1 research outputs found
Radiation semiotics of disseminated pulmonary tuberculosis
The aim of the study was to optimize the radiation diagnosis and differentiation of disseminated pulmonary tuberculosis (DTL) by studying the ray lung semiotics using multislice computed tomography (MSCT), radionuclide diagnostics (RND) with the use of a radiopharmaceutical (RFP) 99mTc-technetril and identifying the most informative for disseminated tuberculosis MSCT- RIA criteria. Materials and methods. The analysis of MSCT data was performed in 67 patients who had X-ray signs of pulmonary dissemination. The study was conducted on a multislice computer tomograph Somatom Emotion 16 from Siemens. 23 patients underwent a radionuclide study with a 99mTc-technetril radiopharmaceutical on the Nucline Spirit gamma camera in the planar and single-photon emission computerized tomography (SPECT) mode. The statistical processing of the data was carried out using the MicrosoftExcel software package. The reliability of the differences between the qualitative indices of the compared groups was determined using the Ο2 criterion. Results. The distribution of foci of dissemination according to MSCT using the high resolution algorithm (HRCT) was characterized by localization of dissemination foci in the structures of the primary, secondary pulmonary lobe, perivascular and peribronchial, involvement of pleura piles of various degrees and reactive changes in the intrathoracic lymph nodes (VGLU). In 55.7% of cases, foci with DTL were distributed in intralobular structures, lobular septa and endobronchial. In 86.3%, fragmentary infiltration of axial interstitium was noted. There was also marked infiltration of pleura sheets involving extrapuleural fat tissue in 50.7% of cases. Hyperplasia of the intrathoracic lymph nodes was established in 12.5% of cases. According to planar and SPECT studies in 21.0%, the prevalence of dissemination by CT correlated with accumulation of RFP in the lungs according to planar research and topically - in VGLU according to SPECT. In 81.8% of cases of hyperplasia of lymph nodes revealed by CT, there was an accumulation of RFP by SPECT. In 42.1% of cases of limited dissemination, according to CT, there was a diffuse accumulation of RFP following the results of planar scintigraphy. Conclusion Interpretation of the obtained data, taking into account the level of damage to the structural units of the lung with the definition of activity and prevalence in the application of different radiotherapy techniques, allows to optimize the diagnosis and differential diagnosis of disseminated pulmonary tuberculosis.Π¦Π΅Π»Ρ ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΡ - ΠΎΠΏΡΠΈΠΌΠΈΠ·Π°ΡΠΈΡ Π»ΡΡΠ΅Π²ΠΎΠΉ Π΄ΠΈΠ°Π³Π½ΠΎΡΡΠΈΠΊΠΈ ΠΈ Π΄ΠΈΡΡΠ΅ΡΠ΅Π½ΡΠΈΠ°ΡΠΈΠΈ Π΄ΠΈΡΡΠ΅ΠΌΠΈΠ½ΠΈΡΠΎΠ²Π°Π½Π½ΠΎΠ³ΠΎ ΡΡΠ±Π΅ΡΠΊΡΠ»Π΅Π·Π° Π»Π΅Π³ΠΊΠΈΡ
(ΠΠ’Π) ΠΏΠΎΡΡΠ΅Π΄ΡΡΠ²ΠΎΠΌ ΠΈΠ·ΡΡΠ΅Π½ΠΈΡ Π»ΡΡΠ΅Π²ΠΎΠΉ ΡΠ΅ΠΌΠΈΠΎΡΠΈΠΊΠΈ Π»ΡΠ³ΠΊΠΈΡ
ΠΌΠ΅ΡΠΎΠ΄ΠΎΠΌ ΠΌΡΠ»ΡΡΠΈΡΡΠ΅Π·ΠΎΠ²ΠΎΠΉ ΠΊΠΎΠΌΠΏΡΡΡΠ΅ΡΠ½ΠΎΠΉ ΡΠΎΠΌΠΎΠ³ΡΠ°ΡΠΈΠΈ (ΠΠ‘ΠΠ’), ΡΠ°Π΄ΠΈΠΎΠ½ΡΠΊΠ»ΠΈΠ΄Π½ΠΎΠΉ Π΄ΠΈΠ°Π³Π½ΠΎΡΡΠΈΠΊΠΈ (Π ΠΠ) Ρ ΠΏΡΠΈΠΌΠ΅Π½Π΅Π½ΠΈΠ΅ΠΌ ΡΠ°Π΄ΠΈΠΎΡΠ°ΡΠΌΠΏΡΠ΅ΠΏΠ°ΡΠ°ΡΠ° (Π Π€Π) 99mTΡ-ΡΠ΅Ρ
Π½Π΅ΡΡΠΈΠ»Π° ΠΈ Π²ΡΡΠ²Π»Π΅Π½ΠΈΠ΅ Π½Π°ΠΈΠ±ΠΎΠ»Π΅Π΅ ΠΈΠ½ΡΠΎΡΠΌΠ°ΡΠΈΠ²Π½ΡΡ
Π΄Π»Ρ Π΄ΠΈΡΡΠ΅ΠΌΠΈΠ½ΠΈΡΠΎΠ²Π°Π½Π½ΠΎΠ³ΠΎ ΡΡΠ±Π΅ΡΠΊΡΠ»ΡΠ·Π° ΠΠ‘ΠΠ’-Π ΠΠ ΠΊΡΠΈΡΠ΅ΡΠΈΠ΅Π². ΠΠ°ΡΠ΅ΡΠΈΠ°Π»Ρ ΠΈ ΠΌΠ΅ΡΠΎΠ΄Ρ. ΠΡΠΎΠ²Π΅Π΄Π΅Π½ Π°Π½Π°Π»ΠΈΠ· Π΄Π°Π½Π½ΡΡ
ΠΠ‘ΠΠ’ ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΡ 67 Π±ΠΎΠ»ΡΠ½ΡΡ
, Ρ ΠΊΠΎΡΠΎΡΡΡ
ΠΎΠΏΡΠ΅Π΄Π΅Π»ΡΠ»ΠΈΡΡ ΡΠ΅Π½ΡΠ³Π΅Π½ΠΎΠ»ΠΎΠ³ΠΈΡΠ΅ΡΠΊΠΈΠ΅ ΠΏΡΠΈΠ·Π½Π°ΠΊΠΈ Π»Π΅Π³ΠΎΡΠ½ΠΎΠΉ Π΄ΠΈΡΡΠ΅ΠΌΠΈΠ½Π°ΡΠΈΠΈ. ΠΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΠ΅ ΠΏΡΠΎΠ²Π΅Π΄Π΅Π½ΠΎ Π½Π° ΠΌΡΠ»ΡΡΠΈΡΡΠ΅Π·ΠΎΠ²ΠΎΠΌ ΠΊΠΎΠΌΠΏΡΡΡΠ΅ΡΠ½ΠΎΠΌ ΡΠΎΠΌΠΎΠ³ΡΠ°ΡΠ΅ Somatom Emotion 16 ΡΠΈΡΠΌΡ Siemens. 23 ΠΏΠ°ΡΠΈΠ΅Π½ΡΠ°ΠΌ ΠΏΡΠΎΠ²Π΅Π΄Π΅Π½ΠΎ ΡΠ°Π΄ΠΈΠΎΠ½ΡΠΊΠ»ΠΈΠ΄Π½ΠΎΠ΅ ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΠ΅ Ρ ΡΠ°Π΄ΠΈΠΎΡΠ°ΡΠΌΠΏΡΠ΅ΠΏΠ°ΡΠ°ΡΠΎΠΌ 99mTΡ-ΡΠ΅Ρ
Π½Π΅ΡΡΠΈΠ»ΠΎΠΌ Π½Π° Π³Π°ΠΌΠΌΠ°-ΠΊΠ°ΠΌΠ΅ΡΠ΅ Nucline Spirit Π² ΠΏΠ»Π°Π½Π°ΡΠ½ΠΎΠΌ ΠΈ ΠΎΠ΄Π½ΠΎΡΠΎΡΠΎΠ½Π½ΠΎΠΌ ΡΠΌΠΈΡΡΠΈΠΎΠ½Π½ΠΎΠΌ ΠΊΠΎΠΌΠΏΡΡΡΠ΅ΡΠ½ΠΎΠΌ ΡΠΎΠΌΠΎΠ³ΡΠ°ΡΠΈΡΠ΅ΡΠΊΠΎΠΌ (ΠΠ€ΠΠΠ’) ΡΠ΅ΠΆΠΈΠΌΠ΅. Π‘ΡΠ°ΡΠΈΡΡΠΈΡΠ΅ΡΠΊΡΡ ΠΎΠ±ΡΠ°Π±ΠΎΡΠΊΡ Π΄Π°Π½Π½ΡΡ
ΠΎΡΡΡΠ΅ΡΡΠ²Π»ΡΠ»ΠΈ Ρ ΠΏΠΎΠΌΠΎΡΡΡ ΠΏΠ°ΠΊΠ΅ΡΠ° ΠΏΡΠΎΠ³ΡΠ°ΠΌΠΌ Β«MicrosoftExcelΒ». ΠΠΏΡΠ΅Π΄Π΅Π»Π΅Π½ΠΈΠ΅ Π΄ΠΎΡΡΠΎΠ²Π΅ΡΠ½ΠΎΡΡΠΈ ΡΠ°Π·Π»ΠΈΡΠΈΠΉ ΠΌΠ΅ΠΆΠ΄Ρ ΠΊΠ°ΡΠ΅ΡΡΠ²Π΅Π½Π½ΡΠΌΠΈ ΠΏΠΎΠΊΠ°Π·Π°ΡΠ΅Π»ΡΠΌΠΈ ΡΡΠ°Π²Π½ΠΈΠ²Π°Π΅ΠΌΡΡ
Π³ΡΡΠΏΠΏ ΠΏΡΠΎΠ²ΠΎΠ΄ΠΈΠ»ΠΈ Ρ ΠΏΠΎΠΌΠΎΡΡΡ ΠΊΡΠΈΡΠ΅ΡΠΈΡ Π²2. ΡΠ΅Π·ΡΠ»ΡΡΠ°ΡΡ. ΡΠ°ΡΠΏΡΠ΅Π΄Π΅Π»Π΅Π½ΠΈΠ΅ ΠΎΡΠ°Π³ΠΎΠ² Π΄ΠΈΡΡΠ΅ΠΌΠΈΠ½Π°ΡΠΈΠΈ ΠΏΠΎ Π΄Π°Π½Π½ΡΠΌ ΠΠ‘ΠΠ’ Ρ ΠΈΡΠΏΠΎΠ»ΡΠ·ΠΎΠ²Π°Π½ΠΈΠ΅ΠΌ Π°Π»Π³ΠΎΡΠΈΡΠΌΠ° Π²ΡΡΠΎΠΊΠΎΠ³ΠΎ ΡΠ°Π·ΡΠ΅ΡΠ΅Π½ΠΈΡ (ΠΠ’ΠΠ ), Ρ
Π°ΡΠ°ΠΊΡΠ΅ΡΠΈΠ·ΠΎΠ²Π°Π»ΠΎΡΡ Π»ΠΎΠΊΠ°Π»ΠΈΠ·Π°ΡΠΈΠ΅ΠΉ ΠΎΡΠ°Π³ΠΎΠ² Π΄ΠΈΡΡΠ΅ΠΌΠΈΠ½Π°ΡΠΈΠΈ Π² ΡΡΡΡΠΊΡΡΡΠ°Ρ
ΠΏΠ΅ΡΠ²ΠΈΡΠ½ΠΎΠΉ, Π²ΡΠΎΡΠΈΡΠ½ΠΎΠΉ Π»Π΅Π³ΠΎΡΠ½ΠΎΠΉ Π΄ΠΎΠ»ΡΠΊΠΈ, ΠΏΠ΅ΡΠΈΠ²Π°ΡΠΊΡΠ»ΡΡΠ½ΠΎ ΠΈ ΠΏΠ΅ΡΠΈΠ±ΡΠΎΠ½Ρ
ΠΈΠ°Π»ΡΠ½ΠΎ, Π²ΠΎΠ²Π»Π΅ΡΠ΅Π½ΠΈΠΈ Π»ΠΈΡΡΠΊΠΎΠ² ΠΏΠ»Π΅Π²ΡΡ ΡΠ°Π·Π»ΠΈΡΠ½ΠΎΠΉ ΡΡΠ΅ΠΏΠ΅Π½ΠΈ ΠΈ ΡΠ΅Π°ΠΊΡΠΈΠ²Π½ΡΠΌΠΈ ΠΈΠ·ΠΌΠ΅Π½Π΅Π½ΠΈΡΠΌΠΈ Π²Π½ΡΡΡΠΈΠ³ΡΡΠ΄Π½ΡΡ
Π»ΠΈΠΌΡΠ°ΡΠΈΡΠ΅ΡΠΊΠΈΡ
ΡΠ·Π»ΠΎΠ² (ΠΠΠΠ£). Π 55,7% ΡΠ»ΡΡΠ°Π΅Π² ΠΎΡΠ°Π³ΠΈ ΠΏΡΠΈ ΠΠ’Π ΡΠ°ΡΠΏΡΠΎΡΡΡΠ°Π½ΡΠ»ΠΈΡΡ Π²ΠΎ Π²Π½ΡΡΡΠΈΠ΄ΠΎΠ»ΡΠΊΠΎΠ²ΡΡ
ΡΡΡΡΠΊΡΡΡΠ°Ρ
, Π΄ΠΎΠ»ΡΠΊΠΎΠ²ΡΡ
ΠΏΠ΅ΡΠ΅Π³ΠΎΡΠΎΠ΄ΠΊΠ°Ρ
ΠΈ ΡΠ½Π΄ΠΎΠ±ΡΠΎΠ½Ρ
ΠΈΠ°Π»ΡΠ½ΠΎ. Π 86,3% ΠΎΡΠΌΠ΅ΡΠ°Π»Π°ΡΡ ΡΡΠ°Π³ΠΌΠ΅Π½ΡΠ°ΡΠ½Π°Ρ ΠΈΠ½ΡΠΈΠ»ΡΡΡΠ°ΡΠΈΡ Π°ΠΊΡΠΈΠ°Π»ΡΠ½ΠΎΠ³ΠΎ ΠΈΠ½ΡΠ΅ΡΡΡΠΈΡΠΈΡ. ΠΎΡΠΌΠ΅ΡΠ°Π»Π°ΡΡ ΡΠ°ΠΊΠΆΠ΅ Π²ΡΡΠ°ΠΆΠ΅Π½Π½Π°Ρ ΠΈΠ½ΡΠΈΠ»ΡΡΡΠ°ΡΠΈΡ Π»ΠΈΡΡΠΊΠΎΠ² ΠΏΠ»Π΅Π²ΡΡ Ρ Π²ΠΎΠ²Π»Π΅ΡΠ΅Π½ΠΈΠ΅ΠΌ ΡΠΊΡΡΡΠ°ΠΏΠ»Π΅Π²ΡΠ°Π»ΡΠ½ΠΎΠΉ ΠΆΠΈΡΠΎΠ²ΠΎΠΉ ΠΊΠ»Π΅ΡΡΠ°ΡΠΊΠΈ Π² 50,7% ΡΠ»ΡΡΠ°Π΅Π². ΠΠΈΠΏΠ΅ΡΠΏΠ»Π°Π·ΠΈΡ Π²Π½ΡΡΡΠΈΠ³ΡΡΠ΄Π½ΡΡ
Π»ΠΈΠΌΡΠ°ΡΠΈΡΠ΅ΡΠΊΠΈΡ
ΡΠ·Π»ΠΎΠ² ΡΡΡΠ°Π½ΠΎΠ²Π»Π΅Π½Π° Π² 12,5% ΡΠ»ΡΡΠ°Π΅Π². ΠΠΎ Π΄Π°Π½Π½ΡΠΌ ΠΏΠ»Π°Π½Π°ΡΠ½ΠΎΠ³ΠΎ ΠΈ ΠΠ€ΠΠΠ’ ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΡ Π² 21,0% ΡΠ°ΡΠΏΡΠΎΡΡΡΠ°Π½Π΅Π½Π½ΠΎΡΡΡ Π΄ΠΈΡΡΠ΅ΠΌΠΈΠ½Π°ΡΠΈΠΈ ΠΏΠΎ ΠΠ’ ΠΊΠΎΡΡΠ΅Π»ΠΈΡΠΎΠ²Π°Π»Π° Ρ Π½Π°ΠΊΠΎΠΏΠ»Π΅Π½ΠΈΠ΅ΠΌ Π Π€Π Π² Π»Π΅Π³ΠΊΠΈΡ
ΠΏΠΎ Π΄Π°Π½Π½ΡΠΌ ΠΏΠ»Π°Π½Π°ΡΠ½ΠΎΠ³ΠΎ ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΡ ΠΈ ΡΠΎΠΏΠΈΡΠ΅ΡΠΊΠΈ - Π²ΠΎ ΠΠΠΠ£ ΠΏΠΎ Π΄Π°Π½Π½ΡΠΌ ΠΠ€ΠΠΠ’. Π 81,8% Π²ΡΡΠ²Π»Π΅Π½Π½ΡΡ
ΠΏΠΎ ΠΠ’ ΡΠ»ΡΡΠ°ΡΡ
Π³ΠΈΠΏΠ΅ΡΠΏΠ»Π°Π·ΠΈΠΈ Π»ΠΈΠΌΡΠ°ΡΠΈΡΠ΅ΡΠΊΠΈΡ
ΡΠ·Π»ΠΎΠ² ΠΎΡΠΌΠ΅ΡΠ΅Π½ΠΎ Π½Π°ΠΊΠΎΠΏΠ»Π΅Π½ΠΈΠ΅ Π Π€Π ΠΏΠΎ ΠΠ€ΠΠΠ’. Π 42,1% ΡΠ»ΡΡΠ°Π΅Π² ΠΎΠ³ΡΠ°Π½ΠΈΡΠ΅Π½Π½ΠΎΠΉ Π΄ΠΈΡΡΠ΅ΠΌΠΈΠ½Π°ΡΠΈΠΈ ΠΏΠΎ Π΄Π°Π½Π½ΡΠΌ ΠΠ’ ΠΎΡΠΌΠ΅ΡΠ°Π»ΠΎΡΡ Π΄ΠΈΡΡΡΠ·Π½ΠΎΠ΅ Π½Π°ΠΊΠΎΠΏΠ»Π΅Π½ΠΈΠ΅ Π Π€Π ΠΏΠΎ ΡΠ΅Π·ΡΠ»ΡΡΠ°ΡΠ°ΠΌ ΠΏΠ»Π°Π½Π°ΡΠ½ΠΎΠΉ ΡΡΠΈΠ½ΡΠΈΠ³ΡΠ°ΡΠΈΠΈ. ΠΠ°ΠΊΠ»ΡΡΠ΅Π½ΠΈΠ΅ ΠΠ½ΡΠ΅ΡΠΏΡΠ΅ΡΠ°ΡΠΈΡ ΠΏΠΎΠ»ΡΡΠ΅Π½Π½ΡΡ
Π΄Π°Π½Π½ΡΡ
Ρ ΡΡΠ΅ΡΠΎΠΌ ΡΡΠΎΠ²Π½Ρ ΠΏΠΎΡΠ°ΠΆΠ΅Π½ΠΈΡ ΡΡΡΡΠΊΡΡΡΠ½ΡΡ
Π΅Π΄ΠΈΠ½ΠΈΡ Π»Π΅Π³ΠΊΠΎΠ³ΠΎ Ρ ΠΎΠΏΡΠ΅Π΄Π΅Π»Π΅Π½ΠΈΠ΅ΠΌ Π°ΠΊΡΠΈΠ²Π½ΠΎΡΡΠΈ ΠΈ ΡΠ°ΡΠΏΡΠΎΡΡΡΠ°Π½Π΅Π½Π½ΠΎΡΡΠΈ ΠΏΡΠΈ ΠΏΡΠΈΠΌΠ΅Π½Π΅Π½ΠΈΠΈ ΡΠ°Π·Π½ΡΡ
Π»ΡΡΠ΅Π²ΡΡ
ΠΌΠ΅ΡΠΎΠ΄ΠΈΠΊ ΠΏΠΎΠ·Π²ΠΎΠ»ΡΠ΅Ρ ΠΎΠΏΡΠΈΠΌΠΈΠ·ΠΈΡΠΎΠ²Π°ΡΡ Π΄ΠΈΠ°Π³Π½ΠΎΡΡΠΈΠΊΡ ΠΈ Π΄ΠΈΡΡΠ΅ΡΠ΅Π½ΡΠΈΠ°Π»ΡΠ½ΡΡ Π΄ΠΈΠ°Π³Π½ΠΎΡΡΠΈΠΊΡ Π΄ΠΈΡΡΠ΅ΠΌΠΈΠ½ΠΈΡΠΎΠ²Π°Π½Π½ΠΎΠ³ΠΎ ΡΡΠ±Π΅ΡΠΊΡΠ»Π΅Π·Π° Π»Π΅Π³ΠΊΠΈΡ