成人纵隔肺门淋巴结结核的多层螺旋CT特点分析

目的:分析成人纵隔淋巴结结核的多层螺旋CT(MSCT)特点以提高诊断水平。方法:回顾性分析经临床病理证实的42例成人纵隔型淋巴结结核的MSCT表现并进行总结。结果:①部位:42例CT共见淋巴结肿大185个,淋巴结主要位于4R区、2R区,8例累及1个区淋巴结,34例累及2个以上区;②大小:短轴直径范围10～54 mm,加权平均(18±6)mm,长轴直径范围10～68 mm,加权平均(26±11)mm;③形态:37例进行病理对照的169个淋巴结中,122个(72.189%)未融合的淋巴结呈卵圆形或圆形,47个(27.811%)融合的淋巴结呈分叶状或不规则形;④边缘:122个(72.189%)未融合的淋巴结边缘光滑、清楚。47个(27.811%)淋巴结干酪样坏死,边缘欠清楚;⑤密度:145个(78.378%)淋巴结平扫密度基本均匀,CT值40～60 HU。40个(21.622%)淋巴结平扫密度不均匀,中央部分CT值16～37 HU,平均25.2 HU;32个淋巴结内或周边有斑点状钙化。⑥增强表现:169个淋巴结表现为7种强化形式。a.均匀强化(12个);b.不均匀强化、中心低强化有小的低密度区(22个);c.周边不规则厚壁强化、中心无强化(52个);d.周边薄环状强化、中心无强化(36个);e.周边不规则强化、中心无强化区延伸至淋巴结外(4个);.f周边不规则环状强化、中心分隔状强化(40个);g.无明显强化(3个);⑦肺内结核:8例(19.048%)肺内有结核病灶,其中6例为非活动性条索状影及钙化灶,2例为斑片状活动性结核。结论:MSCT对成人纵隔淋巴结结核具有重要诊断价值。

Characteristic analysis of MSCT in diagnosis of adult mediastinal lymph tuberculosis

Objective： To improve the diagnosis of adult mediastinal lymph tuberculosis by analysing the characteristics of multislice CT （MSCT）. Methods： MSCT findings of 42 cases of adult-type mediastinal lymph node tuberculosis clinicopathological confirmed were retrospectively analysed and summed up. Results： ①Site： 185 swollen lymph nodes were found in 42 cases by CT , mainly in 4R, 2R district, of which 1 lymph node area was involved in 8 cases, more than 2 lymph nodes area were involved in 34 cases; ②Size：Short-axis diameter range 10 ~ 54 mm with the weighted average of 18 ~ 6mm, long-axis diameter range 10 ~ 68 mm with the weighted average of 26 ~ 11mm; ③Morphology：Of the 169 lymph nodesin 37 cases pathological confirmed, 122 （72.189%） were round or oval without integration, 47 （27.811%） integrated manifesting lobulated or irregu lar; ④Edge： 122 （72.189%） lymph nodes without integration were smooth and well-margined. 47 （27. 811~/00） lymph node with cheese necrosis manifested an obscure boundary. ⑤Density： Plain density of 145 （78.378 % ） lymph nodes was found ho mogenous, with the CT value of 40 ~ 60 HU,while that of another 40 （21. 622~） lymph nodes were inhomogenous, the central CT value was 16 ~ 37 HU, with an average of 25.2 HU;⑥Enhanced findings： 7 kinds of enhancement were found in 169 lymph nodes, a. homogenous enhancement （12）; b.inhomogenous enchancement with small areas of low density in the center （22）; c.peripheral enhancement with irregular thick wall , while the center area was unenhanced （52） ; d.peripheral enhance ment with thin annular wall,while the center area was unenhanced （36）; e. irregular peripheral enhancement with the unen hanced central area extending to the outside of lymph nodes （4） ; f. irregular peripheral ring-like enhancement with the enhanced strip separating the center area（40） ; g. no significant enhancement （3） ;⑦Pulmonary tuberculosis：8 （19.048%） cases had pul monary tuberculosis, of which 6 had non-active cord-like lesions and calcified lesions, 2 had active tuberculosis patchy. Conclusion： MSCT is very valuable in diagnosis of adult mediastinal lymph node tuberculosis.