肺泡状棘球蚴病的CT表现特征

目的 分析肺泡状棘球蚴病的CT表现特征,评价CT诊断该病的价值.方法 回顾性分析26例经病理确诊或临床综合诊断为肺泡状棘球蚴病的CT表现特征及各种表现的病理基础.结果 双肺多发病灶18例,一侧肺多发病灶6例,双肺单发病灶2例.其中病灶为肿块结节混合型17 例,结节型8例,1例为单发肿块.26例中24例病灶边缘可见分叶状或锯齿状突起,13例病灶内可见不规则空洞、空泡,18例病灶内可见钙化,14例病灶邻近的肺组织内见到少量斑片或条索影,20例邻近胸壁的病灶处胸膜增厚明显,病灶以宽基底与胸壁相贴.结论 肺泡状棘球蚴病有较明显的CT表现特征,CT检查能为该病的诊断提供重要价值.

Abstract：

Objective To analyze the CT features of lung alveolar echinococcosis and assess the value of CT scanning for the diagnosis of this disease. Methods The CT features of lung alveolar echinococcosis in 26 patients diagnosed pathologically or clinically were reviewed retrospectively and correlated with histopathology.Results Lung alveolar echinococcosis appeared as multiple lesions bilaterally in 18 patients, as multiple lesions unilaterally in 6 patients, and as single lesion bilaterally in 2 patients. Seventeen cases presented as masses and nodules,8 patients presented as nodules,1 patient presented as a mass. Lobulation and spiculation were showed in most lesions, irregular cavity or bubble-like opacity in 13 patients,calcification in 18 patients,a patchy area or fibrotic cord around lesion in 14 patients. Pleural thickening adjacent to the lesion in 20 patients. Conclusion Lung alveolar echinococcosis has characteristic features on CT, and CT can provide important information for the diagnosis of lung alveolar echinococcosis.     

肺黏膜相关淋巴组织型淋巴瘤的影像表现

目的 探讨肺黏膜相关淋巴组织型(MALT)淋巴瘤CT或18F-脱氧葡萄糖(FDG)PETCT表现及其诊断价值.方法 回顾性分析14例经手术及病理证实的肺MALT淋巴瘤的CT或18F-FDG PET-CT表现特点.结果 单肺病灶7例,双肺病灶7例,其中单发实变影3例,单发肿块影3例,单发结节影1例,多发结节影1例,肿块影合并结节影、斑片状影1例,实变影合并斑片状影4例,弥漫性间质性病变1例.9例有支气管充气征,5例有CT血管造影征.2例FDG代谢不均匀增高,最大标准摄取值超过2.5.结论 肺MALT淋巴瘤的影像特征性表现主要为单发或多发结节、肿块或实变影,内有支气管充气征,18F-FDG高代谢,确诊主要依靠病理组织学和免疫组织化学.

Abstract：

Objective To assess the value of CT or PET-CT with fluorine-18-labeled fluorodeoxyglucose (FDG) for the diagnosis of pulmonary mucosa-associated lymphoid tissue (MALT) type lymphoma. Methods The CT or FDG PET-CT findings in 14 patients with pathologically proved pulmonary MALT lymphoma were retrospectively analyzed. Results Lung lesions were unilateral in 7 patients and bilateral in 7 patients. Lesions presented as a single mass in 3 patients, as a single consolidation in 3 patients, as a nodule in 1 patient, as multiple nodules in 1 patient, as multiple patchy consolidations in 4 patients, as a mass with multiple nodules and patchy consolidations in 1 patients, as diffuse interstitial change in 1 patients. Air bronchogram was found in 9 patients and CT angiogram sign in 5 patients. On PET-CT, lesions showed heterogeneous FDG uptake in 2 patients, maximum standard uptake value was higher than 2. 5. Conclusion Imaging characteristics of pulmonary MALT lymphoma are single or multiple nodules or consolidations with air bronchogram on CT, and heterogeneous high FDG uptake on PET-CT.     

成人麻疹病毒肺炎的影像表现

目的 探讨成人麻疹肺炎的胸部影像表现.方法 对163例成人麻疹患者行胸部X线平片检查,其中3例行MSCT扫描,共确诊10例成人麻疹肺炎患者.结果 10例肺炎患者中8例X线胸片异常,特征性表现为磨玻璃密度影(6例)和支气管增粗(2例);2例X线胸片正常者行MSCT检查.MSCT表现为双肺磨玻璃密度灶1例,右上叶呈肺小叶分布的磨玻璃密度灶2例.结论 了解麻疹肺炎的X线胸片和MSCT表现可以缩小鉴别诊断范围,首次X线胸片正常患者不能除外肺部受累.

Abstract：

Objective To illustrate the chest radiography and MSCT findings of measles pneumonia in adults. Methods One hundred and sixty three measles patients underwent chest radiography, MSCT was performed in 3 of them. Measles pneumonia was confirmed in 10 patients (6.13%). Results Eight of 10 patients had abnormal appearances in initial chest radiography. The characteristic chest radiographic findings were ground-glass opacities (n=6) and bronchial wall thickening (n=2). MSCT showed bilateral multiple ground-glass opacities in 1 patient,unilateral patchy ground-glass opacities with lobular distribution in the right upper lung in 2 patients. Conclusions Familiarizing with radiographic and MSCT appearances of measles pneumonia in adults is very important for the differential diagnosis and appropriate management of measles pneumonia. Normal initial chest radiography cannot exclude the involvement of the lungs.     

Lung parenchymal changes in patients with ankylosing spondylitis

AIM: To assess lung parenchymal changes in ankylosing spondylitis (AS) using high resolution computed tomography (HRCT). METHODS: We included 78 AS patients whose average age was 33.87 (18-56) years with a ratio of 53 males to 25 females who were followed up for 3.88 (1-22) years on average. neumonia and tuberculosis were excluded. In a detailed examination of lung HRCT findings, we investigated the presence of parenchymal micronodules,parenchymal bands, subpleural bands, interlobular and intralobular septal thickening, irregularity of interfaces,ground glass opacity, consolidation, mosaic pattern,bronchial wall thickening, bronchial dilatation, tracheal dilatation, pleural thickening, emphysema, thoracic cage asymmetry, honeycomb appearance, structural distortion, apical fibrosis and other additional findings.RESULTS: In detailed HRCT evaluations, lung parenchymal changes were found in 46 (59%) of all patients. We found parenchymal bands in 21 (27%) cases, interlobular septal thickening in 9 (12%), emphysema in 9 (12%), apical fibrosis in 8 (10%), ground-glass opacities in 7 (9%), parenchymal micronodules in 5 (6%), irregularity in interfaces in 3 (4%), bronchial dilatation in 3 (4%), mosaic pattern in 2 (3%), pleural thickening in 2 (3%), consolidation in 1 (1%), bronchial wall thick ening in 1 (1%) and a subpleural band in 1 (1%) case. Furthermore, we detected subsegmental atelectasis in 2 patients and a cavitary lesion in 1 patient. CONCLUSION: Our study had the highest number of AS cases of all previous studies in evaluating lung paren chymal changes. The rate of lung parenchymal changes was slightly lower than that reported in recent literature.     

18F-FDG PET/CT显像诊断心包恶性病变的价值

Objective To assess the value of integrated 18 F-fluorodeoxyglucose (FDG) PET/CT in differentiation of malignant and benign pericardial effusion. Methods 18F-FDG PET/CT were performed in 23 patients with pericardial effusion. The detected soft tissue tumor or nodulous lession in pericardium or the thickened pericardium, with the maximum standardized uptake value( SUVmax ) ≥2.5, was defined as PET/CT-positive. The invaded lession in pericardium with SUVmax ≥2.5 was also as the positive. The difference of SUVmax of benign and malignant lesions was analyzed with two-independent-sample test of nonparametric tests. The final diagnosis was confirmed by biopsy or post-operative pathology. Results The diagnosis were confirmed with 14 malignant and 9 benign lesions. The median of SUVmax was 6.0 in malignancy group and 2.2 in benign group (z= -3. 279, P =0.001 ). According to the pathology results, there were one false negative case and two false positive cases with PET/CT imaging interpretation. The sensitivity, specificity,accuracy, positive predictive value ( PPV ) and negative predictive value ( NPV ) of 18 F-FDG PET/CT in diagnosis of benignity or malignance of pericardium effusion were 92.9% ( 13/14), 7/9, 87.0% (20/23),86.7% (13/15) and 7/8, respectively. Conclusion For the patients with pericardium effusion 18F-FDG PET/CT may be a helpful modality for malignancy differentiation     

双源CT双能量肺灌注成像对肺栓塞的初步研究

目的 探讨双源CT双能量扫描肺灌注成像的临床诊断价值.方法 选择临床怀疑肺动脉栓塞30例患者行双源CT双能量扫描,生成140、80 kV和融合系数为0.3的3组数据.根据融合数据的CT肺动脉造影(CTPA)图像将患者分为肺栓塞组和正常组.采用双能量评估软件将薄层重建数据进行灌注成像分析,将双肺野分为上、中、下3部分,正常组受试者肺组织灌注定量的双侧比较行配对t检验,2组间肺组织灌注量比较行独立样本t检验,并对融合图像行MinIP,评估肺组织通气情况.结果 正常组(16例)肺灌注均匀,无明显灌注缺损及减弱,灌注定量分析显示左、右全肺的灌注量分别为(27±7)、(28±8)HU,两侧比较差异无统计学意义(t=-1.73,P＞0.05);左肺上、中、下部的灌注量分别为(23±6)、(24±6)、(28±8)HU,右肺上、中、下部灌注量分别为(26±8)、(27±8)、(28±9)HU,两侧分别比较差异均无统计学意义(t值分别为-1.91、-1.96、-1.73,P值均＞0.05).肺栓塞组(14例)CTPA图像显示肺动脉干、段及亚段充盈缺损,肺灌注成像表现为栓塞血管所支配肺野区域的灌注缺损或缺失,灌注定量分析显示全肺及中、下肺的灌注量分别为(22±5)、(22±8)、(21±8)HU,与正常组分别比较差异均有统计学意义(t值分别为-2.10、-2.32、-2.63,P值均＜0.05＝.MinIP显示通气异常区与灌注异常区具有良好的一致性.结论 双源CT双能量扫描可用于肺栓塞的诊断,有利于肺栓塞的早期发现和精确解剖定位.

Abstract：

Objective To explore the diagnostic values of dual energy lung perfusion in the diagnosis of pulmonary embolism by using dual-source CT (DSCT). Methods Thirty patients with clinically suspected pulmonary embolism underwent dual-energy scanning with dual-source CT. The scanned data were integrated into three groups including 140, 80 kV and coefficient of 0.3. According to the CT pulmonary angiography (CTPA) of the fusion data, the patients were divided into pulmonary embolism group and normal group. The thin-slice reconstruction of data was analyzed using dual-energy perfusion imaging analysis software. The lung field was divided into upper, middle and lower part to make quantitative analysis of lung tissue perfusion. Paired t-tests were used in the normal patients to compare bilateral lungs, and independent samples t-tests were applied to compare the embolism group and normal group, while minimum intensity projection images (MinIP) were utilized in the assessment of lung ventilation. Results Dual energy CT showed symmetrical homogeneous perfusion in 16 normal cases, without significant perfusion defects. Quantitative analysis showed that left and right lung perfusion were (27 ± 7) and (28 ± 8 ) HU respectively, and no significant difference was found between the two sides ( t=-1.73, P ＞0.05 ).Perfusion of the left upper, middle and lower lung was ( 23 ± 6), (24 ± 6), and (28 ± 8) HU respectively, while the perfusion of right upper, middle and lower lung was (26 ±8), (27 ±8), and (28 ±9) HU respectively, showing no statistical significant difference between the two sides (t=-1.91, -1.96,-1.73 ,P＞0.05 ). Angiography of pulmonary embolism group(14 cases)showed filling defects in the pulmonary trunk, segments and sub-segments. Pulmonary perfusion imaging showed low perfusion or defectsin lung field that dominated by embolic vessels. Quantitative analysis showed that the perfusion of the whole lung and the middle and lower lung were (22 ±5), (22 ±8), and (21 ±8) HU in the embolism group,which were significantly different from the normal group (t=-2. 10, -2.32, -2.63, P＜0.05).Minimum intensity projection images showed a good consistency of abnormal ventilation zone area and perfusion abnormalities. Conclusions Pulmonary perfusion status, especially pulmonary embolism, can be analyzed by dual energy CT scanning. It helps to early discover and precisely locate the embolism.     

艾滋病合并马红球菌肺炎的胸部影像表现

目的 探讨艾滋病合并马红球菌肺炎的胸部影像表现.方法 回顾性分析3例艾滋病合并马红球菌肺炎的胸部影像表现.结果 3例X线胸片均可见斑片状渗出实变和小结节,见大面积实变及空洞2例.CT显示大面积(叶、段分布)实变及多发空洞、斑片状渗出实变、小叶中心结节和树芽征各2例,支气管扩张1例.结论 肺浸润实变伴空洞及散发结节是艾滋病合并马红球菌肺炎的常见胸部影像表现.

Abstract：

Objective To study the imaging appearances of Rhodococcus equi pneumonia in three patients with acquired immunodeficiency syndrome ( AIDS). Methods Thoracic imaging appearances of Rhodococcus equi pneumonia in three patients with AIDS were retrospectively analyzed. Results The chest radiograph showed patchy consolidations and small nodules ( n = 3 ), large consolidations with multiple cavitations ( n = 2). CT showed large lobar or segmental consolidations with multiple cavitations (n=2),patchy consolidations (n=2), bronchiectasis (n=1), multiple small centrilobular nodules ( n = 2) and tree-in-bud patterns (n = 2). Conclusion The most common radiological findings in AIDS patients with Rhodococcus equi pulmonary infection are large consolidations with multiple cavitations and multiple centrilobular nodules.     

Chest radiographic and computed tomographic manifestations in allergic bronchopulmonary aspergillosis

AIM:To investigate the chest radiographic and high resolution computed tomography(HRCT)chest manifestations in glucocorticoid-naive allergic bronchopulmonary aspergillosis(ABPA)patients.METHODS:This is a prospective observational study and includes 60 consecutive glucocorticoid-naive patients with ABPA who underwent chest radiography and HRCT of the chest(1.25 mm every 10 mm)in the routine diagnostic workup for ABPA.RESULTS:Chest radiographs were normal in 50%of cases.Of the remainder,most patients demonstrated permanent findings in the form of parallel line and ring shadows suggesting bronchiectasis.Consolidation was detected in 17 cases but in the majority,the corresponding HRCT chest scan showed mucus-filled bronchiectatic cavities.Chest HRCT was normal in 22 patients,while central bronchiectasis(CB)was demonstrated in the remaining 38 patients.Bronchiectasis extended to the periphery in 33%-43%depending on the criteria used for defining CB.The other findings observed on HRCT were mucoid impaction,centrilobular nodules and high-attenuation mucus in decreasing order of frequency.CONCLUSION:Patients with ABPA can present with normal HRCT chest scans.Central bronchiectasis cannot be considered a characteristic feature of ABPA as peripheral bronchiectasis is commonly observed.Consolidation is an uncommon finding in ABPA.     

99Tcm-MIBI显像评价非小细胞肺癌三维适形放疗疗效的临床研究

Objective To explore whether the degree of 99Tcm-methoxyisobutylisonitrile (MIBI) uptake in non-small cell lung cancer (NSCLC) could be correlated with the treatment response to three-dimensional conformal radiotherapy.Methods A total of 102 patients with NSCLC were studied with 99Tcm-MIBI SPECT before radiotherapy.The patients were classified by a follow-up CT as responders (complete or partial remission) and non-responders (stable or progressive disease).After intravenous administration of 740 MBq 99Tcm-MIBI, SPECT imaging at 10-30 min (early) and 2-3 h (delayed) were performed.Region of interest (ROI) was placed over the tumors and contralateral normal lung tissue.The uptake ratio of tumor to contralateral normal lung (T/N) was obtained from both early (ER) and delayed (DR) SPECT images.The retention index (RI) was measured as:RI = (DR - ER)/ER×100%.Statistical analysis was performed by two independent-sample t-test and Mann-Whitney U test using software SPSS 13.0.Results 99Tcm-MIBI uptake was significantly higher in responders than in non-responders:2.36 ±0.17 vs 1.82 ±0.14 (ER) and 2.48 ± 0.20 vs 1.94 ± 0.16 (DR), respectively (t = - 13.1,- 12.7, both P＜ 0.05).The median RI in the responders group was also significantly higher than that in the non-responders group (6.60% vs 5.13%, z = - 6.83, P ＜ 0.05).Conclusion ER, DR and RI of 99Tcm-MIBI SPECT might be useful to estimate the treatment response to three-dimensional conformal radiotherapy in patients with NSCLC.     

18F-FDG PET/CT定位诊断异位分泌促肾上腺皮质激素肿瘤的价值

Objective To investigate the diagnostic value of 18F-fluorodeoxyglucose (FDG) PET/CT in the localization of ectopic adrenocorticotrophic hormone ( ACTH)-secreting tumors. Methods Seven patients with ectopic ACTH syndrome (confirmed by clinical symptom, biochemical data or bilateral simultaneous inferior petrosal sinus sampling) were included, 4 males and 3 females with age ranged 27-63 years old.All patients were examined with head MR, chest and abdomen CT, abdomen ultrasonography, and whole body 18F-FDG PET/CT. Location, size, and the maximum standardized uptake value (SUVmax) of the tumor were measured. Results 18 F-FDG PET/CT detected three ectopic ACTH-secreting tumors with the sizes 1. 1 cm×1.0 cm (SUVmax =9.4), 1.5 cm×1.1cm (SUVmax =6.4), and 1.6 cm ×1.5 cm (SUVmax =12.0). The pathological findings of the three tumors were thymoma, lung carcinoid, and mediastinal carcinoid respectively. Conclusion 18 F-FDG PET/CT may help the localization of ecto pic ACTH-secreting tumors .     

容积高分辨CT对肺弥漫病变显示能力的评价

目的 评价容积高分辨CT (VHRCT)对肺弥漫病变的显示能力,探讨VHRCT取代传统高分辨CT (CHRCT)的可行性.资料与方法 102例肺弥漫病变患者行VHRCT及CHRCT检查,比较二者的图像质量,包括图像的伪影、分辨能力及噪声水平:选择无明显呼吸伪影的层面,比较二者对于线状影及网状影、微结节影及树芽征、细支气管扩张、磨玻璃影、肺气肿5种肺弥漫病变征象的显示情况.结果 图像质量比较:VHRCT与CHRCT的图像分辨能力及噪声水平差异均无统计学意义(P=0.317,P=0.091);CHRCT的呼吸伪影较VHRCT明显,二者伪影评分差异有统计学意义(P=0.008).在无明显呼吸伪影的层面中,VHRCT与CHRCT对线状影及网状影、微结节影及树芽征、细支气管扩张、磨玻璃影、肺气肿显示情况评分差异均无统计学意义(P=0.729,P=0.603,P=0.189,P=0.672,P=0.541).结论 VHRCT对于肺弥漫病变的显示能力与CHRCT接近,可以通过一次螺旋扫描得到全肺的高分辨率图像,其取代CHRCT具有可行性.     

Assessment of diffuse infiltrative lung disease: comparison of conventional CT and high-resolution CT

The diagnostic accuracies of conventional computed tomography (CT) and high-resolution CT (HRCT) in examination of the entire lungs were compared prospectively, and the diagnostic utility of a limited number of HRCT sections in the evaluation of diffuse infiltrative lung disease (DILD) was determined in 150 consecutive patients. Conventional 10-mm CT sections were equivalent to 1.2-mm HRCT sections in the recognition of nodules, masses, nodular irregularities of the interfaces, large cystic air spaces, and architectural distortion. Conventional CT was superior to HRCT in the diagnosis of micronodules and infiltrates. However, 15% of micronodules were recognized only on HRCT images because of their small size and low density. Fine bronchial and parenchymal lesions were best seen on HRCT scans. HRCT was the only technique that allowed assessment of the presence of areas of ground-glass attenuation. HRCT improves visualization of small parenchymal structures and allows a confident evaluation of DILD, providing that the entire lungs are studied. Nevertheless, an optimal CT evaluation of micronodular patterns requires additional thick-section CT scans.     

CT findings in "pseudoalveolar" sarcoidosis.

To determine the specific high resolution CT (HRCT) features for "pseudoalveolar" sarcoidosis, we reviewed HRCT of 10 patients with pathologically proven sarcoidosis. On HRCT the lesions of pseudoalveolar sarcoidosis were shown as homogeneous or inhomogeneous opacities 1-4 cm in diameter located either along the bronchovascular bundles or in the lung periphery adjacent to the pleural surface. The margin was irregular, and numerous nodules 1-2 mm in diameter were observed in the surrounding lung. Air bronchograms were observed in 6 patients. In addition to these lesions, other CT abnormalities such as nodules, groundglass opacities, thickened bronchovascular bundles, and interlobular septa were found in all 10 cases. Good response of pseudoalveolar sarcoid lesions to administration of corticosteroid was observed in all three cases in which follow-up CT was available.     

Thin-section CT findings in flock worker's lung,a work-related interstitial lung disease

PURPOSE: To characterize the thin-section computed tomographic (CT) features of flock worker's lung (FWL) and to determine whether these features may be used to distinguish workers with FWL from flock workers who do not fulfill diagnostic criteria for FWL. MATERIALS AND METHODS: Thin-section CT images obtained in 43 flock workers (including 11 with FWL) were reviewed independently by radiologists blinded to occupational and clinical details. CT features recorded included ground-glass opacities, consolidation, micronodules, reticular abnormality, and septal thickening. Thirty-five of the CT scans (including nine obtained in patients with FWL) were also studied by using quantitative image analysis. The Student t test was used to compare mean lung attenuation between the workers with FWL and those without it. RESULTS: Every patient with FWL and 19 (59%) of the 32 exposed flock workers who did not meet criteria for the disease had an abnormal thin-section CT scan. The most common findings in FWL were ground-glass opacities and micronodules. Quantitative analysis showed a mean lung attenuation of -736.4 HU in patients with FWL, compared with -775.0 HU in workers without the disease (P <.05). CONCLUSION: While ground-glass opacities, micronodules, or both were found in all cases of FWL, these abnormalities were also present in a substantial proportion of symptomatic flock workers who did not satisfy current criteria for FWL. Although nonspecific, these findings should suggest the diagnosis of FWL in exposed individuals.     

Pulmonary histiocytosis X: evaluation with high-resolution CT

Eighteen patients with pulmonary lesions of histiocytosis X were studied with high-resolution computed tomography (CT). Thin-walled cysts were found in all but one patient. The other abnormalities included nodules (n = 14), cavitated nodules (n = 3), thick-walled cysts (n = 7), reticulation (n = 4), ground-glass opacities (n = 4), and irregular interfaces (n = 4). The lesions were most often diffuse (n = 16), with a topographic predominance in the upper or middle lung zones in nine patients. Comparison of CT scans and chest radiographs shows that small and large cysts and micronodules are better detected with CT. Comparison of abnormalities found in patients in the early and late stages of the disease, as well as the evolution observed in one case, suggests that CT patterns progress from nodules to cavitated nodules and thick-walled cysts to cysts to confluent cysts.     

Cytomegalovirus pneumonia after bone marrow transplantation: high resolution CT findings

Cytomegalovirus (CMV) pneumonia is one of the most common pulmonary complications after bone marrow transplantation (BMT). We describe the high resolution CT (HRCT) findings of 13 patients with CMV pneumonia diagnosed after allogenic BMT. The study included 13 consecutive patients who developed CMV pneumonia after BMT and who had HRCT of the chest performed within 24 h of the onset of symptoms. HRCT scans were reviewed by two radiologists who assessed pattern and distribution of findings. There were nine male and four female patients, ranging from 9 years to 56 years of age (mean age 33 years). BMT was performed for treatment of chronic myelogenous leukaemia (54%), severe aplastic anaemia (23%), acute myelogenous leukaemia (15%) and Fanconi's anaemia (8%). The time elapsed until diagnosis ranged from +18 days to +405 days (median of 54 days, mean +81.6 days). The predominant patterns of abnormality on HRCT scans were ground-glass opacities (69%), small centrilobular nodules (69%) and air-space opacities (54%). The abnormalities were distributed in the central and peripheral zones of the lungs in six cases, only in the periphery in four cases, and only in the central zone in three cases. In all cases the lung lesions were bilateral, and asymmetry was observed in seven cases. The authors conclude that the most common HRCT findings in patients with CMV pneumonia after BMT consist of bilateral asymmetric ground-glass, air-space opacities and small centrilobular nodules.     

胸部结节病的CT诊断

目的:分析胸部结节病的CT表现,提高对本病的认识和诊断水平。方法:回顾性分析经活检病理证实或临床治疗观察符合诊断标准的26例胸部结节病的CT表现。结果:26例结节病中,肺门、纵隔淋巴结肿大23例(88.5%),其中肺门或/和纵隔淋巴结肿大8例(30.7%),肺门或/和纵隔淋巴结肿大伴有肺内病变15例(57.7%),仅见肺部浸润性改变而无淋巴结肿大1例(3.8%),肺纤维性改变2例(7.7%)。肺内主要表现为结节影15例,支气管血管束增粗7例,小叶间隔增厚4例,实变影1例,磨玻璃影1例。结论:双侧肺门对称性淋巴结肿大和/或纵隔淋巴结肿大以及沿支气管血管束分布的结节影是胸部结节病的特征性表现;不典型者需密切结合临床检查及治疗后随访。     

甲型H1N1流感合并肺炎的影像表现

目的 探讨甲型H1N1流感合并肺炎的影像表现.方法 分析确诊的甲型H1N1流感合并肺炎患者51例,均摄床旁X线胸片,44例同期行胸部CT检查.按肺内病变程度将所有患者分为轻度、中度、重度3型.结果 轻度患者4例,表现为肺内局限片状阴影;中度33例,肺内片状阴影超过2个肺野,其中双侧病变30例,单侧病变3例;重度14例,肺内广泛分布片状及磨玻璃密度阴影,可以合并间质改变,其中2例合并感染,成人呼吸窘迫综合征(ARDS)6例,并发皮下气肿1例.结论 甲型H1N1流感合并肺炎以片状影及磨玻璃密度阴影为主,可见间质病变,合并感染后影像表现多样,部分患者可进展为ARDS.     

Nonspecific interstitial pneumonia: histologic correlation with high-resolution CT in 29 patients

Purpose

To determine the pathological correlation with various high-resolution CT (HRCT) findings in cases with nonspecific interstitial pneumonia (NSIP), paying special attention to pathological subgroups.

Material and methods

The study involved 29 patients diagnosed with NSIP by surgical lung biopsy. A total of 54 specimens were obtained and grouped according to Katzenstein's classification (groups 1–3) for NSIP. Two observers then evaluated the HRCT findings for every biopsy site and classified the findings according to the main pattern evident into the following four radiologic pattern groups: A, ground-glass attenuation and fine reticulation; B, ground-glass and coarse reticulation; C, consolidation and D, ground-glass attenuation and consolidation.

Results

The pathological pattern was NSIP group 1 in 6 patients, group 2 in 22 and group 3 in 25, while 1 specimen was normal. The main HRCT pattern was pattern A in 15 specimens, B in 8, C in 9 and D in 21. Although there were no significant correlation between HRCT patterns and histological subgroups (Chi-square test, p = 0.07), pattern C was more frequently seen in group 2 (7 of 9) and pattern A was more common in group 3 (11 of 15). HRCT pattern A corresponded pathologically to areas of thickened alveolar septa with temporal uniformity. Pattern B correlated with areas with airspace enlargement/emphysema or dilation of small airways superimposed on thickened alveolar septa. Pattern C was pathologically associated with areas of severe thickened alveolar septa, mucin stasis in the small airways and intraluminal organization.

Conclusion

The pathological backgrounds of the same CT findings in patients with NSIP varied among all pathological subgroups. Areas of ground-glass attenuation and air-space consolidation did not always correspond to reversible pathological findings.     

Influenza A (H1N1) virus-associated pneumonia: high-resolution computed tomography-pathologic correlation

Objective

The purpose of this study was to describe the high-resolution computed tomography (HRCT) features of fatal cases of Influenza A (H1N1) virus-associated pneumonia and to correlate them with pathologic findings.

Methods

The study included six adult patients who died following Influenza A (H1N1) virus-associated pneumonia. All patients had undergone HRCT, and the images were retrospectively analyzed by two chest radiologists, who reached decisions by consensus. Two experienced lung pathologists reviewed all pathological specimens. The HRCT findings were correlated with the histopathologic data.

Results

The predominant HRCT findings included areas of airspace consolidation (n = 6) and ground-glass opacities (n = 3). The main pathological features consisted of diffuse alveolar damage with hyaline membrane formation (n = 5), associated with various degrees of pulmonary congestion, edema, hemorrhage, inflammatory infiltration and bronchiolitis. A patient who survived longer showed findings of organizing pneumonia.

Conclusion

Fatal cases of Influenza A (H1N1) virus-associated pneumonia can present as areas of consolidation on CT, with or without ground-glass opacities. These abnormalities can be pathologically correlated with diffuse alveolar damage. Patients with longer survival may present with findings of organizing pneumonia.