目的:分析侵袭性肺曲霉菌感染的CT特征表现与疾病预后.方法:对168例疑似侵袭性肺曲霉菌感染患者进行多层螺旋CT(MSCT)检查,以痰培养或活组织病理学检查结果作为金标准,探讨MSCT对侵袭性肺曲霉菌感染的诊断价值,分析其影像学特征及预后.结果: 168例疑似患者中,最终确诊为侵袭性肺曲霉菌感染者132例;以痰培养或活组织病理学检查结果为金标准,MSCT正确诊断侵袭性肺曲霉菌感染125例,正确排除侵袭性肺曲霉菌感染31例;MSCT对侵袭性肺曲霉菌感染的诊断准符合率、灵敏度、特异度、阳性预测值、阴性预测值、误诊率及漏诊率分别为92.9%、94.7%、86.1%、96.2%、81.6%、13.9%及5.3%.病灶在左肺26.4%,右肺32.0%,双肺41.6%;肺上叶56.0%,中下叶44.0%;肺外周带70.4%,内中带29.6%.侵袭性肺曲霉菌感染在MSCT的以结节、晕轮征、空洞最为常见,结节以单侧上肺多发多见,晕轮征以单侧、上肺多发为主,空洞以上肺、多发为主.血液病与非血液病患者在斑片影、团块影以及实变影方面比较具有统计学差异(P<0.05).经治疗,结节、晕轮征及空洞等MSCT特征性表现治愈好转组显著少于恶化死亡组(P<0.05或P<0.01).结论:MSCT能够客观显示肺内病变的部位、数目、形态学特征,对侵袭性肺曲霉菌感染具有较高的诊断价值,同时对于治疗过程中病情的监测以及预后评估也具有重要作用.%Objective:To discuss the imaging features in spiral CT of invasive pulmonary Aspergillus infection, and analyzed the prognosis.Methods:Multi slice spiral CT(MSCT) were performed in 168 patients with suspected invasive pulmonary Aspergillus infection, and the diagnostic value of MSCT were investigate by sputum culture or biopsy results as the gold standard, and the imaging features and prognosis were analyzed.Results:132 cases of invasive pulmonary Aspergillus infection were diagnosed in 168 cases by sputum culture or pathologic examination.MSCT right diagnosis of invasive pulmonary fungal infection in 125 cases, exclude invasive 31 cases by sputum culture or pathologic examination results as the gold standard;MSCT quasi coincidence rate, sensitivity, specificity degree, positive predictive value, negative predictive value, the rate of misdiagnosis and missed diagnosis rate were 92.9%, 94.7%, 86.1%, 96.2%, 81.6%, 13.9%, and 5.3% for the diagnosis of invasive pulmonary aspergillosis.The lesion in the left lung 26.4%, right lung 32%, both lung 41.6%;upper lobe 56%, lower lobe 44%;pulmonary peripheral zone 70.4%, middle zone 29.6%.Imaging features in MSCT were main nodules, halo sign, void sign, nodules were mainly on one side of the lung and multiple, halo sign with unilateral pulmonary multiple, void sign with upper pulmonary multiple.There were significantly differences in spot film, mass shadow and real change shadow between hematologic disease and non hematologic diseases (P<0.05).After treatment, MSCT features such as nodules, halo sign, void sign in the cure group were significantly less than the deterioration and death group(P<0.05 or P<0.01).Conclusion: MSCT can objectively display the lung lesion location, number and morphology, which has high diagnostic value in invasive pulmonary Aspergillus infection, and also plays an important role in the monitoring and prognosis in the treatment of disease.
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