MSCT对成人纵隔肺门淋巴结结核细节征象的研究

发布时间：2018-06-23 01:02

本文选题：成人 + 纵隔肺门淋巴结肿大　；参考：《广州医科大学》2017年硕士论文

【摘要】：背景成人纵隔肺门淋巴结肿大可见于淋巴结结核、淋巴结转移癌、淋巴瘤、结节病、巨淋巴细胞增生症及非特异性淋巴结炎等多种不同性质疾病,是以上几种疾病所伴随的一种影像学征象。虽然疾病的性质不同,但淋巴结肿大的影像学形态表达方式大体相同、比较抽象、缺乏特征和特点,临床上对不同类型纵隔疾病的影像学定性及鉴别诊断较为困难。因此,充分认识成人纵隔肺门淋巴结核引起的淋巴结肿大的影像学细节征象及特点,对疾病的诊断、鉴别诊断及及时治疗至关重要。目的通过研究分析成人纵隔肺门淋巴结结核的多层螺旋CT(MSCT)细节征象,同时以淋巴结转移癌及纵隔淋巴瘤作对照研究分析,提高对成人纵隔肺门淋巴结结核的认识及鉴别度,为临床诊断及治疗提供重要帮助。材料与方法收集我院(广州市胸科医院)自2011年1月1日到2016年7月30日确诊的成人纵隔肺门淋巴结结核患者104例(作为研究组;共544个成人纵隔淋巴结结核病灶的MSCT平扫及增强扫描细节征象)。其中成人纵隔肺门淋巴结结核病灶经规则抗结核治疗随访大于和或等于1年、以淋巴结结核病灶显著缩小(大于和或等于1/2)或钙化为最后诊断、经取痰组织细胞学培养阳性诊断、经颈部或腋下淋巴结穿刺活检病理诊断、经纤维支气管镜取病变组织病理诊断或经手术活组织病理诊断。并与广州市胸科医院同时期确诊的52例淋巴结转移癌患者(作为对照组1;共250个淋巴结转移癌病灶的MSCT平扫及增强扫描细节征象)及21例纵隔淋巴瘤(作为对照组2)进行对比研究分析。通过对研究组与对照组患者MSCT平扫及增强薄层扫描细节特点的对比研究,分析成人纵隔淋巴结结核的MSCT细节征象特征。对成人纵隔肺门淋巴结结核病灶(研究组104例共544个)的细节征象评价因素包括:病灶的大小、发生的部位、边缘、形态、密度变化、融合情况、钙化灶情况、强化程度与方式、周围脂肪间隙情况以及病灶与周围血管、气管支气管关系等;将成人纵隔肺门淋巴结结核与淋巴结转移癌、纵隔淋巴瘤各征象进行对比研究分析。因为是两个独立样本,组间比较采用两个独立样本频率的χ2检验、Fisher's确切概率法或χ2检验的连续性校正。对成人纵隔肺门淋巴结结核病灶(研究组:104例共544个)与淋巴结转移癌(对照组1:52例共250个)及21例纵隔淋巴瘤(对照组2)的细节征象两两对比评价因素包括:病灶的大小、发生部位、边缘、形态、密度变化、融合情况、钙化灶情况、强化程度与方式、周围脂肪间隙情况以及病灶与周围血管、气管支气管关系等。结果1、成人纵隔肺门淋巴结结核病灶发生部位主要分布为:排在前五位的分别是,4R区86例共105个,7区56例共79个,2R区66例共78个,10R区43例共56个,10L区34例共38个。其中纵隔肺门淋巴结结核病灶局限于1个区域的仅3例,其余均为多个区域淋巴结发生结核病灶。2、成人纵隔肺门淋巴结结核病灶MSCT平扫细节征象:病灶大小1-4cm共101例521个(95.8%),4cm共5例23个(4.2%),36例107个(31.2%)病灶合并钙化;79例316个(58.1%)病灶不融合,38例228个(41.9%)病灶融合;32例174个(40.0%)病灶平扫密度均匀,81例370个(60.0%)病灶平扫密度不均匀,与对照组1及对照组2对比,均为P0.05,有统计学意义;其中研究组(纵隔肺门淋巴结结核组)高于对照组(淋巴结转移癌组、淋巴瘤组)的是:1-4cm的病灶,钙化灶,病灶的不融合和密度的不均匀。3、成人纵隔肺门淋巴结结核病灶MSCT增强扫描细节征象:22例94个(17.2%)病灶明显均匀强化,与淋巴结转移癌组对比,χ2=10.380,P0.05,有显著统计学意义,与淋巴瘤组对比,χ2=0.515,P0.05,无统计学意义;32例101个(18.6%)病灶轻中度强化,与淋巴结转移癌组对比χ2=1.926,P0.05,无统计学意义,与淋巴瘤组对比χ2=18.462,P0.05,有显著统计学意义;37例108个(19.8%)病灶边缘薄壁环形强化,与淋巴结转移癌组对比χ2=5.191,P0.05,有显著统计学意义,与淋巴瘤组对比χ2=6.396,P0.05,有显著统计学意义;6例20个(3.7%)病灶边缘厚壁环形强化,与淋巴结转移癌组对比χ2=33.591,P0.05,有显著统计学意义,与淋巴瘤组对比χ2=4.186,P0.05,无统计学意义;29例72个(13.2%)病灶环形细小分隔样强化,与淋巴结转移癌组对比χ2=9.190,P0.05,有显著统计学意义,与淋巴瘤组对比χ2=7.625,P0.05,有显著统计学意义;33例94个(17.2%)病灶多环重叠性强化,与淋巴结转移癌组对比χ2=6.319,P0.05,有显著统计学意义,与淋巴瘤组对比χ2=4.274,P0.05,有显著统计学意义;6例18个(3.3%)病边缘结节样强化,与淋巴结转移癌组对比χ2=9.506,P0.05,有显著统计学意义,与淋巴瘤组对比χ2=0.034,P0.05,无统计学意义;6例22个(4.0%)病灶无明显强化,与淋巴结转移癌组对比χ2=3.230,P0.05,无统计学意义;与淋巴瘤组对比χ2=1.273,P0.05,无统计学意义。淋巴结结核组高于淋巴结转移癌组的强化特点是:边缘薄壁环形强化、环形细小分隔样强化、多环重叠性强化(PO.05);结核组高于淋巴瘤组的强化特点是:边缘薄壁环形强化,环形细小分隔样强化(PO.05)结论1、成人纵隔肺门淋巴结结核有主要的好发部位,主要以4R区、2R区和7区、10R和10L区为主;2、在研究组(成人纵隔肺门淋巴结结核)与对照组1、2(对照组1:淋巴结转移癌;对照组2:纵隔淋巴瘤)对比研究中发现:成人纵隔肺门淋巴结结核的钙化灶情况、病灶的不融合及病灶密度的不均匀情况均明显高于淋巴结转移癌及纵隔淋巴瘤。3、成人纵隔肺门淋巴结结核以多种不同形态强化为主要特点:可呈不均匀强化、边缘薄壁环形强化、环形细小分隔样强化、多环融合性强化边缘呈微结节样强化并存中心低密度区、无明显强化、邻近血管被包绕;其中研究组(成人纵隔肺门淋巴结结核)出现率高于对照组1(淋巴结转移癌)的强化特点是:病灶不均匀强化、边缘薄壁环形强化、环形细小分隔样强化和多环融合性强化(P0.05);研究组(成人纵隔肺门淋巴结结核)出现率高于对照组2(纵隔淋巴瘤)的强化特点是:边缘薄壁环形强化和环形细小分隔样强化(P0.05)。4、成人纵隔肺门淋巴结结核具有自限性,病灶短径一般4cm,区别于淋巴结转移癌与淋巴瘤的肿瘤性生长方式,病变短径多大于4cm。5、MSCT扫描具有较高的形态及密度分辨率,易于对纵隔肺门淋巴结结核的检出,对各种原因所致纵隔肺门淋巴结肿大的诊断、鉴别具有重要意义。
[Abstract]:Background the enlargement of the hilar lymph nodes in the mediastinum of the adult can be seen in many different diseases, such as nodule tuberculosis, lymph node metastasis, lymphoma, sarcoidosis, giant lymphocytic hyperplasia and nonspecific lymphadenitis. It is an imaging sign associated with the above diseases. Although the nature of the disease is different, the imaging form of lymph nodes is enlarged. State expression is generally the same, abstract, lack of characteristics and characteristics. It is difficult to identify and differentiate the imaging of different types of mediastinal diseases. Therefore, we fully understand the imaging details and characteristics of the lymphadenopathy caused by the mediastinal pulmonary hilar tuberculosis, and the diagnosis, differential diagnosis and timely treatment of the disease. Objective to study and analyze the details of the multi-slice spiral CT (MSCT) of adult mediastinal pulmonary hilar nodules, and to study and analyze the lymph node metastasis and mediastinal lymphoma, and to improve the recognition and differentiation of the adult mediastinal pulmonary hilar nodule tuberculosis, and provide important help for the diagnosis and treatment of the clinic. 104 cases of adult mediastinal pulmonary hilar nodules confirmed by our hospital (Guangzhou Chest Hospital) from January 1, 2011 to July 30, 2016 (as a study group; a total of 544 adult mediastinal tuberculous lesions of the mediastinal lymph nodes, MSCT scan and enhanced scan details). Among them, adult mediastinal pulmonary hilar lymph nodes were followed up by regular anti tuberculosis treatment. More than and equal to 1 years, the nodule lesion of the lymph nodes was significantly reduced (greater than and or equal to 1/2) or calcification as the final diagnosis. The positive diagnosis of sputum tissue cytology was diagnosed by biopsy of the phlegm tissue. The pathological diagnosis of the cervical or axillary lymph node biopsy, the pathological diagnosis of the pathological tissue by the fiberoptic bronchoscopy, and the pathological diagnosis of the surgical tissue through the operation, and Guangzhou city. 52 cases of lymph node metastases diagnosed at the same time in the thoracic hospital (as control group 1, MSCT plain and enhanced scan details in 250 lymph node metastases) and 21 cases of mediastinal lymphoma (as control group 2) were compared and analyzed. The details of MSCT plain scan and enhanced thin layer scan in the study group and the control group were observed. The characteristics of MSCT details in adult mediastinal lymph node tuberculosis were analyzed. The evaluation factors of the details of the adult mediastinal pulmonary hilar nodule tuberculosis (544 of the 104 cases) included the size, location, edge, morphology, density, fusion, calcification, enhancement and manner, and the surrounding fat. The gap and the relationship between the lesion and the surrounding vessels, tracheobronchial relationship, and so on; compare and analyze the signs of the adult mediastinal lymph node tuberculosis with lymph node metastasis and mediastinal lymphoma. It is two independent samples, and the two independent sample frequencies are compared with the chi 2 test, the exact probability method or the continuity of the chi 2 test. Correction. For adult mediastinal pulmonary hilar nodules (544) and 104 cases of lymph node metastasis (250 in the control group, 250 in the control group) and 21 cases of mediastinal lymphoma (control group 2), the 22 evaluation factors included the size, location, edge, morphology, density, fusion, calcification, calcification, calcification, enhancement, and enhancement. Degree and mode, the surrounding fat space and the relationship between the focus and the surrounding vessels, tracheobronchial and so on. Results 1, the main distribution of tuberculosis foci in the adult mediastinal pulmonary hilar lymph nodes was the first five, 86 cases in 4R area, 79 in 56 cases in 7 areas, 78 in 66 cases in the area of 10R, 43 in region of 2R and 34 in District 10L. The tuberculous foci of the pulmonary portal lymph nodes were limited to 1 regions in only 3 cases, and the rest were.2 in multiple regional lymph nodes, and MSCT scan details in adult mediastinal pulmonary hilar nodules: 101 cases, 521 (95.8%) of the lesion size 1-4cm, 23 (4.2%) in 5 cases of 4cm, 107 (31.2%) with calcification in 107 (31.2%), 79 (58.1%) lesions. No fusion, 228 (41.9%) lesion fusion in 38 cases, 32 cases with 174 (40%) uniform scan density, 81 cases with 370 (60%) unevenly scanning density, compared with the control group 1 and the control group 2, all were P0.05, and the study group (mediastinal pulmonary hilar nodule group) was higher than the control group (lymph node metastasis and Lymphoma Group): 1-4cm lesions, calcification, non fusion and uneven density of.3, and MSCT enhanced scan details of the adult mediastinal pulmonary hilar nodules: 22 cases (17.2%) were obviously enhanced, compared with the lymph node metastasis group, X 2=10.380, P0.05, statistically significant, and compared with the Lymphoma Group, Chi 2=0.515, P0.05, no statistics. Study significance; 32 cases (18.6%) of 101 (18.6%) light and moderate enhancement, compared with lymph node metastatic carcinoma group, X 2=1.926, P0.05, no statistical significance, compared with the Lymphoma Group, X 2=18.462, P0.05, and significant statistical significance; 37 cases 108 (19.8%) edge thin-walled circular enhancement, and lymph node metastatic carcinoma group compared with 2=5.191, P0.05, significant statistical significance. Compared with the Lymphoma Group, the X 2=6.396 and P0.05 were statistically significant. 6 cases (3.7%) had a thick circumferential enhancement on the edge of the lesion, and compared with the lymph node metastasis group, X 2=33.591, P0.05, with significant statistical significance, compared with the Lymphoma Group, 2=4.186, P0.05, and no statistically significant sense; 29 cases were 72 (13.2%) foci of ring-shaped fine separation, and lymph nodes. The metastatic carcinoma group compared with the X 2=9.190, P0.05, significant statistical significance, compared with the Lymphoma Group x 2=7.625, P0.05, there were significant statistical significance; 33 cases 94 (17.2%) polycyclic overlapping enhancement, and lymph node metastatic carcinoma group compared with 2=6.319, P0.05, significant statistical meaning, and lymphoma group compared with 2=4.274, P0.05, significant statistical significance. 6 cases of 18 (3.3%) patients with marginal nodular enhancement, compared with the lymph node metastasis group, X 2=9.506, P0.05, had significant statistical significance, compared with the Lymphoma Group x 2=0.034, P0.05, no statistical significance, 6 cases 22 (4%) no significant enhancement, and lymph node metastatic carcinoma group to X 2=3.230, P0.05, no statistical significance; and lymphoma group compared Chi 2=1.273 P0.05, no statistical significance. The enhancement characteristic of the lymph node tuberculosis group is higher than that of the lymph node metastasis group: marginal thin-walled ring strengthening, circular fine separation enhancement and multi ring overlapping enhancement (PO.05). The enhancement characteristic of the tuberculosis group is higher than the Lymphoma Group: the marginal thin-walled ring strengthening, the circular fine separation enhancement (PO.05) conclusion 1, the adult mediastinum. The main location of tuberculosis of the hilar lymph node was mainly 4R, 2R and 7, 10R and 10L. 2, in the study group (adult mediastinal pulmonary hilar nodule tuberculosis) and the control group 1,2 (control group 1: lymph node metastasis cancer; control group 2: mediastinal lymphoma) contrast study: calcification focus of adult mediastinal pulmonary hilar nodules, focus of focus. Nonuniformity of non fusion and lesion density were significantly higher than that of lymph node metastases and mediastinal lymphoma.3. Adult mediastinal pulmonary hilar nodule tuberculosis was characterized by a variety of different morphologic intensification: inhomogeneous enhancement, marginal thin-walled ring enhancement, annular fine separation enhancement, and polycyclic fortified edges with micro nodular enhancement. In the central low density area, there was no obvious enhancement and adjacent vessels were wrapped around, and the rate of the study group (adult mediastinal pulmonary hilar nodule tuberculosis) was higher than that of the control group of 1 (lymph node metastasis), which was characterized by uneven intensification of the lesions, marginal thin-walled ring enhancement, annular fine separation enhancement and polycyclic fusion (P0.05); the study group (adult longitudinal) The occurrence rate of pulmonary portal lymph node tuberculosis was higher than that of the control group of 2 (mediastinal lymphoma), which was characterized by marginal thin-walled ring strengthening and annular fine separation enhancement (P0.05).4. The adult mediastinal pulmonary hilar lymph node tuberculosis was self limited, the short diameter of the lesion was generally 4cm, and the tumor growth pattern of lymph node metastasis and lymphoma was different from that of lymphomas, and the short diameter of the lesion was different. More than 4cm.5, MSCT scanning has high morphological and density resolution, and it is easy to detect tuberculosis of the mediastinal hilar lymph nodes. It is of great significance for the diagnosis of the mediastinal lymph node enlargement caused by various causes.
【学位授予单位】：广州医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R52;R816.41

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