Analysis of CT imaging findings appearing as focal ground glass opacity in patients with pulmonary tuberculosis

doi:10.3969/j.issn.1000-6621.2020.03.005

Abstract

Abstract:

Objective To investigate the characteristics of CT images of focal ground glass opacity (fGGO) in patients with pulmonary tuberculosis in order to improve the understanding of rare signs. Methods Eleven cases of pulmonary tuberculosis admitted in Beijing Chest Hospital from 2009 to 2019 were collected as pulmonary tuberculosis group (totally 11 fGGO lesions) including 7 cases by composite reference standard (CRS), 3 cases by surgical pathology and 1 case by percutaneous lung puncture. According to the ratio of 1∶4, 44 cases with lung cancer confirmed by surgical pathology in our hospital during the same period were selected as the lung cancer group (totally 44 fGGO lesions). The CT image characteristics of fGGO lesions in the two groups were analyzed. Results The fGGO lesions in patients with pulmonary tuberculosis and lung cancer were distributed in the upper lobe (63.6% (7/11) vs. 65.9% (29/44)), the middle lobe (9.1% (1/11) vs. 11.4% (5/44)), and the lower lobe (27.3% (3/11) vs. 22.7% (10/44)) without statistically significant difference (χ ²=2.608,P=0.106). The characteristics of fGGO imaging with round or oval (36.4% (4/11)), clear interface between lesion and lung tissue (9.1% (1/11)), and the lobulation sign (0.0% (0/11)) in the pulmonary tuberculosis group were significantly lower than those (77.3% (34/44),93.2% (41/44),43.2% (19/44)) in the lung cancer group with statistically significant differences (χ ²=5.114,P=0.024;χ ²=29.974,P=0.000;χ ²=5.473,P=0.019). The features of fGGO imaging with internal homogeneous density (9.1% (1/11)), bronchial shadow or vacuoles (0.0% (0/11)), thickened or twisted vessels (0.0% (0/11)) in the pulmonary tuberculosis group were significantly lower than those (54.5% (24/44), 38.6% (17/44) and 77.3% (34/44)) in the lung cancer group with statistically significant differences (χ ²=7.333,P=0.007;χ ²=4.475,P=0.034;χ ²=19.108,P=0.000). However, the frequency of the multiple nodular lesions (90.9% (10/11)) in the pulmonary tuberculosis group were significantly higher than that (0.0% (0/44)) in the lung cancer group with statistically significant difference (χ ²=42.969,P=0.000). Conclusion The distribution of fGGO lesions is not specifically different in two groups. But the characteristic of fGGO imaging with blurred edges, no lobulation sign, no pleural depression, internal inhomogeneous density inside the lesion, no bronchial shadow or vacuoles, no thickened or twisted vessels, and multiple cluster-like noduleshave certain reference value for differential diagnosis in pulmonary tuberculosis from lung cancer.

Key words: Tuberculosis, pulmonary, Lung neoplasms, Tomography, X-ray computed, Diagnostic imaging, Comparative study, Ground-glass opacity

LYU Yan,WANG Jue,LI Fang,HE Wei,ZHOU Zhen,MU Jing,ZHOU Xin-hua. Analysis of CT imaging findings appearing as focal ground glass opacity in patients with pulmonary tuberculosis[J]. Chinese Journal of Antituberculosis, 2020, 42(3): 204-209. doi: 10.3969/j.issn.1000-6621.2020.03.005

Figures/Tables 5

References 20

[1]	Ichinose J, Kohno T, Fujimori S , et al. Invasiveness and malignant potential of pulmonary lesions presenting as pure ground-glass opacities. Ann Thorac Cardiovasc Surg, 2014,20(5):347-352.
[2]	李镭, 刘丹, 朱盈盈 , 等. 肺磨玻璃结节临床研究进展. 中国肺癌杂志, 2016,19(2):102-107.
[3]	Liu Y, Balagumnathan Y, Atwater T , et al. Radiological image traits predictive of cancer status in pulmonary nodules. Clin Cancer Res, 2017,23(6):1442-1449.
[4]	杨越清, 高杰, 金梅 , 等. 纯磨玻璃密度肺腺癌内异常空气支气管征预测病理亚型的价值. 中华放射学杂志, 2017,51(7):489-492.
[5]	李凤, 邱太春, 黎佳维 , 等. 磨玻璃样肺腺癌多维度CT征象特点对其浸润程度预测的临床研究. 结核病与肺部健康杂志, 2018,7(4):245-250.
[6]	刘大伟, 朱建坤, 金锋 , 等. 以磨玻璃样密度影为表现的早期肺癌并发肺结核患者的诊治分析. 中国防痨杂志, 2019,41(1):64-68.
[7]	中华医学会. 临床诊疗指南:结核病分册. 北京: 人民卫生出版社, 2005: 1-15.
[8]	唐神结, 高文 . 临床结核病学. 北京: 人民卫生出版社, 2011: 20-25.
[9]	周新华 . 肺结核的影像学诊断——从形态分析到分子影像诊断. 中国防痨杂志, 2014,36(8):638-642.
[10]	谢汝明, 吕岩, 周震 , 等. 33例肺结核不典型CT征象分析. 中国防痨杂志, 2014,36(3):171-175.
[11]	柳澄 . 肺结核基本病理改变的MSCT表现. 中国中西医结合影像学杂志, 2013,11(3):341-342.
[12]	周新华 . 肺结核少见影像表现分析. 新发传染病电子杂志, 2017,2(2):127-128.
[13]	中华医学会呼吸病学会肺癌学组. 中国肺癌防治联盟专家组肺结节诊治中国专家共识(2018年版). 中华结核和呼吸杂志, 2018,41(10):763-771.
[14]	Ettinger DS, Wood DE, Aisner DL , et al. Non-Small Cell Lung Cancer, Version 5.2017, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw, 2017,15(4):504-535.
[15]	MacMahon H, Naidich DP, Goo JM , et al. Guidelines for Management of Incidental Pulmonary Nodules Detected on CT Images:From the fleischner Society 2017. Radiology, 2017,284(1):228-243.
[16]	吕岩, 谢汝明, 周新华 , 等. 磨玻璃晕征环绕的周围型肺癌的CT特征及病理对照观察. 中国医学影像技术, 2010,26(6):1096-1099.
[17]	何明宸, 许茂盛, 曹志坚 . 肺磨玻璃结节的影像诊断研究进展. 国际医学放射学杂志, 2014,37(2):123-126,151.
[18]	康柳青, 黎海亮, 张孝先 , 等. 磨玻璃密度肺腺癌内血管异常CT表现与病理亚型及磨玻璃分型的相关性. 中国医学影像技术, 2018,34(4):548-552.
[19]	Fridman WH, Dieu-Nosjean MC, Pagès F , et al. The immune microenviroment of human tumors:general siganificance and clinical impact. Cancer Microenviron, 2013,6(2):117-122.
[20]	Hu H, Wang Q, Tang H , et al. Multi-slice computed tomography characteristics of solitary pulmonary ground-glass nodules: Differences between malignant and benign. Thoracic Cancer, 2016,7(1):80-87.

组别	上叶	中叶	下叶	χ²值	P值
肺结核组(11例)	7(63.6)	1(9.1)	3(27.3)	2.608	0.106
肺癌组(44例)	29(65.9)	5(11.4)	10(22.7)

组别	上叶尖后段	上叶舌段	上叶前段	下叶背段	下叶基底段	中叶内侧段	中叶外侧段
肺结核组(11例)	4(36.3)	1(9.1)	2(18.2)	2(18.2)	1(9.1)	0(0.0)	1(9.1)
肺癌组(44例)	12(27.3)	1(2.3)	16(36.3)	1(2.3)	9(20.4)	1(2.3)	4(9.1)
χ²值	0.050	-	0.625	-	0.191	-	-
P值	0.824	0.363	0.429	0.099	0.662	1.000	1.000

组别	形态		边缘与肺交界面		分叶		毛刺		胸膜凹陷征
组别	圆或椭圆	不规则	模糊	清晰	有	无	有	无	有	无
肺结核组(11例)	4(36.4)	7(63.6)	10(90.9)	1(9.1)	0(0.0)	11(100.0)	0(0.0)	11(100.0)	0(0.0)	11(100.0)
肺癌组(44例)	34(77.3)	10(22.7)	3(6.8)	41(93.2)	19(43.2)	25(56.8)	8(18.2)	36(81.8)	13(29.6)	31(70.4)
χ²值	5.114		29.974		5.473		1.106		2.776
P值	0.024		0.000		0.019		0.293		0.096

组别	密度均匀	斑片	多发结节	间质增厚	支气管影或空泡	增粗或扭曲血管影
肺结核组(11例)	1(9.1)	0(0.0)	10(90.9)	5(45.5)	0(0.0)	0(0.0)
肺癌组(44例)	24(54.5)	11(25.0)	0(0.0)	11(25.0)	17(38.6)	34(77.3)
χ²值	7.333	2.053	42.969	0.931	4.475	19.108
P值	0.007	0.152	0.000	0.335	0.034	0.000