J Korean Radiol Soc.  1996 May;34(5):605-615.

High Resolution computed Tomography(HRCT) Findings of a Solitary Pulmonary Nodule: Differential Diagnosis of Cancer and Tuberculosis

• Kim HS
• Choe KO

Abstract

PURPOSE
To evaluate the role of HRCT in the differentiation of pulmonary tuberculosis and lung cancer, where the manifestation of disease is a solitary pulmonary nodule(SPN). MATERIAL AND METHODS : Forty eight SPNs including 29 cancers proven by surgery(n=10), by bronchoscopic biopsy(n=7) and by fine needle aspirationbiopsy(n=12), and 19 tuberculous nodules proven by surgery(n=4), by bronchoscopic biopsy(n=4), by fine needle aspiration biopsy(n=5), by a positive result in AFB culture without evidence of malignant cells(n=3), and by adecrease in size on serial plain chests despite negative AFB culture(n=3) were included. Scanning parameters forHRCT were 140KVp, 170mA, 1.5mm collimation, 3 sec scanning time, and a high spatial frequency algorithm was used.
RESULTS
With regard to the marginal features of nodules, the findings mor commonly observed in malignant nodules were greater average length of the longest spicule(5.35 +/-3.19mm versus 2.75 +/-1.56mm), and more commonspiculated nodules greater than 3cm in diameter, 16(55%) versus 2(10.5%)(P<0.05). Regarding the internal characteristics of nodules and perinodular parenchymal changes, the findings more commonly observed in cases of cancer were air-bronchograms within nodules(14;48.3%) and interlobar fissure puckering(6;20.7%), whereas intuberculosis cases the most common findings were low density of nodule(16;84.2%), cavitation(12;63.1%), and perinodular focal lung hypodensity(5;26.3%),(p<0.05). No statstically significant difference was observed between the incidence of satellite lesions of tuberculous(73.7%) and of malignant nodules(34.5%). However, perilobular nodules or bronchovascular bundle thickenings were more commonly observed in the satellite lesions of malignant nodules(9;90%), whereas centrilobular nodules or lobular consolidation were more commonly observed in those of tuberculous nodules(12;85.7%),(p<0.05).
CONCLUSION
HRCT provides detailed information concerning perinodularparenchymal changes and characteristics of satellite nodules as well as marginal features and internal characteristics of SPNs which may play a significant role in differentiating pulmonary tuberculosis from malignant nodules.

Keyword

Lung, nodule; Lung, CT; Tuberculosis, pulmonary; Lung neoplasms, CT

MeSH Terms

Diagnosis, Differential*
Incidence
Lung
Lung Neoplasms
Needles
Solitary Pulmonary Nodule*
Thorax
Tuberculosis*
Tuberculosis, Pulmonary