抗中性粒细胞胞浆抗体相关性原发性小血管炎的肺部影像表现(附2例报告)

抗中性粒细胞胞浆抗体（ANCA）相关性原发性小血管炎是临床少见的累及多系统的自身免疫性疾病,最常累及肾脏和肺部．造成相应器官的功能损害或衰竭,以ANCA阳性为特征。由于其临床及影像表现缺乏特异性。误诊率很高。现将我院确诊的2例报告如下（诊断参考美国风湿病学会1990年诊断标准及1994年ChapelHill分类标准）。     

原发性肝癌TACE术后肺部炎症的影像表现及原因分析

目的 归纳及分析原发性肝癌TACE术后肺部炎症的影像表现,以提高对肝癌TACE术后肺炎的认识.方法 对25例原发性肝癌TACE治疗后发生肺部炎症患者的影像资料进行回顾性分析.结果 其中24例患者影像资料出现明确的肺部影像病变,影像表现有4种:①肺不张,14例,表现为肺段不张,10例伴胸腔积液;②坠积性炎症,4例,表现为单侧或双侧下肺野纹理增粗紊乱;③局部肺野浸润,4例,表现为肺野的局限性浸润;④弥漫性肺野浸润,2例,表现为两肺多发浸润性病变.结论 原发性肝癌TACE术后有部分患者发生肺部炎症,胸部影像学表现以右肺下叶肺段不张为主,多伴有胸腔积液,部分会出现典型的渗出性病变,重度肺炎表现为两肺弥漫浸润炎症.     

AIDS患者肺部机遇性感染的影像表现分析

目的探讨AIDS患者常见肺部机遇性感染影像表现。方法收集2005年1月至2006年8月23例AIDS病合并肺部感染患者的胸部X线片及CT片,结合临床进行分析总结。结果合并肺结核13例,细菌性肺炎3例,肺部影像表现与普通肺结核、肺炎相似;卡氏肺囊虫肺炎（PCP）7例,主要表现为两肺弥漫分布斑片状、网格状、结节状影或磨玻璃样改变。结论肺部感染是AIDS病患者晚期的主要机遇性感染,影像表现对卡氏肺囊虫肺炎的诊断有重要意义。     

系统性红斑狼疮肺部病变的CT表现

系统性红斑狼疮 (ｓｙｓｔｅｍｉｃｌｕｐｕｓｅｒｙｔｈｅｍａｔｏｓｕｓ ,ＳＬＥ)是侵犯结缔组织的全身性疾病 ,可累及全身多个器官和 /或组织。ＳＬＥ较其他结缔组织疾病更易侵犯肺部和胸膜 ,包括急性肺泡炎、肺泡出血、肺泡壁坏死、水肿、透明膜变、间质性肺炎、间质性纤维化、纤维性肺泡炎、血管炎、胸膜炎[1] 。而ＣＴ在评价ＳＬＥ肺部病变时可起到很大作用。ＳＬＥ肺部ＣＴ表现多样 ,它与ＳＬＥ并发肺部细菌感染、肺结核容易混淆。笔者搜集 3例ＳＬＥ患者有肺部病变的完整资料 ,对其临床ＣＴ征象作一回顾性分析 ,旨在提高对原发性Ｓ…     

儿童结核常见和少见的X线表现

作者介绍了儿童原发性肺结核和肺外结核常见及少见的X线表现。肺门及纵隔旁淋巴结肿大,伴有或没有肺实质感染是儿童原发性肺结核X线诊断标准,并且92％患者可见其他肺部表现包括索条状实质改变,间质性改变,小结节(含粟粒形)密度,肺实变,肺不张,实变中的空洞,肺气肿,甚至局部肿块。胸腔积液和肺钙化少见。     

显微镜下多血管炎肺部CT表现1例

显微镜下多血管炎(microscopic polyangiitis, MPA)是一种以侵犯小血管即毛细血管、小静脉或微小动脉,且很少有免疫复合物沉积为病理特点的坏死性血管炎[1].属于自身免疫疾病,可累及全身各个器官,肺为仅次于肾脏的最易受累的器官,约50%的患者可出现肺损害[1].现回顾分析本院经临床确诊的MPA 1例,并结合相关文献,旨在对MPA肺部CT表现进行更深一步的阐述.     

儿童原发性水痘肺炎的26例影像诊断分析

目的探讨儿童原发性水痘肺炎(PVP)的影像表现,以提高对本病的认识。方法回顾性分析26例PVP的肺部影像特点,并复习相关文献。结果 26例PVP的胸片影像表现可分为轻型和重型:轻型20例仅表现为间质性炎症改变,重型6例表现为双肺间质性肺炎并肺泡炎改变。结论双肺间质性炎症伴弥漫性结节是儿童PVP轻型较为特征性改变;肺泡炎伴肺出血是重型较为特征性改变。     

抗中性粒细胞胞浆抗体相关性血管炎的肺部影像表现及临床特点分析

目的：探讨抗中性粒细胞胞浆抗体(ANCA)相关性血管炎的肺部影像表现与临床特点。方法回顾性分析本院经临床确诊为 ANCA 相关性血管炎的患者16例。所有患者均行胸部16排高分辨 CT(HRCT)扫描。总结其胸部影像学与临床特点。结果16例患者确诊为 ANCA 相关性血管炎时发病时间为1周~2年不等,表现为多个脏器受累均伴有不同程度的肾功能受损,临床以发热、咳嗽等呼吸道症状就诊。肺部 HRCT 表现如下：斑片影14例(87.5%),条索状阴影12例(75%),结节影3例(18.8%),空洞征4例(25%),肺气肿、肺大泡6例(37.5%);树芽征6例(37.5%);胸腔积液4例(25%);纵隔淋巴结增大3例(18.8%);胸膜增厚6例(37.5%;)蜂窝样5例(31.3%);支气管扩张6例(37.5%);磨玻璃影10例(62.5%);网状改变8例(50%);部分患者经规范糖皮质激素或联用免疫抑制剂治疗后伴随着临床症状改善 X 线影像明显减轻或消失。结论ANCA 相关性血管炎发病以中老年居多,男女发病无明显差异,发病到确诊时间较长,易被误诊。临床易累及全身多个器官,肺、肾脏最易受累,易被误诊为感染征象。结合影像表现,早期诊断及时治疗,有助于改善预后。     

SARS的CT表现及动态变化

目的 探讨严重急性呼吸综合征的CT表现及动态变化。方法 对60例严重急性呼吸综合征患者进行X线胸片(已有另文报道)和高分辨率CT(HRCT）的动态观察。患者在入院时及入院后连续进行CT观察检查，间隔4～6d。结果 发病初期进行影像检查者25例，CT表现为小片状影像者22例，占88.0％(22／25)；其中类圆形磨玻璃样影20例，占80．0％(20／25)。其余35例在进行影像检查时已发病3d，病变已经有所进展。3d后患者肺部均出现多发大片状影像，其中呈单一磨玻璃样影者10例，占16.7％(10／60)；磨玻璃样影合并实变影者4：5例，占75．0％(45／60)；主要呈肺实变影者5例，占8.3％(5／60)。入院10～14d内病变明显进展者50例，占83.3％(50／60)；病变范围减少者10例，占16．7％(10／60)；合并肺间质增生者4例，占6．7％。结论 HRCT可清楚反映SARS病变的密度、形态和范围，以及显示肺间质增生改变。因而，HRCT可以用于早期诊断和了解病变的动态变化。     

原发性干燥综合征肺部病变的HRCT诊断价值

目的探讨HRCT对原发性干燥综合征(pSS)肺部病变的诊断价值。方法回顾分析12例原发性干燥综合征患者肺部CT及HRCT表现。结果12例患者肺部CT及HRCT均表现为不同程度的肺间质纤维化,并以两肺外周分布为主,磨玻璃样密度影以及小叶间隔增厚为其常见表现。结论磨玻璃样密度影是病变的早期活动性表现,蜂窝样囊腔改变为后期表现。应用HRCT检查,可以帮助确定原发性干燥综合征浸润肺的程度,并能估计预后。     

创伤性湿肺的螺旋CT诊断(附60例分析)

目的探讨螺旋CT对创伤性湿肺诊断及鉴别诊断的价值。方法回顾性分析了60例创伤性湿肺病人的螺旋CT资料,观察其CT征象,并加以总结。结果CT表现分为4型:(1)间质型10例,肺血管影增粗、模糊,(2)弥漫实变型15例:肺实质内散在斑点状、小片状稍高密度灶;(3)云雾型20例,呈磨砂玻璃改变的云雾状稍高密度灶(即“面纱征”);(4)节段实变型15例,大片状或呈叶、段分布的高密度灶。结论螺旋CT能够明确显示创伤性湿肺的部位、类型、范围和发现合并伤的存在,是目前诊断创伤性湿肺有效的检查手段之一。     

Bildgebung zerebraler Vaskulitiden

Cerebral vasculitis can have a variety of origins. Furthermore, there are no vasculitis-specific symptoms or imaging signs and vasculitis of the CNS can mimic many other neurological diseases, which require different treatment approaches. Thus, the clinical and radiological diagnosis of cerebral vasculitis is challenging. Magnetic resonance imaging (MRI) and MR angiography (MRA) should be the radiological imaging methods of choice to assess the degree of parenchymal damage and to detect vessel wall changes. If the results are unclear digital subtraction angiography (DSA) should be pursued in order to also detect changes in medium sized vessels. Vasculitis of small vessels cannot be detected by vascular imaging and requires brain or leptomeningeal biopsy. In this review we present the current diagnostic approach and a variety of imaging findings in cerebral vasculitis and discuss the main radiological differential diagnoses.     

Isolated central nervous system vasculitis manifesting as a pseudotumor

Vasculitis is characterized by inflammation of the vessel walls, with or without necrosis, that causes narrowing and occasionally obstruction of the vessels. Vasculitis can be a primary process or it can occur secondary to other disease. Isolated central nervous system vasculitis (ICNSV) is a rare type of primary vasculitis that predominately affects the supratentorial regions. The clinical presentation and imaging findings are unspecific and diagnosis is made by exclusion and biopsy. We present a case manifesting as a pseudotumor in the posterior fossa on computed tomography and magnetic resonance imaging. The diagnosis was after biopsy, and the patient evolved favorably after treatment.     

Neue Aspekte der MRT-Bildgebung zur Diagnostik der Großgefäßvaskulitiden sowie der primären Angiitis des zentralen Nervensystems

Vasculitis is a rare disease and clinical symptoms are often unspecific. Accurate and early diagnosis is mandatory in order to prevent complications, such as loss of vision or stroke. Imaging techniques can contribute to establishing a definite diagnosis and to evaluate disease activity and the extent of the disease in various vascular regions. Conventional imaging methods, such as computed tomography (CT) and magnetic resonance (MR) angiography, as well as digital subtraction angiography allow the vessel lumen but not the vessel wall to be depicted. However, vasculitis is a disease which primarily affects the vessel wall, therefore conventional imaging modalities often fail to make a definite diagnosis. Recently black-blood high resolution MR in vivo imaging has been used to visualize cervical and intracranial vasculitis. This review article presents imaging protocols for intracranial and cervical black-blood MR imaging and clinical cases with large vessel vasculitis and vasculitis of the central nervous system. Furthermore the current literature, examples of the most common differential diagnoses of cervical and cranial arteriopathy and the potential of other imaging modalities, such as PET/CT and ultrasound will be discussed.     

中枢神经系统血管炎的影像特征及研究进展

中枢神经系统(CNS)血管炎是一组主要累及CNS的炎性血管病变。数字减影血管造影(DSA)、CT血管成像(CTA)及MR血管成像(MRA)能够清楚显示管腔的形态变化,但对于管壁的显示存在缺陷。近年来,一些新的成像技术能够提供管壁信息并判断疾病的活动性,其中高分辨力血管壁成像(HR-VWI)能够直接显示病变的管壁特征,在血管炎的鉴别诊断及治疗随访方面发挥重要作用。回顾CNS血管炎的分类和诊断标准,并对各种影像技术在CNS血管炎的成像特征及应用予以综述。     

肺炎性假瘤41例X线和CT影像

目的探讨肺炎性假瘤的放射学及临床表现。方法对41例患者进行X线胸片及肺尖至肺底的螺旋CT容积扫描,并进行结果分析。结果肺炎性假瘤多位于肺的外围,按CT形态可分为结节或肿块型、浸润型。其特征性表现：桃尖征、平直征、灶周网点征和晕征及均匀强化等征象,注意分析肺部阴影前的病史及症状对诊断本病有帮助。结论CT影象对炎性假瘤的诊断具有重要价值。     

Pulmonary angiitis and granulomatosis: a review

Vasculitis is a clinical-pathological process characterized by inflammation and necrosis of blood vessels. It has been effectively classified by Fauci. Granulomatosis in the lung may be angiocentric or bronchocentric in distribution. The angiocentric forms of granulomatosis and vasculitis include Wegener's granulomatosis, allergic angiitis and granulomatosis of Churg and Strauss, lymphomatoid granulomatosis, and necrotizing sarcoid granulomatosis. Wegener's granulomatosis is a well-defined syndrome characterized by necrotizing granulomatous vasculitis of the upper and lower respiratory tracts, segmental necrotizing glomerulonephritis, and systemic small vessel vasculitis. Allergic angiitis and granulomatosis is a less common multisystem vasculitis with many features similar to polyarteritis nodosa. Lymphomatoid granulomatosis is an angiocentric and angiodestructive lymphoreticular proliferative and granulomatous disease involving predominantly the lungs and resembling lymphoma. Necrotizing sarcoid granulomatosis is probably a variant of sarcoidosis in which an angiitis is a prominent feature. Because the radiology of these diseases can be similar, their important differences are highlighted. The appearance of multiple nodules, often with cavities, and pleural-based consolidations resembling pulmonary infarcts should suggest pulmonary angiitis and granulomatosis, especially if improvement occurs in one area while disease is progressing elsewhere. Bronchocentric granulomatosis is not a primary vasculitis but is discussed because of its similarity to the other diseases.     

CNS vasculitis and vasculopathy: efficacy and usefulness of diffusion-weighted echoplanar MR imaging

This pictorial essay illustrates the usefulness of diffusion-weighted imaging (DWI) on various vasculitis or vasculopathies, including systemic lupus erythematosus (SLE), Beh?et's disease, Churg-Strauss disease, primary angitis of the central nervous system (PACNS), giant cell arteritis, infectious vasculitis, sickle cell disease, drug-induced vasculopathy and hypertensive vasculopathy. DWI proves to detect small and active ischemic changes not visible on conventional MRI, and it clearly discriminates cytotoxic from vasogenic edema in patients with cerebral vasculitis or vasculopathy. DWI seems useful in assessing the treatment and patient outcome.     

Radiologic features of vasculitis involving the gastrointestinal tract.

Vasculitides can cause local or diffuse pathologic changes in the gastrointestinal tract, resulting in nonspecific paralytic ileus, mesenteric ischemia, submucosal edema and hemorrhage, or bowel perforation or stricture. The extent and clinical course of disease depend on the size and location of the affected vessel and the histologic characteristics of the lesion. Vasculitis may primarily involve large vessels (eg, giant cell arteritis, Takayasu arteritis), medium-sized vessels (eg, polyarteritis nodosa, Kawasaki disease, primary granulomatous central nervous system vasculitis), or small vessels (eg, Wegener granulomatosis, Churg-Strauss syndrome, microscopic polyangiitis, Henoch-Sch?nlein syndrome, systemic lupus erythematosus, rheumatoid vasculitis, Beh?et syndrome). Radiologic findings in various types of vasculitis often overlap considerably and therefore have limited value in making a specific diagnosis. Nevertheless, the possibility of vasculitis should be considered whenever mesenteric ischemic changes occur in young patients, are noted at unusual sites (eg, stomach, duodenum, rectum), have a tendency to concomitantly involve the small and large intestine, and are associated with genitourinary involvement. Knowledge of systemic clinical manifestations in affected patients may suggest and even help establish the specific diagnosis.