Study On The Details Of MSCT In Adult Tuberculosis Of Mediastinal Lymph Node

BackgroundAdult mediastinal lymph nodes,sign an image of tuberculosis,transfer lymphoma,sarcoidosis,giant lymph node hyperplasia,nonspecific lymphadenitis and other different diseases associated with mediastinal lymph node metastasis.Because of the different nature of the disease,but the morphology of different lymph nodes Imaging expression in much the same way abstract,and lack of features and characteristics of different types of diseases,therefore the imaging diagnosis and differential diagnosis has brought many difficulties.Therefore,it is very important to fully understand the imaging features and features of lymph node enlargement caused by mediastinal hilar lymph nodes in the diagnosis and treatment of the disease.ObjectiveThrough study on the details of MSCT in adult tuberculosis of mediastinal lymph node,at the same time to metastatic mediastinal lymph nodes and mediastinal lymphoma for comparative study analysis,objective to improve the recognition and differentiation of adult mediastinal hilar lymph node tuberculosis,and to provide help for clinical diagnosis and treatment.Materials and MethodsRetrospective analysis 52 patients with tuberculosis of mediastinal lymph node which were diagnosed in Guangzhou chest hospital from January 1,2011 to July 30,2016(The study group: MSCT detailed features of 272 cases of adult tuberculosis of mediastinal lymph node),the adult mediastinal lymph node tuberculosis after anti tuberculosis therapy more than 1 years of follow-up,with lymph node lesions significantly reduced or calcification,bronchofiberscopic pathological diagnosis,the neck or axillary lymph node biopsy diagnosis biopsy or by surgical biopsy diagnosis.a comparative study was conducted between 52 patients with metastatic carcinoma of lymph node which were diagnosed at the same time in Guangzhou chest hospital(The control group:MSCT detailed features of a total of 250 cases of metastatic carcinoma of lymph node).The two groups of cases of MSCT plain scan and enhanced thin layer scanning characteristics were compared and analyzed..The hilar and mediastinal lymph node tuberculosis(104 patients 544 cases)including the details of signs: lymph node size,location,shape,edge,density,fusion,calcification,enhancement degree and pattern,fat clearance,and the relationship between surrounding vessels and trachea.Comparing the intrathoracic mediastinal lymph node tuberculosis and metastatic mediastinal lymph nodes and mediastinal lymphoma were compared between groups using continuous X-test,X-test or Fisher’s exact probability correction two independent sample frequency.The mediastinal lymph node tuberculosis(104 patients 544 cases)and metastatic lymphadenopathy(52 patients 544 cases)including signs of comparative evaluation and 21 cases of mediastinal lymphoma: lymph node size,location,shape,edge,density,fusion,calcification,enhancement degree and pattern,and the fat clearance around the relationship between vessels and trachea.Results1、mediastinal lymph node tuberculosis mainly occurred: the top five were:4R area is 86 patients 105 cases,7 area is 56 patients 79 cases,2R area is 66 patients 78 cases,10 R area is 43 patients 56 cases,10 L area is 34 patients 38 cases,Of which 3 cases of 1 regional lymph nodes,the rest are nodes of 2 or more than 2 regional lymph nodes.2、The MSCT scan of the mediastinal lymph node tuberculosis in adults:The size of the lesions of 1-4cm were 101 patients 521 cases(95.8%),a total of 5 patients 23 cases were >4cm(4.2%),36 patients 107 cases(31.2%)lesions with calcification;79 patients 316 cases(58.1%)were not fusion,38 patients 228 cases(41.9%)were fusion;32 patients 174 cases(40%)were plain uniform density,81 patients 370 cases(60%)were scan density not even,compared with the control group,both P<0.05,was statistically significant;Tuberculosis group was higher than that of metastasis and lymphoma: 1-4cm lesions,calcification lesions,not fusion and uneven density.At the same time,the difference between the central and peripheral density of the mediastinal lymph node tuberculosis.3、The MSCT enhanced scan of adult mediastinal hilar lymph node tuberculosis:22 patients 94(17.2%)cases were obvious homogeneous enhancement,compared with the transfer group χ2=10.380,P<0.05,it have a significant statistical significance;Compared with Lymphoma Group,χ2=0.515,P>0.05,it do not have statistical significance 。32 patients 101(18.6%)cases were mild to moderate enhancement,compared with the transfer group χ2=1.926,P>0.05,it do not have statistical significance;Compared with Lymphoma Group,χ2=18.462,P<0.05,it have statistical significance.37 patients 108(19.8%)cases were edge thin wall annular enhancement,compared with the transfer group χ2=5.191,P<0.05,it have a significant statistical significance,compared with Lymphoma Group,χ2=6.396,P<0.05,it have a significant statistical significance。6 patients 20(3.7%)cases were the edge of thick walled ring enhancement,compared with the transfer group χ2=33.591,P<0.05,it have a significant statistical significance,compared with Lymphoma Group,χ2=4.186,P>0.05,it do not have a significant statistical significance.29 patients 72(13.2%)cases were the ring like enhancement of fine separation,compared with the transfer group χ2=9.190,P<0.05,it have a significant statistical significance,compared with Lymphoma Group,χ2=7.625,P<0.05,it have a significant statistical significance.33 patients 94(17.2%)cases were multiple overlapping enhancement,compared with the transfer group χ2=6.319,P<0.05,it have a significant statistical significance,compared with Lymphoma Group,χ2=4.274,P<0.05,it have a significant statistical significance.6 patients 18(3.3%)cases were edge nodular enhancement,compared with the transfer group χ2=9.506,P<0.05,it have a significant statistical significance,compared with Lymphoma Group,χ2=0.034,P>0.05,it do not have a significant statistical significance.6 patients 22(4.0%)cases were no obvious enhancement,compared with the transfer group χ2=3.230,P>0.05,it do not have statistical significance,compared with Lymphoma Group,χ2=1.273,P>0.05,it do not have statistical significance.Lymph node tuberculosis group was higher than that in metastasis group is enhanced features: edge enhancement,small annular thin-walled ring like enhancement,separating polycyclic overlap(P<O.05);strengthening tuberculosis group was higher than that of Lymphoma Group is enhanced features: edge enhancement,small annular thin-walled ring like enhancement(P<O.05)Conclusions1、Adult mediastinal lymph node tuberculosis has some predilection sites,mainly in the 4R area,2R area and 7 area,10 R and 10 L area.2、In the study group(adult mediastinal hilar lymph node tuberculosis)and control group 1,2(control group 1: lymph node metastasis of cancer;control group 2: mediastinal lymphoma)comparative study found: adult mediastinal lymph node tuberculosis fusion、inhomogeneous density and plain CT value difference advantage higher than metastatic lymph node and mediastinal lymphoma.3、Adult mediastinal lymph node tuberculosis with multiple shapes enhanced features: inhomogeneous enhancement,edge enhancement,small annular thin-walled ring like enhancement,separating polycyclic fusion edge enhancing nodular enhancement coexist in micro center low density area,no obvious enhancement,wrapped around the adjacent vessels;lymph node tuberculosis group was higher than that of enhanced features transfer group: uneven enhancement,edge enhancement,small annular thin-walled ring like enhancement,separating polycyclic fusion strengthening(P<0.05);lymph node tuberculosis group was higher than that in Lymphoma Group is enhanced features:edge enhancement,small annular thin-walled ring like enhancement(P<0.05).4、.Adult mediastinal lymph node tuberculosis has self limitation,the focus of the disease is <4cm,which is different from the metastatic lymph node and the tumor growth pattern,the lesions are more than >4cm.5、MSCT scan has a high shape and density resolution,it is easy to detect the mediastinal lymph node tuberculosis,which is of great significance for the diagnosis and differential diagnosis of mediastinal lymph nodes caused by various reasons.