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中国防痨杂志 ›› 2018, Vol. 40 ›› Issue (7): 713-718.doi: 10.3969/j.issn.1000-6621.2018.07.009

• 论著 • 上一篇    下一篇

66例颈部淋巴结结核的CT征象分析

任荣,袁功玲,李敏(),刘荣荣   

  1. 215000 苏州市第五人民医院放射科
  • 收稿日期:2018-03-19 出版日期:2018-07-10 发布日期:2018-09-07
  • 通信作者: 李敏 E-mail:105549156@qq.com
  • 基金资助:
    苏州市临床重点病种诊疗技术专项(LCZX201514);苏州市科技局民生科技项目(SS201541);苏州市科技局民生科技项目(SS201656);苏州市科技局民生科技项目(SYS201778);苏州市科技局民生科技项目(SYSD2016167);江苏省青年医学人才项目(QNRC2016226)

Analysis of CT imaging signs of 66 cases with cervical lymph node tuberculosis

Rong REN,Gong-ling YUAN,Min LI(),Rong-rong. LIU   

  1. Department of Radiology, the Fifth People’s Hospital of Suzhou, Suzhou 215000, China
  • Received:2018-03-19 Online:2018-07-10 Published:2018-09-07
  • Contact: Min LI E-mail:105549156@qq.com

摘要:

目的 探讨颈部淋巴结结核的CT征象特点。方法 搜集2015年8月至2017年8月苏州市第五人民医院诊治的66例经手术切除并经病理学证实的颈部淋巴结结核患者,回顾性分析上述患者CT表现资料。其中,男28例(42.4%),女38例(57.6%),年龄15~75岁,平均年龄(31.7±12.9)岁。对66例患者的发病部位、CT分型及征象进行总结分析。结果 66例颈部淋巴结结核患者中,多发者65例(98.5%),单发者1例(1.5%);双侧发病39例(59.1%),单侧发病27例(40.9%)。淋巴结分布于多个分区者59例(89.4%),分布于单个分区者7例(10.6%);淋巴结常见的分布区域依次为,Ⅱb区35例(53.0%),Ⅰa区30例(45.5%),Ⅰb区30例(45.5%),Ⅳb区26例(39.4%),Ⅱa区23例(34.8%),Ⅲ区22例(33.3%),Ⅳa区18例(27.3%)。淋巴结CT分型及征象为:均匀强化型(Ⅰ型)49例(74.2%),表现为结核结节及肉芽肿形成;包膜强化型(Ⅱ型)24例(36.4%),表现为淋巴结干酪样坏死,包膜强化,中心低密度区无强化;边缘强化型(Ⅲ型)34例(51.5%),表现为淋巴结包膜坏死,有分隔,边缘强化,中心低密度区无强化,周围脂肪间隙消失;不均匀强化型(或融合型;Ⅳ型)44例(66.7%),其中并发窦道形成8例(12.1%),表现为淋巴结干酪样坏死破溃侵犯周围组织,不均匀边缘强化,淋巴结正常结构消失,周围脂肪间隙消失,可见窦道。60例(90.9%)患者主发病灶均出现不同程度的周围组织侵犯。结论 颈部淋巴结结核具有多分区、多分型、多种CT征象显现同时存在的特点,CT增强扫描可以很好地显示病变形态和反映病理学改变,具有较高的诊断价值。

关键词: 结核, 淋巴结, 颈, 诊断显像, 病理学, 临床

Abstract:

Objective To explore the CT imaging features of cervical lymph node tuberculosis.Methods A retrospective analysis was conducted to analyze the CT imaging data of 66 patients with surgical excision and pathological confirmed cervical lymph tuberculosis in the Fifth People’s Hospital of Suzhou from August 2015 to August 2017. Among them, there were 28 (42.4%) males and 38 (57.6%) females. Patients were aged 15-75 years, with an average age of (31.7±12.9) years. The lesion location, CT classification and imaging signs of all patients were analyzed.Results Among the 66 cases with cervical lymph tuberculosis, 65 (98.5%) cases had multiple lesions, 1 (1.5%) case had single lesion, 39 (59.1%) cases had bilateral lesions, and 27 (40.9%) cases showed unilateral lesion. As for the location distribution, lesions in 59 cases (89.4%) were distributed in multiple node levels, but only 7 cases (10.6%) had lesions in single level. The most common levels of cervical lymph node tuberculosis were as follows: 35 (53.0%) cases in Ⅱb level, 30 (45.5%) cases in Ⅰa level, 30 (45.5%) cases in Ⅰb level, 26 (39.4%) cases in Ⅳb level, 23 (34.8%) cases in Ⅱa level, 22 (33.3%) cases in Ⅲ level, and 18 (27.3%) cases in Ⅳa level. Lymph nodes CT classification and imaging findings were as follows.Type Ⅰ: homogeneous enhancement type was observed in 49 (74.2%) cases, showing tuberculous nodules and granuloma; Type Ⅱ: envelop enhancement was detected in 24 (36.4%) cases, manifested as caseous necrosis of lymph nodes, envelop enhancement, and no enhancement in the central low-density area; Type Ⅲ: edge enhancement was detected in 34 (51.5%) cases, manifested as lymph node envelope necrosis, segregation, marginal enhancement, no enhancement in the central low-density area, and disappearance of the surrounding fat gap; Type Ⅳ: non-uniform reinforcement type (or fusion type) was found in 44 (66.7%) cases, of which 8 (12.1%) cases were complicated with sinus tract, manifested as lymph node caseous necrosis, destruction and invasion to the surrounding tissues, inhomogeneous marginal enhancement, disappearance of the normal structure of lymph nodes, disappearance of the surrounding fat space, and visible sinus tract. In most cases (90.9%, 60/66), peripheral tissue invasion from the primary lesions was found in varying degrees.Conclusion Cervical lymph node tuberculosis has the characteristics of lesion distribution in multiple lymph node levels, multiple CT classification types and multiple imaging sings. The method of CT-enhanced examination can display the pathological changes of lesions with high quality, and has a high diagnostic value.

Key words: Tuberculosis, lymph node, Neck, Diagnostic imaging, Pathology, clinical