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目的 研究分析成人纵隔淋巴结结核的多层螺旋CT(MSCT)细节征象,提高成人纵隔淋巴结结核的诊断水平.方法 回顾性分析广州市胸科医院2011年1月1日至2016年7月30日确诊的52例成人纵隔淋巴结结核患者(作为研究组;共272个淋巴结结核病灶)的MSCT细节表现,并与广州市胸科医院同时期确诊的52例成人淋巴结转移癌患者(作为对照组;共250个淋巴结转移癌病灶)的MSCT细节表现进行比较.通过对两组患者MSCT平扫及增强薄层扫描细节特点的对比,分析成人纵隔淋巴结结核的MSCT特征.结果 (1)研究组纵隔淋巴结结核发生部位排在前三位的区域依次是4R区、2R区、7区,分别为96个(35.3％,96/272)、69个(25.4％,69/272)、47个(17.3％,47/272),均明显高于对照组[分别为59个(23.6％,59/250)、21个(8.4％,21/250)、18个(7.2％,18/250)],差异均有统计学意义(x2值分别为8.53、26.28、11.00,P值分别为＜0.01、＜0.01、＜0.01);(2)研究组纵隔淋巴结结核的MSCT薄层扫描显示,钙化灶、融合及密度不均匀的淋巴结结核病灶分别为85个(31.2％,85/272)、158个(58.1％,158/272)、163个(59.9％,163/272),均明显高于对照组[分别为7个(2.8％,7/250)、123个(49.2％,123/250)、65个(26.0％,65/250)],差异均有统计学意义(x2值分别为72.63、4.14、60.95,P值分别为＜0.01、0.042、＜0.01);(3)研究组纵隔淋巴结结核病灶的MSCT增强薄层扫描强化特点为薄壁环形强化、环形细小分隔样强化、多环重叠性强化,分别为104个(38.2％,104/272)、56个(20.6％,56/272)、47个(17.3％,47/272),均明显高于对照组[分别为63个(25.2％,63/250)、25个(10.0％,25/250)、26个(10.4％,26/250)],差异均有统计学意义(x2值分别为10.17、11.14、5.13,P值分别为＜0.01、＜0.01、0.024);(4)研究组纵隔淋巴结结核伴随征象为,42例(80.8％,42/52)并发肺结核,17例(32.7％,17/52)肺内有斑条状纤维增殖性病灶,15例(28.8％,15/52)肺内有斑点状钙化灶,22例(42.3％,22/52)出现胸腔积液,3例(5.8％,3/52)胸膜粘连钙化,5例(9.6％,5/52)并发胸膜结核瘤.结论 成人纵隔淋巴结结核好发于右上纵隔,病灶的钙化灶、融合及密度不均匀比率明显高于淋巴结转移癌,以薄壁环形强化、环形细小分隔样强化、多环重叠性强化为主要表现.“,”Objective To analysis the details of multi-slice spiral CT (MSCT) in adult tuberculosis with mediastinal lymph node,helping diagnosing of tuberculosis with mediastinal lymph nodes.Methods Details of MSCT in 52 tuberculosis patients with mediastinal lymph node from Guangzhou Chest Hospital between January 1,2011 and July 30,2016 (study group with a total of 272 lymph node tuberculosis) were retrospectively studied,compared to 52 patients with metastatic carcinoma of lymph node which were diagnosed during the same period in Guangzhou Chest Hospital (control group with a total of 250 metastatic carcinoma of lymph node).MSCT plain scan and enhanced thin layer scanning characteristics of the two groups were compared and analyzed.Results (1)The 4R area (96 (35.3％,96/272)),2R area (69 (25.4％,69/272)),and 7 area (47 (17.3％,47/272)) were the top three lesions that mediastinal lymph node infiltrated,which were significantly higher than those of the control group (59 (23.6％,59/250),21 (8.4％,21/250),and 18 (7.2％,18/250),respectively) (x2 =8.53,26.28,11.00,P=＜0.01,＜0.01,＜0.01,respectively).(2)MSCT thin layer scanning of the study group indicated that calcification,fusion and density were significantly higher than those of the control group (85 (31.2％,85/272) vs.7 (2.8％,7/250),158 (58.1％,158/272) vs.123 (49.2％,123/250),and 163 (59.9％,163/272) vs.65 (26.0％,65/250);x2 =72.63,4.14,60.95,P＜0.01,0.042,＜0.01;respectively).(3) Characteristics of enhanced MSCT scan of the study group were thin wall annular reinforcement,annular fine separation and multiple overlapping enhancement,which were significantly higher than those in the control group (104 (38.2％,104/272) vs.63 (25.2％,63/250),56 (20.6％,56/272) vs.25 (10.0％,25/250),47 (17.3％,47/272) vs.26 (10.4％,26/250);x2=10.17,11.14,5.13,P＜0.01,＜0.01,0.024;respectively).(4)Complicated signs with the study group were pulmonary tuberculosis (42 (80.8％,42/52)),striped fibers in the lung (17 (32.7％,17/52)),speckled calcification (15 (28.8％,15/52)),pleural effusion (22 (42.3％,22/52)),pleural adhesion calcification (3 (5.8％,3/52)) and pleural tuberculosis (5 (9.6％,5/52)).Conclusion The adult tuberculosis of mediastinal lymph node occurs mainly in right upper mediastinal,the calcification,fusion and density of lesions were significant ly higher than those of lymph node metastatic.The main features of MSCT are thin wall annular reinforcement,annular fine separation,and multiple overlapping enhancement.