MINIMAL TUBERCULOSIS - PROBLEMS IN ROENTGENOLOGIC INTERPRETATION
MINIMAL TUBERCULOSIS - PROBLEMS IN ROENTGENOLOGIC INTERPRETATION
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DOI：
10.1148/52.4.519
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发表时间：
1949-01-01
期刊：
影响因子：
19.7
通讯作者：
HURST, A
中科院分区：
文献类型：
--
作者：
BOBROWITZ, ID;HURST, A
通过X线检查诊断肺结核，特别是在常规和大规模的胸部X光检查中，已经成为一种常见的做法。对于微小病变尤其如此，人们承认实验室和临床结果往往缺乏或不足以帮助早期诊断。由于确定微小病变的临床意义的基本标准尚未建立，胸科医生和放射科医生已越来越频繁地试图从胶片中读取病变的临床病理性质以达到适当处理的目的。在对微小结核病变的X线描述中使用的术语隐含着每种类型的浸润性的某些病理意义，即渗出性、渗出性-产生性、生产性-纤维性和纤维钙化性。Reisner和Downes(1)为浸润性的X线特征提供了下列极好的定义：“渗出性：X线上，密度通常显示不明确的边界；有时它可能会被很好地限定；它的外观是‘软’的，形状要么是圆形的，要么是不规则的。大小不一，通常直径从一厘米到两厘米或三厘米不等。单个病变可以代表单个病灶，也可以由几个较小的融合密度组成。阴影的强度取决于病变的大小，在外观上可以是均匀的或絮状的。“生产性和纤维性：从X线表现来看，可以区分两种主要形式，即：(A)离散的结节密度，通常为多个，大小较小，边界清楚，外观‘硬’，圆形或不规则；(B)线状或线状密度，轮廓清晰，形状和分布通常不规则。这一类别中的大多数病例表现为a和b两种类型的组合。渗出性-生产性：这种类型可以被视为介于前两种类型之间的中间类型，X线表现为渗出性和生产性-纤维成分的特征组合，比例不同。纤维-钙化型：放射学上，变化包括清晰界定的结节密度，表现为圆形或不规则边界。结节通常是多个的；它们的分布是分散的；它们通常很小，直径几毫米，很少超过一厘米。阴影的强度通常被解释为钙沉积的特征。在最近的一项研究(2)中，我们试图在一组220例疗养院病例中确定微小肺结核的临床意义和预后。
The diagnosisof pulmonary tuberculosis by roentgenographic examination, particularly in routine and mass chest x-ray surveys, has become a common practice. This is especially true as regards minimal lesions, where it is admitted that laboratory and clinical findings are often absent or inadequate to help in early diagnosis. Since basic criteria for the determination of the clinical significance of the minimal lesion have not been established, it has become an increasingly frequent custom of chest physicians and roentgenologists to attempt to read from the film the clinicopathologic nature of the lesion for the purpose of proper disposition.The terms used in the roentgenologic description of minimal tuberculous lesions imply a certain pathologic significance for each type of infiltration,i.e., exudative, exudative-productive, productive-fibrotic, and fibro-calcific, Reisner and Downes (1) have provided the following excellent definitions for the roentgenologic character of the infiltration:“Exudative:Roentgenologically, the density usually shows rather ill-defined borders; occasionally it may be well circumscribed; it is ‘soft’ in appearance, either round or irregular in shape. The size is variable, usually ranging from one to two or three centimeters in diameter. The individual lesion may represent either a single focus or it may be composed of several smaller confluent densities. The intensity of the shadow depends on the size of the lesion, it may be either homogeneous or flocculent in appearance.“Productive and Fibrotic:From the roentgenological appearance a distinction may be made between two main forms, namely: (a) discrete nodular densities, usually multiple, of small size, showing well defined borders, ‘hard’ in appearance, either round or irregular in shape; (b) strand-like or linear densities, sharply outlined, often irregular in shape and distribution. The majority of the cases included in this category present a combination of form ‘a’ and ‘b’.“Exudative-Productive:This form may be regarded as an intermediate group between the two preceding types, the roentgenological findings presenting a combination of the features of both the exudative and productive-fibrotic elements in varying proportions.“Fibre-Calcific Form:Roentgenologically, the changes consist of sharply defined nodular densities, showing either round or irregular borders. The nodules are usually multiple; their distribution is scattered; they are generally of small size, measuring several millimeters in diameter, only rarely exceeding one centimeter. The intensity of the shadows is of a type usually interpreted as characteristic of calcium deposition. Such findings often occur in combination with changes indicative of strand-like and linear fibrosis.”In a recent study (2) we attempted to determine the clinical significance and prognosis of minimal pulmonary tuberculosis in a group of 220 sanatorium cases.