25例电焊工尘肺的影像学比较在职业病诊断鉴定的价值

目的探讨电焊工尘肺在DR与HRCT的影像表现特征性比较与诊断分析的价值,有利于提高尘肺职业病诊断的正确率。方法对我院进行电焊工尘肺诊断的25例患者采取DR摄影、HRCT扫描检查,由三人组成职业病尘肺鉴定小组进行回顾性诊断分析。结果 DR影像质量明显优于传统高仟伏胸片,在总体密度、小阴影形态、病变区域的显示判定等更为清晰。而HRCT对肺小叶中心磨玻璃样结节、分枝状线影、小叶间隔增厚和小叶中央型肺气肿,尤其是对电焊工尘肺所致的肺内尘斑及其纤维化程度更有优势。结论 DR、HRCT可以为尘肺职业病(电焊工尘肺)的诊断鉴定提供优质精确的影像资料,最大限度地避免误诊和医疗纠纷。     

尘肺CT扫描方案的探讨

目的比较常规剂量CT、低剂量CT及高分辨率CT（HRCT）3种扫描方案对尘肺的诊断能力,以期确定最佳方案。方法 37例经专业机构确诊的尘肺患者均经常规剂量CT、低剂量CT及HRCT3种方案扫描。采用统计学方法分析与比较该3种方案对尘肺特征性表现,小阴影、大阴影及进行性团块状纤维化（PMF）及纤维化早期表现及合并症的检出率。结果 3种扫描方案对小阴影、大阴影及团块状纤维化（PMF）的检出例数相符,均为36例、20例及16例,而对于大、小阴影及PMF周围的瘢痕肺气肿、肺纹理扭曲等征象,以HRCT显示较清晰。HRCT对早期肺间质纤维化,诸如胸膜改变、小叶间隔增厚、小叶肺气肿及蜂窝状影的显示例数显著多于其他两组（P〈0.05）。除肺气肿外,3种方案对其他合并症肺结核、肺癌及呼吸系统感染等的检出率无明显差别。结论低剂量CT与常规剂量CT均可用于尘肺的普查与诊断,为减少受检者的辐射剂量,应尽可能采用低剂量CT扫描。而对于肺间质改变的观察,HRCT应作为首选方案。     

煤工尘肺HRCT的形态学表现及诊断价值研究

目的：探索煤工尘肺的ＨＲＣＴ特征。方法：１２４例煤工尘肺作肺部常规ＣＴ,然后在主动脉弓顶、隆突水平、气管分叉下３ｃｍ右膈上２ｃｍ及重点兴趣区加作ＨＲＣＴ,对其图像表现进行研究。结果：本组１２４例煤工尘肺ＨＲＣＴ清晰地显示了肺小叶间隔增厚、小叶核心改变及小叶间质增厚、尘肺结节、各型肺气肿和大阴影等病变的特征。结论：ＨＲＣＴ对显示煤工尘肺微细病变的多种形态学表现极有帮助,在鉴别诊断中亦具有重要价值     

肺间质性疾病的HRCT表现及相关病理研究

目的：分析肺间质性疾病的HRCT表现及其与病理学的关系。方法：38例经手术病理证实的肺间质纤维化患者和疾病对照组14例分别行HRCT扫描、组织病理学检查（包括HE、Masson氏三色染色）及免疫组化。结果：早期组中肺小叶间隔增厚81.25%，肺内渗出毛玻璃影18.75%，肺内小结节影66.67%，胸膜下曲线12.5%；中、晚期组中肺小叶间隔纡曲、僵直、变形85.71%，支气管血管束纡曲、僵直35.71%，范围较广的肺气肿32.14%，蜂窝肺28.57%，胸膜增厚39.29％。结论：HRCT是一种安全、反映准确、无创性的诊断ILD的手段，经与病理对照、毛玻璃影、小叶间隔增厚，肺内小结节影、网状影和胸膜下曲线是ILD早期征象；而肺小叶间隔纡曲、僵直、变形，支气管血管束纡曲、僵直，范围较广的肺气肿及蜂窝肺是中、晚期的征象。     

生理通气辅助下HRCT靶扫描与薄层CT靶重建在肺磨玻璃样小结节诊断中的价值对比

目的：探讨生理通气辅助下高分辨率CT (HRCT)靶扫描与薄层CT靶重建在肺磨玻璃样小结节（sGGN）定性诊断中的价值比较。方法：回顾性分析经手术病理证实为肺腺癌的98例孤立性sGGN患者的临床及影像资料，其中不典型腺瘤样增生（AAH）+原位腺癌（AIS）组45例、微浸润性腺癌（MIA）组38例、浸润性腺癌（IAC）组15例。对所有结节均分别按薄层CT靶重建（A方案）及生理通气辅助下HRCT靶扫描（B方案）进行处理，评价图像质量、判断结节类型及统计结节征象、评估诊断信心并给出诊断结果，对阅片结果进行统计学分析。结果：2种方案在AAH+AIS组中的sGGN检出率相仿，但生理通气辅助下HRCT靶扫描在MIA组（P<0.001）和IAC组（P=0.017）中的sGGN检出率均显著高于薄层CT靶重建。生理通气辅助下HRCT靶扫描相较于薄层CT靶重建在密度征（P<0.001）、充气支气管征（P<0.001）、空泡征（P<0.005）及微血管征（P<0.001）等征象判断上有显著差异。生理通气辅助下HRCT靶扫描相较于薄层CT靶重建在肿瘤微血管征分型及与小支气管关系分...     

肺泡微石症的影像学诊断

目的：探讨肺泡微石症的影像学特征。方法;报道肺泡微石症6例,全部病例均行胸部X线检查,2例行常规CT,1例行HRCT。并对全部影像学表现进行了回顾性分析。结果：6例胸片表现为弥漫粟粒样微细结节（2例）。“鱼子样”或“暴风沙样”（2例）、“白肺样”（1例）及高密度“面纱样”改变（1例）,CT可明确肺内微细结节的钙化密度,肺尖部气肿样改变及支气管血管束增粗并呈钙化密度,HRCT则可进一步显示肺野磨砂玻璃样改变,小叶间隔,叶间胸膜及支气管血管束钙化密度与串珠状增厚,小叶中心分布的微细结节与胸膜下蜂窝,结论：肺泡微石症是一种罕见病,其影像学表现具有特征性,影像学检查尤以HRCT检查对该病的诊断有决定性作用。     

肺癌性淋巴管播散的CT表现

分析肺癌性淋巴管播散的CT表现，讨论诊断与鉴别诊断以及CT检查对本病的诊断价值。材料和方法：分析问例肺癌性淋巴管播散的有关资料，原发灶12例是肺癌，正例原发灶不明。且11例有常规CT扫描，其中8例加作高分辨率CT（HRCT）扫描：另2例单作HRCT检查。结果：10例有支气管血管束增厚，大部分呈边缘不规则状。9例显现多为均匀的小叶间隔增厚。胸膜病变有叶间胸膜增厚（8例）、胸膜结节（3例）、胸水（4例）。心包积液4例。9例有胸内淋巴结肿大，其中7例累及肺门淋巴结。结论：常规CT加HRCT能清晰显示肺癌性淋巴管播散的影像学表现而有利于正确诊断。考虑到的鉴别诊断有胸部结节病、间质性肺水肿。     

肺部HRCT术语含义辨释

肺部高分辨CT(HRCT)是采用1-2mm薄层及高空间频率重建算法所形成的能显示肺部细节的图像，是一种简单的肺取样手段。它能显示肺小叶水平上的微细结构和病变，为胸片和常规CT所不及。Todo在1982年最先报道用HRCT诊断肺部弥漫性病变，并将成像所见与相应的充气固定的肺标本作病理对照。从那时起对HRCT成像的解释基础一直仍应用X线——病理对照方法，借以阐明病变与肺小叶结构的关系。     

脓毒性肺栓塞的高分辨CT表现初探

目的探讨脓毒性肺栓塞(SPE)的高分辨CT(HRCT)表现。资料与方法回顾分析11例SPE患者的胸部HRCT表现。结果11例SPE的HRCT表现为实变及磨玻璃影、结节、楔形阴影、空洞、胸膜改变(如胸腔积液)等征象。其中52%结节影及37%楔形阴影可见滋养血管。7例经治疗后肺部改变消失。结论周围性分布的结节影、楔形阴影,结节影、楔形阴影内空洞形成以及与结节影及楔形阴影相连的血管影是SPE较为特征性的HRCT表现,对早期诊断及指导临床治疗有重要意义。     

特发性肺纤维化的高分辨率CT评价

目的 评价高分辨率CT（HRCT）对特发性肺纤维化（IPF）的诊断及鉴别诊断的价值,探讨病程与HRCT表现之间的关系。材料与方法 经临床及病理证实的29例IPF患者常规CT检查后对兴趣区行HRCT扫描,观察病变的分布及HRCT表现,并按病程在1年以下、1－2年、2－3年及3年以上分为4组,分析病程与HRCT表现之间的关系。结果 IPF的主要HRCT表现：（1）磨玻璃样密度影;（2）肺小叶间隔增厚;（3）小叶内间质增厚;（4）小叶结构变形;（5）蜂窝肺;（6）交界面不规则;（7）胸膜增厚。小叶间隔增厚及小叶内间质增厚。病程在2年以上分别占72％（21／29）及86％（12／14）。蜂窝肺病程在3年以上占60％（12／20）。病变呈周围型分布。结论 HRCT能细致、准确地反映IPF的大体病理变化,但各种征象均可见于其他各种间质性疾病,小叶间隔增厚及小叶间质增厚伴有肺结构变形和病变的周围型分布对诊断和鉴别诊断较有意义。诊断须结合临床并除外其他原因引起的肺纤维化。     

Subpleural micronodules in diffuse infiltrative lung diseases: evaluation with thin-section CT scans

Thin-section computed tomography (CT) was performed in 244 patients with infiltrative lung diseases and 29 healthy control subjects to evaluate the frequency, profusion, and diagnostic value of subpleural parenchymal micronodules. These areas of increased attenuation (less than 7 mm in diameter) were analyzed in four groups: coal miners with chest radiographic findings of coal worker's pneumoconiosis (n = 61), coal miners with no radiographic evidence of pneumoconiosis (n = 73), patients with nonoccupational chronic infiltrative lung disease (n = 110), and healthy adults (n = 29). Subpleural parenchymal micronodules were observed with high frequency in pulmonary lymphangitic carcinomatosis, coal worker's pneumoconiosis, and sarcoidosis but were also seen in 14% of control subjects. Predominant sites of lesions were the posterior subpleural areas in the upper lobes. Subpleural parenchymal micronodules have no diagnostic value when observed as an isolated CT finding but may suggest that diagnosis of pneumoconiosis, sarcoidosis, or pulmonary lymphangitic carcinomatosis when observed in association with mild parenchymal lesions.     

Pathologic-HRCT correlation of pneumoconiosis--a study on inflation-fixed lungs]

High resolution computed tomography (HRCT) findings were correlated with pathologic features of 14 inflation-fixed postmortem lungs with pneumoconiosis to evaluate the ability of HRCT to depict pneumoconiotic changes. The results are as follows: 1) Irregular peribronchiolar and interlobular fibrosis was the most constant pathologic feature in all lungs. This pathologic finding corresponded to an area of hazy increased density or reticular density on HRCT. The reticular density on HRCT became coarser with the progression of fibrosis. Mild fibrosis, confirmed by histologic procedures, could not be detected with HRCT. 2) Subpleural curvilinear line seen on HRCT in 5 lungs corresponded to band-like zone of fibrosis containing bronchioles or zone of collapsed alveoli with fibrotic thickening on histologic sections. A subpleural band-like zone of organized pneumonia was recognized in 2 cases. Subpleural patchy density was seen on HRCT in 8 cases. Five of them were histologically a focus of fibrosis and the other 3 were localized pulmonary edema, organized pneumonia, or atelectasis without fibrosis. 3) Pneumoconiotic nodules were located at centrilobular portion or along interlobular septa on histologic sections. These location were correspond to HRCT findings. They were round with irregular borders and were surrounded by a zone of enlarged air space. Overall 71% (182/256) of pathologically proved nodules were seen on HRCT, but 63% (52/83) of small "p" type nodules (smaller than 1.5 mm) could not be detected. Enlarged air space at the periphery of the nodules was seen on HRCT in 78% (122/156) of those pathologically proved. 4) A total of 12 lesions of progressive massive fibrosis was found in 5 lungs. An irregular border, seen on HRCT in all lesions, was pathologically based on the fibrosis extending into the surrounding alveoli and partially confluencing pneumoconiotic micronodules. Pleural indentation was seen in 8 lesions. Patent residual bronchi, spared from destructive fibrotic change, were seen as strand-like air density on HRCT in 4 of 6 lesions. 5) Focal emphysema was found pathologically in 9 of the 14 lungs. They appeared as non-peripheral, small low-attenuation area with a central dot on HRCT. The dot histologically corresponded to fibrosis around centriacinar bronchovascular bundle. The limit of visibility of this form of emphysema on HRCT was 2.0 mm in size. When emphysema was complicated by pneumonia, some showed honeycomb appearance on HRCT. 6) It is concluded that HRCT can detect and quantify the various pneumoconiotic changes of the lung and the HRCT-pathological correlation data presented here will be useful for the interpretation of the findings in clinical cases of pneumoconiosis.     

Evaluation of pneumoconiosis by high-resolution CT]

Forty-eight patients with pneumoconiosis (47 males and 1 female) were evaluated by high-resolution computed tomography (HRCT), which was compared with chest radiography and pulmonary function studies. 1) HRCT was superior to chest radiography in detecting small nodular shadows. There was a good correlation between HRCT and chest radiography in evaluating nodule quantity and size. 2) HRCT was superior to chest radiography in detecting emphysematous changes, and the difference was significant. HRCT and chest radiography were closely correlated in their evaluation of the grade of emphysema. 3) The grade of emphysema on HRCT was negatively correlated with the number of nodules. Subpleural curvilinear shadow (SCLS) on HRCT was correlated with the grade of emphysema, but not with the number of nodules. 4) The comparison with pulmonary function studies showed that emphysematous change on HRCT alone was correlated with %DLCO, while SCLS was correlated with FEV1.0%, RV/TLC and %DLCO. HRCT of the lung is useful for complementing chest radiography and pulmonary function studies in the evaluation of pneumoconiosis.     

尘肺某些并发症的CT对照分析

目的 分析尘肺及其并发症的CT表现。方法 24例呼吸系疾病患者被分为3组:8例经X线胸片确诊的尘肺,5例有接尘史,11例无接尘史。全部患者最初均经胸部常规性CT扫描。尘肺组还经薄层扫描及重建肺部HKCT图像。结果 CT显示3组病人或多或少均存在磨玻璃样改变,叶间裂间质增厚,全小叶型肺气肿,以及支气管血管束变细等病变,且未见组间明显差异。小叶间隔增厚与支气管血管束变粗仅见于尘肺组与接尘组。胸膜下肺气肿亦见尘肺组明显多于其他两组。结论 CT扫描不仅能显示X线胸片上所看到的尘肺特有的病变,还能提供尘肺并发症存在的可靠信息,因而有助于及时指导治疗。     

孤立性肺结节CT诊断的评价（附54例分析）

目的：探讨孤立性肺结节的CT表现及诊断。方法：对54例3．0cm以下的孤立性肺结节CT表现进行回顾性分析,其中恶性肿瘤30例,良性病变24例。CT常规扫描加病灶薄层扫描28例,常规扫描后行病灶区HRCT26例,增强扫描4例。结果：26例行HRCT扫描者术前显示病灶特征性改变,并作出正确诊断者22例（84．6％）,病灶局部薄层扫描术前诊断正确者15例（57．6％）,3例恶性肿瘤及1例良性肿瘤增强扫描均显示明显强化。结论：HRCT对肺癌及限局性机化性肺炎的鉴别诊断有较高价值,对孤立性肺结节以HRCT结合增强扫描并综合分析CT表现有助于提高定性诊断。     

Chest wall infiltration by lung cancer: value of thin-sectional CT with different reconstruction algorithms

The aim of this investigation was to evaluate whether thin-sectional CT with different reconstruction algorithms can improve the diagnostic accuracy with regard to chest wall invasion in patients with peripheral bronchogenic carcinoma. Forty-one patients with intrapulmonary lesions and tumor contact to the thoracic wall as seen on CT staging underwent additional 1-mm CT slices with reconstruction in a high-resolution (HR) and an edge blurring, soft detail (SD) algorithm. Five criteria were applied and validated by histological findings. Using the criteria of the intact fat layer, HRCT had a sensitivity of 81 % and a specificity of 79 %, SD CT had a sensitivity of 96 % and a specificity of 78 %, and standard CT technique had a sensitivity of 50 % and a specificity of 71 %, respectively. Regarding changes of intercostal soft tissue, HRCT achieved a sensitivity of 71 % and a specificity of 96 %, SD CT had a sensitivity of 94 % and a specificity of 96 % (standard CT technique: sensitivity 50 % and specificity 96 %) . For the other criteria, such as pleural contact area, angle, and osseous destruction, no significant differences were found. Diagnostic accuracy of chest wall infiltration can be improved by using thin sectional CT. Especially the application of an edge-blurring (SD) algorithm increases sensitivity and specificity without additional costs. Received: 4 September 1997; Revision received: 13 August 1998; Accepted: 15 January 1999     

Spiral CT findings in septic pulmonary emboli

OBJECTIVES: The aim of the study was to determine the characteristics of septic pulmonary emboli and their prevalence on spiral computed tomographic (CT) scans. METHODS AND MATERIALS: We evaluated 65 lesions on spiral CT scans in ten patients with septic pulmonary emboli. Spiral CT scans (10-mm collimation) were obtained at 10-mm intervals from the lung apex to the diaphragm and were compared with posteroanterior chest radiographs obtained within 24 h after CT scanning. RESULTS: Only 21 (32%) of the 65 lesions detected on CT scans were also detected on chest radiographs. Peripheral nodules (39 lesions (60%)) were seen in all ten patients, wedge-shaped peripheral lesions (15 lesions (23%)) in nine patients, and infiltrates (11 lesions (17%)) in four patients. Subpleural lesions (45 lesions (69%)) and feeding vessels (35 (54%)) were found in all patients, and cavitary lesions (seven lesions (11%)) were seen in four patients. Subpleural peripheral nodules and wedge-shaped peripheral lesions were seen in nine patients. Thirty-two lesions (49%) ranged in diameter from 10 to 19 mm, and 59 lesions (91%) were less than 30 mm. CONCLUSIONS: Spiral CT is useful in detecting septic pulmonary emboli. On spiral CT subpleural peripheral nodules and wedge-shaped peripheral lesions less than 30 mm in diameter are often found in patients with septic pulmonary emboli.     

Comparison of chest radiography and high-resolution computed tomography findings in early and low-grade coal worker's pneumoconiosis

INTRODUCTION: High-resolution computed tomography (HRCT) is more sensitive than chest X-ray (CXR) in the depiction of parenchymal abnormalities. We aimed to present and compare CXR and HRCT findings in coal workers with and without early and low-grade coal worker's pneumoconiosis (CWP). MATERIALS AND METHODS: 71 coal workers were enrolled in this study. All workers were male. The CXR and HRCT of those workers were obtained and graded by two trained readers. HRCT's were graded according to Hosoda and Shida's Japanese classification. After grading, 67 workers with CXR profusion 0/0-2/2 were included in the study. Four patients with major opacity were excluded. Profusion 0/1 to 1/1 cases were accepted as early and profusion 1/2 and 2/2 cases as low-grade pneumoconiosis. RESULTS: Discordance between CXR and HRCT was high. Discordance rate was found higher in the early pneumoconiosis cases with negative CXR than low-grade pneumoconiosis (60, 36 and 8%, respectively). When coal miners with normal CXR were evaluated by HRCT, six out of 10 cases were diagnosed as positive. In low-grade pneumoconiosis group, the number of patients with positive CXR but negative HRCT were low in comparison to patients with CXR negative and early pneumoconiosis findings. Most of the CXR category 0 patients (10/16) were diagnosed as category 1 by HRCT. Eleven cases diagnosed as CXR category 1 were diagnosed as category 0 (7/11) and category 2 (4/11) by HRCT. In CXR category 2 (eight cases), there were four cases diagnosed as category 1 by HRCT. CONCLUSIONS: Discordance between CXR and HRCT was high, especially for CXR negative and early pneumoconiosis cases. The role of CXR in screening coal workers to detect early pneumoconiosis findings should be questioned. We suggest using HRCT as a standard screening method instead of CXR to distinguish between normal and early pneumoconiosis.     

肺内2cm以下结节的HRCT诊断(附63例分析)

目的 :分析 2 .0cm以下肺内结节的HRCT表现。探讨提高早期肺癌的诊断正确率的征象 ,并与其他结节进行鉴别。方法 :行CT平扫检查 ,发现病灶后行HRCT连续扫描。结果 :6 3例均为单发结节 ,其中肺癌 4 7例 (占 74 .6 0 % ) ,结核 11例 ,炎性假瘤 3例 ,错构瘤 2例。结节与支气管关系的分类可分为五型 ,4 7例肺癌中Ⅲ、Ⅳ型表现者占 6 7% ,Ⅲ、Ⅳ型高度疑诊肺癌 (t =2 .4 6 9;P <0 .0 1)。普通平扫与HRCT相比征象确定率分别为 5 2 .38%和 87.2 0 %。结论 :HRCT在诊断肺内 2 .0cm以下结节上有较大优势 ,所见征象更真实、可靠 ,提高了早期肺癌诊断正确率 ,并可与其他结节作出较明确的鉴别诊断