Diagnostic value of multislice spiral CT and DDR in patients with different types of tuberculosis
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摘要:
目的 探讨多层螺旋CT（MSCT）、直接数字成像系统（DDR）诊断活动性肺结核（ATB）、非ATB的价值。 方法 选择2018年2月~2019年10月我院收治的80例肺结核患者，其中ATB 39例、非ATB 41例，均行MSCT和DDR检查。观察ATB、非ATB患者DDR和MSCT征象特征，以病理结果为准，利用受者工作特征曲线分析MSCT、DDR、DDR+MSCT对肺结核诊断价值。 结果 DDR肺结核检出率65.00%，ATB组片状、边缘不清、密度不匀致密阴影检出率高于非ATB组（P < 0.05）。MSCT肺结核检出率76.25%，ATB组MSCT征象以磨玻璃密阴影，结节，树芽征，支气管壁增厚，边缘模糊实变，空洞为主，非ATB组MSCT征象以高密度结节，条索影，肺结构扭曲为主。以病理结果为准，DDR、MSCT、DDR+MSCT诊断ATB的灵敏度为64.10%、84.62%、92.31%，特异度为65.85%、68.29%、87.80%，AUC为0.638、0.752、0.888，DDR+MSCT诊断AUC高于单独DDR、MSCT（P < 0.05）。 结论 MSCT、DDR诊断肺结核均有一定价值，DDR+MSCT可提高对肺结核检出率以及ATB鉴别诊断价值。 Abstract:Objective To explore the diagnostic value of multi-slice spiral CT (MSCT) and direct digital radiography (DDR) in active pulmonary tuberculosis (ATB) and non-active pulmonary tuberculosis (non-ATB). Methods From February 2018 to October 2019, 80 cases of tuberculosis in our hospital were admitted, including 39 cases of ATB and 41 cases of non-ATB. All patients were examined by MSCT and DDR. The DDR and MSCT features of ATB and non-ATB patients were observed. The diagnostic value of MSCT, DDR and DDR+MSCT were analyzed by receiver operator characteristics curve(ROC)based on the pathological results. Results The detection rate of pulmonary tuberculosis by DDR was 65.00%. The detection rate of patchy, indistinct edge and unevenly dense shadow in ATB group were higher than that in non-ATB group (P < 0.05). Pulmonary tuberculosis detection rate was 76.25% by MSCT. The MSCT signs in group ATB were to give priority to ground glass density shadow, nodules, tree bud sign, thickening of bronchial wall, fuzzy consolidation at the edge, mainly cavity, while the MSCT signs in group non-ATB were high-density nodules, stripe shadow and lung structure distortion. According to the pathological results, the sensitivity and specificity of DDR, MSCT and DDR+MSCT in diagnosing ATB were 64.10%, 84.62%, 92.31%;65.85%, 68.29%, 87.80%, respectively, and the AUC was 0.638, 0.752, 0.888, respectively. Conclusions MSCT and DDR have certain value in diagnosing pulmonary tuberculosis. DDR+MSCT can improve the detection rate of pulmonary tuberculosis and the value of ATB differential diagnosis. -
图 1 痰涂片抗酸染色
A-B:抗酸染色阴性; C-D:抗酸染色阳性.
Figure 1. Acid-fast staining of sputum smears (×1000).
图 3 肺结核MSCT征象
A:腺泡结节; B:结节内空洞; C:空洞; D:磨玻璃; E:树芽征; MSCT: Multislice spiral computed tomography.
Figure 3. MSCT signs of pulmonary tuberculosis.
图 4 DDR、MSCT、DDR+MSCT诊断ATB的ROC
Figure 4. ROC diagram of DDR, MSCT, DDR + MSCT diagnosis ATB.
表 1 ATB、非ATB患者DDR征象检出率比较
Table 1. Comparison of detection rates of DDR signs in patients with ATB and non-ATB[n(%)]
DDR征象 ATB组(n=25) 非ATB组(n=27) χ2 P 致密阴影 20 (80.00) 13 (48.15) 5.680 0.017 蜂窝状改变伴少量纤维条索影 14 (56.00) 9 (33.33) 2.704 0.100 DDR: Direct digital radiography; ATB: Active tuberculosis. 
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表 2 DDR、MSCT、DDR+MSCT诊断ATB价值
Table 2. Diagnostic value ofDDR, MSCT, DDR+MSCT in ATB (%)
影像检查 病理(n) 灵敏度 特异度 阳性预测值 阴性预测值 ATB 非ATB DDR 25 27 64.10 65.85 64.10 65.85 MSCT 33 28 84.62 68.29 71.74 82.35 DDR+MSCT 36 36 92.31 87.80 85.71 92.31
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