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目的运用多层螺旋CT扫描技术,探讨结核与尘肺累及纵隔淋巴结的优势解剖分布及强化特点的差异。方法对经临床及病理证实的33例结核和40例尘肺的受累纵隔淋巴结在多层螺旋CT(MSCT)上的形态学特征、强化类型及解剖分布特点进行回顾性分析。结果 25例(75.8%)结核的增大淋巴结呈环状强化,其中10例(30.3%)表现为“多房样”征象。38例(95.0%)尘肺的增大淋巴结呈均匀一致强化。纵隔淋巴结结核常优势地累及4R(75.8%)、5(57.6%)、7(81.8%)以及10R(60.6%)等区域;尘肺则优势地累及2R(52.5%)、3(67.5%)、4R(97.5%)、5(77.5%)、7(97.5%)、10R(97.5%)以及10L(95%)等纵隔淋巴结分布区域。相对而言,尘肺较结核更多地累及3、4L、8、10R、10L区域的淋巴结(P<0.05)。结论依据纵隔淋巴结的解剖分布及强化特点,MSCT增强扫描对结核与尘肺的鉴别有较高的诊断价值。
Objective To explore the advantages of anatomical distribution and enhancement characteristics of tuberculosis and pneumoconiosis involving mediastinal lymph nodes by using multi-slice spiral CT scan. Methods The morphological features, enhancement types and anatomical distribution of 33 cases of tuberculosis and 40 cases of pneumoconiosis involving mediastinum lymph node confirmed by clinic and pathology were retrospectively analyzed by multi-slice spiral CT (MSCT). Results The enlarged lymph nodes of 25 cases (75.8%) of tuberculosis showed ring enhancement, of which 10 cases (30.3%) showed “multi-room” signs. Thirty-eight cases (95.0%) of pneumoconiosis increased lymph nodes were uniformly enhanced. Mediastinal lymphadenopathy often predominantly affects 4R (75.8%), 5 (57.6%), 7 (81.8%) and 10R (60.6%) and other areas; pneumoconiosis predominantly affects 2R (52.5%) and 3 (67.5% 4R (97.5%), 5 (77.5%), 7 (97.5%), 10R (97.5%) and 10L (95%). In contrast, pneumoconiosis involved more lymph nodes in the 3,4L, 8,10R, and 10L regions than tuberculosis (P <0.05). Conclusion According to the anatomic distribution and enhancement characteristics of mediastinal lymph nodes, MSCT enhanced scan has a high diagnostic value for the identification of tuberculosis and pneumoconiosis.