呈不规则斑片状影（34例），边界不清，密度不均；X线胸片22例可见病灶内钙化，呈散在斑片状或宽点状，而CT显示为36例；X线胸片9例存在薄壁或厚壁空洞，CT可见19例；X线胸片显示病灶周围有支气管播散灶者6例，CT可见14例；CT显示肺门或（和）纵隔淋巴结增大15例，淋巴结钙化19例，而X线胸片只分别显示9例和12例；CT显示胸腔积液16例，胸膜增厚、粘连或钙化27例，而X线胸片只分别显示8例和18例。结论胸部X线检查是评价肺结核的主要和常用方法，CT在发现细小、隐匿病灶，鉴别可疑病灶，确定病灶是否活动方面有着不可替代的重要作用，可明显提高诊断准确率。

    关键词：肺结核；活动性；X线胸片；CT

    中图分类号：R521　文献标识码：B

    Value of imaging diagnosis of active pulmonarytuberculosis

    ZHA Qi*， ZHANG Hong， FANG Yun， XU Jin-ming

    *Shanghai International Travel Healthcare Center,Shanghai 200335, China

    Abstract:   Objective   To investigate theradiological features and differentiation of active pulmonarytuberculosis.  Methods   A total of 63 patients withactive pulmonary tuberculosis were retrospectively analyzed andcompared by using X-ray chest films and CT scan.  Results  X-ray and CT examination results showed the predominantlocation of pulmonary TB were the apicoposterior segment of bothupper lobes and the dorsal segment of inferior lobes(47 cases).Heterogeneous，irregular and illegible patchy lesion in mostcases（34 cases）. X-ray chest films showed mottling or patchycalcification inside the lesion in 22 cases while CT showed 36cases. Chest films found thin or thick wall cavities in 9 caseswhile CT showed 19 cases. 6 cases of bronchogenic spread lesionfound in chest films while 14 cases found in CT. CT showed hilarand /or mediastinal lymphadenopathy in 15 cases and calcificationof the lymph nodes in 19 cases while X-ray chest films only found 9and 12 cases. 16 cases of hydrothorax and 27 cases of pleuralthickening，adhesion and calcification showed in CT while X-raychest films only found 8 and 18 cases． Conclusion   Chestradiography is the mainstay in the evaluation of pulmonary TB．CT isgenerally useful to detect fine lesions overlooked on chestradiographs，to determine equivocal lesions，to evaluatecomplications or to determine the activity of pulmonary TB, and itcan improve the diagnostic accuracy of active pulmonarytuberculosis．

    Key words:   Pulmonarytuberculosis；Activity；X-ray chest films；Computed Tomography

    《中国国境卫生检疫杂志》2013年10月刊