CT Study Of Tuberculosis In Digestive System

IntroductionIn recent years, increased incidence of tuberculosis has been attributed to several causes, including AIDS epidemic, iv drug abuse and increase in the number of immunocompromised patients. Tuberculosis in digestive system can affect the gastrointestinal tract, peritoneum, lymph nodes, solid viscera including liver, spleen and pancreas or bile duct and its incidence has been increasing too. The diagnosis of the disease is often difficult because of its protean clinical manifestations and non-specific laboratory investigations. Though CT is considered to be an excellent modality to assess the disease, few specific features on CT were mentioned for the diagnosis. So it is important for us to assess CT manifestations and its diagnostic value in the present study.ObjectiveTo assess CT manifestations and CT diagnostic value of tuberculosis in digestive system; To ascertain the relationship between CT features and pathological basis of the disease; To assess diagnostic value of the different medical imaging exams on the disease and to assess the clinical significance of CT classification in solid viscera tuberculosis and tuberculous peritonitis.Materials and Methods1. Subjects: The CT findings in 87 cases of tuberculosis in digestive system confirmed by clinical or pathology, including tuberculous lymphadenopathy in 31 cases, tuberculous peritonitis in 24 cases (including serohepatic type of hepatic tuberculosis in 2 cases), solid viscera in 22 cases (including liver in 10, spleen in 7 and pancreas in 8 cases), intestinal tuberculosis in 24 cases, and tuberculosis of bile duct in 3 cases (including tuberculous cholangitis in 1 case and gallbladder tuberculosis in 2 cases), were analyzed retrospectively. Of the 87 tuberculosis patients, 48 were male and 39 female, aged from 16 to 73 years (mean, 39.4 years). The diagnosis was proved by surgery (n = 47), biopsy (n = 18), fibrocolonoscope (n = 7) and abdominoscopy (n = 8). Abdominal tuberculous lymphadenopathy was also diagnosed in patients for whom CT or other imaging exams showed that documented tuberculosis in extra-node sites improved after antituberculous chemotherapy (n = 7).2. CT Scanning: CT was performed with Siemens Somatom DR3, HiQ and Volume Zoom units for the patients in routine fasting state. Some patients were given 500 ~ 2000 mL of diluted iodinated contrast medium (10g/L meglumine diatrizoate) orally 30 min before scanning. Scan scope ranged from the dome of diaphragm to symphysis pubica. All patients were examined with plain and enhanced scanning.3. Methods: (1) Tuberculosis in digestive system: correlation between CT features and pathological results, including correlation between CT features and surgical and pathological results (main method), and correlation between CT features and other pathological results including biopsy, fibrocolonoscope, and abdominoscopy results. (2) Tuberculosis in digestive system: correlation between CT features and other medical imagings including MRI, Ultrasound, intestinal radiological examination or K.UB findings.ResultsAccording to pathological results and pathological classification, the main CT manifestations in 87 cases of tuberculosis in digestive system could be summarized asfollows:1. Tuberculosis of solid viscera (including hepatosplenic tuberculosis and pancreatic tuberculosis, (n = 22): (1) miliary, micronodular type (n = 6; diameter < 2 cm in size) : CT shows multiple, miliary, micronodular and low-density lesions with multiple flecked calcifications in the diffuse, enlarged parenchymal organs. (2) macronodular type (n = 15; diameter > 2 cm in size) : low-density mass with multiple flecked calcifications in 5 cases; multiple micronodular and low-density lesions fusing into multiloculated cystic mass or "cluser" sign in 5 cases; and multiple cystic lesions in 4 cases; massive pancreatic head calcification in 1 case. (3) Mixed type (n = 1) : singular, macronodular and low-density lesion with multiple miliary c...