| Objective:The aim of this study was to investigate if magnetic resonance imaging?MRI?can be used to differentiate atypical pulmonary tuberculoma from small peripheral lung cancer and provide a significant auxiliary and noninvasive diagnostic method.Methods:In the study,both plain,longer delayed muitiphasic contrast-enhanced MRl and diffusion-weight imaging?DWI?were performed preoperatively on a 1.5T scanner?Siemens 1.5T Avanto?in 20 patients with atypical PT and 20patients with SPLC.Morphologic features and MR signal intensity were examined in detail.Statistical difference between atypical PT and SPLC was determined using the Mann-Whitney U test.A P value of less than 0.05 was considered statistically significant.Results:?1?Atypical PT lesions accompanied by many MRI signs including:spicule sign?15%,3/20?,lobulation sign?5%,1/20?,vascular convergence sign?10%,2/20?pleural indentation?20%,4/20?and cavity sign?20%,4/20?,which in SPLC lesions are?40%,8/20?,?35%,7/20?,?65%,13/20?,?55%,11/20?and?10%,2/20?.?2?Signal intensity:in atypical PT group,9 cases?45%?showed isointense in T1-weighted images,7?35%?cases showed slightly hypointense and 4?20%?cases showed the surrounding hyperintense,hypointense in the central area.11?50%?cases showed isointense in T2-weighted images,5?30%?cases showed hyperintense,and4?20%?cases showed the surrounding hyperintense,hypointense in the central area.DWI imagse showed hyperintense 13?65%?cases and isointense 7?35%?cases.In SPLC group,15 cases?75%?showed slightly hypointense in T1-weighted images and5?25%?cases showed isointense.12?60%?cases showed hyperintense in T2-weighted images,7?35%?cases showed isointense,and 1?5%?case showed the surrounding hyperintense,hypointense in the central area.DWI imagse showed hyperintense 15?75%?cases and isointense 5?25%?cases.?3?MR signal intensity:The mean values of T2WI,peak height and enhanced increment in atypical PT?243.99±95.34,319.13±57.16 and 92.97±65.33,respectively?were both lower than the SPLC?303.98±52.41,428.11±72.95 and 224.63±47.66,respectively?,and the difference was statistically significant?P<0.05?.The mean values of T1WI and ADC in atypical PT(226.16±40.92 and?1.616±0.422?×10-3mm/s2,respectively)were both higher than the SPLC(205.52±35.45 and?1.141±0.150?×10-3mm/s2,respectively),while ADC had significant difference?P<0.05?,T1WI had no significant difference?P=0.096,P>0.05?.?4?Enhanced pattern:atypical PT showed a marginal rim enhancement pattern in 18 cases?90%?,inhomogeneous enhancement in 1?5%?case and homogeneous enhancement in 1?5%?case;SPLC showed inhomogeneous enhancement in 13?65%?cases,homogeneous enhancement in5?25%?cases and ring enhancement in 2?10%?cases.Conclusions:?1?Higher proportion of spicule sign,lobulation sign,vascular convergence sign and pleural indentation was observed in SPLC lesions than in atypical PT lesions,while cavity sign was less observed.?2?The signal of atypical PT depends on the pathological stage,DWI imagse showed hyperintense.SPLC showed slightly hypointense in T1-weighted images,showed hyperintense in T2-weighted images,DWI imagse showed hyperintense.?3?The mean values of T2WI,peak height and enhanced increment in SPLC were both higher than the atypical PT,and the mean values of ADC in was lower than the atypical PT,and the difference was statistically significant?P<0.05?.The mean values of T1WI had no significant difference?P>0.05?.?4?Atypical PT showed characteristic ringlike enhancement,SPLCshowedhomogeneousorinhomogeneousobvious enhancement. |
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