| Background and purposePeople are infected with the human immunodeficiency virus(HIV), the cause of the acquired immunodeficiency syndrome(AIDS). Pulmonary tuberculosis is the most common opportunistic infection and the leading cause of death in AIDS. The computed tomography has high resolution, scanning speed, higher accuracy and reliability for the disease. People have paied close attention to the value of high resolution computerized tomography (HRCT) in the diagnosis of lesion edges and details of the internal structure of tuberculosis.The CD4 lymphocyte is main receptor of HIV infection. HIV have conspicuous tropism for CD4 cells and specially intruded into human immune cells, resulting in opportunistic infections and cancers for immune system defects and leading to AIDS. So as the counting of CD4 lymphocyte is a direct assessment method of immune function and provide a definite index for damage condition of the immune system of patients with HIV infection.The imaging appearance of AIDS with tuberculosis is diverse. The radiographic and CT findings of AIDS with pulmonary tuberculosis are up to the severity of immunosuppressive. The clinical correlation studies between the imaging manifestations of AIDS with tuberculosis and CD4 lymphocyte count classification have not been reported. The purpose of this study is to explore correlation between the imaging features of AIDS with tuberculosis and CD4 lymphocyte count classificationMaterials and MethodsFifty-six cases diagnosed of AIDS with pulmonary tuberculosis patients were performed for common CT scan and HRCT scan; fifteen of 56 patients were contrast-enhanced scan. Forty-three patients with pulmonary tuberculosis were performed for common CT scan and HRCT scan. CT scan were performed at the end of the holding breath and deep inspiration and scan range from apex of lung to the level of facies diaphragmatica and costo-phrenic angle. Scan parameter: 120kV, 160mA,collimation 10mm, pitch 1, Field of View(FOV) 350mm. window with 350 HU, window level 40 HU for Soft tissue windows and window with 1500HU, window level-700 HU for pneumono-tissue windows. The region of interest was scan by HRCT. Scan parameter: 120kV, 280mA, collimation 1-2mm, interval 5-10mm, bone calculation method. The contrast-enhanced scan was performed when the mass or mediastinal lymphadenectasis when doubtful glandular phthisis was defined after definite extent of disease. The non-ionic contrast agent was injected into elbow vein with the speed of among 2.5 ml～3ml/sec and the dosage of 1.5ml/kg. The contrast medium was Omnipaque made in Nycomed company or Ultravist made in Schering company Germany (300mgI/m1), 20s (the arterial phase) and 40s ( the venous phase) were included in the contrast enhanced scan. Spiral CT examination was performed with GE Hispeed Advantage Rp22 Helical scanner.CD4 lymphocyte counts will be divided into two classifications: I : < 100/mm3, II:≥100/mm3. Related research on the imaging features and locus of AIDS with tuberculosis and the classification of CD4 lymphocyte counts. Statistical analysis was performed with SPSS 13.0 software and SAS 9.13 software, using t-test, Chi-square and Spearman. Statistically significant level was considered as alpha equals 0.05.Results1. Comparment between AIDS with tuberculosis and pulmonary tuberculosis1.1 Lesion typingPrimary pulmonary tuberculosis incidence rate is relatively low but secondary pulmonary tuberculosis incidence rate is relatively high reaching 32 (57.1%) cases. The difference was statistically significant between the two groups, P<0.05.1.2 Lesion locusThe diseased regions have more in the incidence of the lobes of the lungs in AIDS with tuberculosis. The superior lobe of right lung, 41(73.2%) cases, the middle lobe of right lung,26(46.4%)cases, the inferior lobe of right lung,34(60.7%) case, the superior lobe of left lung, 39(69.6%) cases and the inferior lobe of left lung;32(57.1%)cases. The difference was statistically significant between the two groups in lobes of the lungs, P<0.05.1.3 Lesion imaging characteristicThe patching and (or) large consolidation shadows have largest proportion reaching 44 (78.6%) cases in AIDS with tuberculosis patients. The multiple nodules, 35 (62.5%) cases, the multi-cavitates, 27 (48.2%) cases, the pleural effusion,26 (46.4%) cases, the single cavitas, 4 (7.1%) cases and the mediastinum and (or) axillary lymphadenectasis,24(42.9%) cases. The difference was statistically significant between the two groups, P<0.05.1.4 Age and CD4 lymphocyte countsThe difference was not statistically significant in Age, t=0.256, P>0.05, and the difference was statistically significant between two groups in CD4 lymphocyte counts, t =147.623, P < 0.052. Comparement of CD4 lymphocyte counts classification in AIDS with tuberculosis2.1 Lesion typingThe probability primary pulmonary tuberculosis of involvement was positive correlation between CD4 lymphocyte counts classifications. P < 0.05. The probability secondary pulmonary tuberculosis of involvement was negative correlation between CD4 lymphocyte counts classifications. P < 0.05. The probability hemo-disseminated pulmonary tuberculosis and tuberculous pleuritis of involvement were no correlation between CD4 lymphocyte counts classifications. P >0.05.2.2 Lesion regionThe probability of involvement was no correlation between CD4 lymphocyte counts classifications in the superior lobi of bilateral lungs, P > 0.05. The probability of involvement was negative correlation between CD4 lymphocyte counts classifications in the middle lobe of right lung and the inferior lobi of bilateral lungs, P< 0.05.2.3 Lesion imaging characterThe probability was negative correlation between CD4 lymphocyte counts classifications in Patching or (and) large consolidation shadows, multi-cavitates, multiple nodules, mediastinum and (or) axillary lymphadenectasis. P<0.05. The probability was positive correlation among CD4 lymphocyte counts classifications in single cavitas, P<0.05. The probability was no correlation between CD4 lymphocyte counts classification in pleural effusion, P>0.05.2.4 Age and CD4 lymphocyte countsThe difference was not statistically significant in Age, t =0.613, P>0.05., and the difference was statistically significant in CD4 lymphocyte counts classification. t =215.096, P<0.05.Conclusions:1. AIDS patients with tuberculosis compared with pulmonary tuberculosis patients in the type of lesion, location and imaging features have differences. Lesions often occurs two or more multi-lobe . The imaging features and lesions are diverse and complex.2. AIDS patients with tuberculosis lesions character have relevant with CD4 T lymphocytes immune dysfunction. The probability was negative correlation between CD4 lymphocyte counts classifications in the lesion typing (secondary pulmonary tuberculosis) and the lesion region(the middle lobe of right lung and the inferior lobi of bilateral lungs) and the lesion imaging character (patching or (and) large consolidation shadows, multi-cavitates, multiple nodules, mediastinum and (or) axillary lymphadenectasis). The pulmonary imaging manifestations are not typical when the lower number of CD4 counts.
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