Analysis of MRI characteristics of pleural tuberculoma

doi:10.3969/j.issn.1000-6621.2020.11.003

Abstract

Abstract:

Objective To explore the characteristics of MRI imaging of pleural tuberculoma, so as to improve the imaging diagnosis of this disease. Methods Clinical and imaging data of 87 patients diagnosed of pleural tuberculoma by pathology and/or bacteriology or clinically confirmed (based on clinical manifestations, immunological tests, response to diagnostic anti-TB treatment) in Hunan Chest Hospital from January 2018 to December 2019 were retrospectively analyzed. Among them, 60 patients (41 males, 19 females, 13-78 years old, median age 27 years) with complete information were selected, which included 8 cases confirmed by surgical pathology and 43 cases by percutaneous pleural puncture, 9 cases according to clinical diagnosis standard. They were all tested with tuberculosis related laboratory examinations, as well as CT scan, MRI scan and enhanced MRI examination. Results Among 60 patients, there were 47 (78.3%) with single lesions and 13 (21.7%) with multiple lesions; 37 lesions (37/74, 50.0%) occupied the lower right lobes. Rounded shadows were the most common signs, which were present in 34 lesions (45.9%).Most of lesions (68.9%) were close to the pleura with a wide base and smooth edges. Thirteen cases (21.7%) were immature tuberculomas, showed iso-intensity or slight hypo-intensity signal on T₁WI, DWI; slight hyper-intensity signal on T₂WI,ADC; nodular enhancement after contrast injection. Twenty-nine cases (48.3%) were mature tuberculomas with caseous necrosis, showed iso-intensity or slight hypo-intensity signal on T₁WI, DWI and variegated hyper-intensity signal on T₂WI,ADC,and nodular or annular enhancement. Eighteen cases (30.0%) were mature tuberculomas with liquefactive necrosis, showed hypo-intensity signal on T₁WI and high hyper-intensity signal on T₂WI,DWI,ADC,and annular enhancement after contrast injection. Multiple tuberculomas fused to form an abscess that ruptured into the extra-pleural fat gap and/or the chest wall in 2 cases (3.3%), showed high hyper-intensity signal on DWI and hypo-intensity signal ADC, and variegated-annular enhancement after contrast injection. Conclusion Pleural tuberculosis has certain characteristics of MRI which have advantages in determining the scope of pleural tuberculosis and its pathological stage.

Key words: Tubereuloma, Tuberculosis, pleural, Magnetic resonance imaging, Disease attributes

YIN Qu-hua, JIANG Zhi-shan, NIE Gan-juan, YAO Qi-neng. Analysis of MRI characteristics of pleural tuberculoma[J]. Chinese Journal of Antituberculosis, 2020, 42(11): 1153-1157. doi: 10.3969/j.issn.1000-6621.2020.11.003

Figures/Tables 6

References 11

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病灶	T₁WI	T₂WI	DWI	ADC	增强扫描检查
未成熟结核瘤	等或稍低信号	稍高信号	等信号	稍高信号	结节状强化
中心凝固性坏死结核瘤	等或稍低信号	混杂高信号	等信号	混杂高信号	不均匀结节状或环形强化
中心液性坏死性结核瘤	低信号	高信号	混杂高信号	混杂高信号	环形强化
结核脓肿	低信号	高信号	高信号	低信号	环形和分隔样强化

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