肺结核好发部位上肺癌与结核瘤的CT影像研究

目的：探讨肺结核好发部位上周围型肺癌与结核瘤的CT征象及鉴别诊断依据。方法：搜集近6年来有结节或肿块发生在肺结核好发部位的陈旧性肺结核患者134例,其中合并周围型肺癌80例,继发结核瘤54例,所有病例均有完整CT影像资料,并均经病理证实。将周围型肺癌病例定为Ⅰ组,结核瘤病例定为Ⅱ组。再分别将结节或肿块与陈旧性肺结核灶不在同一肺段而孤立存在的,定为Ⅰa组（49例）和Ⅱa组（39例）;两者在同一肺段上混合存在的,定为Ⅰb组（31例）和Ⅱb组（15例）。回顾性分析各组的CT征象,对Ⅰ组和Ⅱ组数据组间及组内CT征象分别进行χ2检验并分析。结果：Ⅰ组患者中腺癌比例最高（61/80）。Ⅰ组与Ⅱ组病灶发生部位比较,差异无统计学意义（P〉0.05）。Ⅰa组与Ⅱa组对比,病灶大小≥3 cm、密度不均匀、空泡征、浅分叶征,强化≥20 Hu及不均匀强化以Ⅰa组多见（P〈0.05）;密度均匀、钙化、边缘清楚、强化〈20 Hu及环形强化以Ⅱa组多见（P〈0.05）。Ⅰb组与Ⅱb组对比,病灶大小≥3 cm、密度不均匀、强化≥20 Hu、不均匀强化及合并肺气肿以Ⅰb组多见（P〈0.05）;密度均匀及强化〈20 Hu以Ⅱb组多见（P〈0.05）。Ⅰa组与Ⅰb组对比,空洞及强化〈20 Hu以Ⅰa组多见（P〈0.05）;钙化、强化≥20 Hu、不均匀强化及合并肺气肿以Ⅰb组多见（P〈0.05）;Ⅱa组与Ⅱb组CT征象对比差异无统计学意义（P〉0.05）。结论：陈旧性肺结核患者合并周围型肺癌与继发结核瘤CT征象多有重叠,对各种CT征象综合分析是鉴别诊断的重要依据。

CT Imaging Study of Peripheral Lung Cancer and Pulmonary Tuberculoma in the Predilection Site of Pulmonary Tuberculosis

Objective： To discuss CT signs and differential diagnosis of peripheral lung cancer and pulmonary tuberculoma in the predilection site of pulmonary tuberculosis. Methods： 134 cases of obsolete pulmonary tuberculosis patients with the tuberculoma or tumor in the predilection site of pulmonary tuberculosis who had underwent CT examination over the last 6 years were collected, of which there were 80 cases with peripheral lung cancer and 54 cases with pulmonary tuberculoma confirmed by pathology. All patients were divided into two groups. Group I were the patients with the peripheral lung cancer, and group II were the patients with pulmonary tuberculoma. Define the cases with tuberculum or tumor with obsolete pulmonary tuberculosis which were in the different lung segment and isolated existent as group I a （49 cases） and group 1 a （39 cases）; the cases with the mixture of the tumor and obsolete pulmonary tuberculosis in the same lung segment were defined as group I b （31 cases） and group IIb （15 cases）. Reviewing CT images of each group, group I and group 11 data between groups and within groups were respectively tested and analyzed with chi-square criterion. Results： Group I had the highest proportion of adenocarcinoma differences in distribution of lesions between group I and group II a, the factors （tumor diameter〉3 cm,uneven （61/80）. There were no statistically significant group II （P〉 0.05）. Comparing group 1 a with density, vacuole sign, shallow lobulation, enhancement 〉 20 Hu and inhomogeneous enhancement） were more common in group I a （P 〈 0.05）; and the factors （uniform density, calcification, clear edge, enhancement〈 20 Hu, ring enhanced） were more common in group II a （P 〈 0.05）. Comparing Group I b with group II b, the factors （the size of tumor〉 3 cm, uneven density, enhancement〉 20 Hu, inhomogeneous enhancement and emphysema） were more common in group I b （P〈0.05）; and the facts （uniform density and enhancement〈 20 Hu） were