弥漫型肺泡癌的高分辨CT特征分析

目的 :回顾性分析弥漫型肺泡癌的高分辨CT(HRCT)表现特征。方法 :总结 12例经临床和病理证实的弥漫型肺泡癌HRCT表现。结果 :12例弥漫型肺泡癌可见磨玻璃影者 11例 ,实变 9例 ,多发结节 7例 ,“碎石路样”表现者 2例 ,其中 11例为混合表现。 6例有支气管气像 ,9例病变呈均匀或不均匀低密度 ,2例出现“血管造影征” ,2例伴少量胸腔积液 ,1例纵隔淋巴结肿大。结论 :弥漫型肺泡癌的HRCT表现多种多样 ,最常见的表现是多发结节、实变和磨玻璃影的混合影。HRCT片上出现实变和结节共存、伴磨玻璃影的小叶中心结节和远离实变的磨玻璃影时 ,则强烈提示弥漫型肺泡癌。     

Pulmonary tuberculosis presenting as acute respiratory failure: radiologic findings

PURPOSE: The purpose of this work was to describe the radiologic findings of pulmonary tuberculosis in patients who presented with acute respiratory failure. METHODS: We included patients who had newly diagnosed active pulmonary tuberculosis and who presented with acute respiratory failure. Initial chest radiographic (n = 17) and high-resolution CT (n = 11) findings of each patient were analyzed retrospectively. RESULTS: Of 1,010 patients with active pulmonary tuberculosis, 17 patients (1.7%) presented with acute respiratory failure. Nine (53%) of the 17 patients died. The most common initial chest radiographic findings were small nodular lesions (16/17; 94%), consolidation (13/17; 76%), and ground-glass opacity (12/17; 70%). Eleven (69%) of 16 nodular lesions, 9 of 13 (69%) consolidations, and 10 of 12 (83%) ground-glass opacities were bilateral. On HRCT (n = 11), miliary micronodular lesions were seen in 6 patients (55%), whereas bronchogenic spread of tuberculosis with disseminated centrilobular nodules and tree-in-bud appearance was seen in 5 patients (45%). Diffuse areas of ground-glass attenuation were seen in all six patients with miliary nodules and four of five patients with bronchogenic spread of tuberculosis. CONCLUSION: Patients with pulmonary tuberculosis occasionally present with acute respiratory failure. In this condition, chest radiograph most commonly shows bilateral small nodular lesions mixed with consolidation or ground-glass opacity, whereas HRCT demonstrates findings of miliary or bronchogenic disseminated tuberculosis with diffuse areas of ground-glass attenuation.     

Near drowning: thin-section CT findings in six patients

PURPOSE: The purpose of this study was to assess the thin-section CT findings of near drowning in six patients. METHOD: Thin-section (1 mm collimation) CT scans of six patients who experienced near drowning were retrospectively analyzed. The CT scans were performed 0-5 days (median 1 day) after near drowning. RESULTS: Thin-section CT findings included bilateral patchy or diffuse areas of ground-glass attenuation (n = 6) with geographic pattern (n = 3) and fine intralobular reticular opacities ("crazy-paving" appearance) (n = 3), ill-defined centrilobular nodules (n = 4), and air-space consolidation (n = 1). Distribution of ground-glass attenuation was predominantly central (n = 4) or diffuse (n = 2). Interstitial pulmonary emphysema and pneumomediastinum were present in two patients. CONCLUSION: The thin-section CT findings of near drowning consist of ground-glass opacities with or without associated reticular opacities and centrilobular nodules.     

Squalene-induced extrinsic lipoid pneumonia: serial radiologic findings in nine patients.

PURPOSE: The purpose of this work was to demonstrate the initial and follow-up radiologic findings of squalene-induced extrinsic lipoid pneumonia. METHOD: Follow-up chest radiographs (n = 9) and high-resolution CT scans (n = 3) as well as initial radiographs (n = 9) and CT scans (n = 8) were obtained in nine patients with squalene-induced extrinsic lipoid pneumonia. The serial radiologic findings were analyzed retrospectively by three chest radiologists, focusing on the pattern and distribution of parenchymal abnormalities. RESULTS: The most frequent pattern of parenchymal abnormalities on chest radiograph was areas of ground-glass opacity (n = 9, bilateral 6), followed by consolidation (n = 7, bilateral 3) and poorly defined small nodules (n = 4, bilateral 2). The abnormalities were distributed in the right lower lung (n = 9), left lower lung (n = 6), and right middle lung (n = 6) zones. Initial CT scans (n = 8) demonstrated bilateral areas of ground-glass attenuation (n = 8), poorly defined centrilobular nodules (n = 8), crazy paving (n = 6), and consolidation (n = 3). The abnormalities were distributed in the right middle lobe (n = 8) and in both lower lobes (n = 5). Follow-up chest radiograph (n = 9) showed complete disappearance (n = 2) and decrease (n = 7) in the extent of the parenchymal abnormalities. Follow-up CT scans (n = 3) demonstrated decrease (n = 2) and no change (n = 1) in the extent of the abnormalities. CONCLUSION: Squalene-induced extrinsic lipoid pneumonia most commonly appears as areas of ground-glass attenuation mixed with poorly defined centrilobular nodules and crazy paving on CT, being distributed mainly in the right middle and both lower lobes. The lesions are indolent and remain after cessation of squalene ingestion.     

Thoracic CT findings of adult T-cell leukemia or lymphoma

OBJECTIVE: The aim of this study was to assess pulmonary CT findings in patients with adult T-cell leukemia or lymphoma. MATERIALS AND METHODS: We retrospectively reviewed CT scans of the lung in 87 patients with adult T-cell leukemia or lymphoma who had undergone chest CT between January 1996 and March 2002 at two institutions. The CT scans were interpreted by two chest radiologists working in consensus. Parenchymal abnormalities (ground-glass attenuation, consolidation, nodules, thickening of bronchovascular bundles, interlobular septal thickening, honeycombing, crazy-paving appearance, and bronchiectasis) were evaluated, as were enlarged lymph nodes, pleural effusion, and pleural thickening. In 46 patients who underwent surgical biopsy or autopsy, CT-pathologic correlation was performed with the actual specimens by a pathologist and two chest radiologists. RESULTS: On the CT scans, abnormal findings were seen in 60 patients (69.0%). CT findings consisted of ground-glass attenuation (n = 37), centrilobular nodules (n = 25), thickening of bronchovascular bundles (n = 22), and consolidation (n = 13). These abnormalities were predominantly seen in the peripheral lung parenchyma (n = 26). Pathologically, these findings corresponded with atypical lymphocyte infiltration along the interstitium and the alveolar spaces. Pleural effusion and enlarged lymph nodes were found in 22 and 27 patients, respectively. CONCLUSION: CT findings in patients with adult T-cell leukemia or lymphoma consisted mainly of ground-glass attenuation, centrilobular nodules, and thickening of the bronchovascular bundles in the peripheral lung. These findings, although nonspecific, are considered suggestive of thoracic involvement in patients with adult T-cell leukemia or lymphoma.     

Pulmonary CT findings in 320 carriers of human T-lymphotropic virus type 1

PURPOSE: To retrospectively evaluate pulmonary computed tomographic (CT) findings in human T-lymphotropic virus type 1 (HTLV-1) carriers, who were characterized by means of polyclonal integration of proviral DNA. MATERIALS AND METHODS: Institutional review board approval was obtained, and informed consent was waived. Chest CT scans obtained between January 1996 and October 2004 in 320 (154 men, 166 women; age range, 31-86 years; mean, 64 years) patients with HTLV-1 were retrospectively evaluated by three chest radiologists. Parenchymal abnormalities (ground-glass opacity, consolidation, centrilobular nodules, thickening of bronchovascular bundles, interlobular septal thickening, and bronchiectasis) were evaluated, along with enlarged lymph nodes and pleural effusion. In 58 patients who underwent surgical biopsy or transbronchial biopsy, comparison of CT images with the actual specimens was performed by a pathologist and three chest radiologists. RESULTS: On CT scans, abnormal findings were seen in 98 (30.1%) patients and consisted of centrilobular nodules (n = 95), thickening of bronchovascular bundles (n = 55), ground-glass opacity (n = 51), bronchiectasis (n = 50), interlobular septal thickening (n = 28), and consolidation (n = 5). These abnormalities were predominantly seen in the peripheral lung parenchyma (n = 70). Pathologically, these findings corresponded to lymphocytic infiltration along respiratory bronchioles and bronchovascular bundles. Pleural effusion and enlarged lymph nodes were found in two and five patients, respectively. CONCLUSION: CT findings in patients with HTLV-1 consisted mainly of centrilobular nodules, ground-glass opacity, and thickening of the bronchovascular bundles in the peripheral lung. These CT findings are considered suggestive of thoracic involvement in patients with HTLV-1.     

Pulmonary tuberculosis: CT and pathologic correlation

Typical CT findings of active postprimary pulmonary tuberculosis include centrilobular nodules and branching linear structures (tree-in-bud appearance), lobular consolidation, cavitation, and bronchial wall thickening. The CT findings of inactive pulmonary tuberculosis include calcified nodules or consolidation, irregular linear opacity, parenchymal bands, and pericicatricial emphysema. The typical appearance of primary tuberculosis on CT scans is homogeneous, dense, well-defined segmental or lobar consolidation with enlargement of lymph nodes in the hilum or the mediastinum. Miliary nodules may be seen in primary and postprimary tuberculosis. On CT, tuberculomas appear as a nodule with surrounding satellite nodules and internal cavitation on CT. Atypical radiologic manifestations of tuberculosis, encountered in as many as one third of the cases of adult-onset tuberculosis, are single or multiple nodules or masses, basilar infiltrates, miliary tuberculosis with diffuse bilateral areas of ground-glass opacity, and reversible multiple cysts. Underlying histopathologic findings of typical and atypical CT findings of tuberculosis are caseating granulomas or pneumonia in the active phase and fibrosis and dystrophic calcification in the inactive phase.     

Lymphocytic interstitial pneumonia: thin-section CT findings in 22 patients.

PURPOSE: To assess the thin-section computed tomographic (CT) findings of lymphocytic interstitial pneumonia. MATERIALS AND METHODS: The study included 22 patients (five men, 17 women; age range, 24-83 years; mean age, 50 years) with biopsy-proved lymphocytic interstitial pneumonia. The CT scans were obtained by using 1-3-mm collimation and reconstructed by using a high-spatial-frequency algorithm. RESULTS: The predominant abnormalities consisted of areas of ground-glass attenuation and poorly defined centrilobular nodules present in all 22 patients and subpleural small nodules seen in 19 patients. Other common findings included thickening of bronchovascular bundles (n - 19), interlobular septal thickening (n = 18), cystic airspaces (n = 15), and lymph node enlargement (n = 15). Less common findings included large nodules, emphysema, airspace consolidation, bronchiectasis, architectural distortion, honeycombing, and pleural thickening. CONCLUSION: Lymphocytic interstitial pneumonia is characterized by the presence of ground-glass attenuation, poorly defined centrilobular nodules, and thickening of the interstitium along the lymphatic vessels. Lymph node enlargement is more common than previously recognized; it was seen in 68% of patients.     

Pulmonary infections following bone marrow transplantation: high-resolution CT findings in 35 paediatric patients

PURPOSE: The purpose of this study was to assess the high-resolution CT findings of paediatric patients who had pulmonary infections following bone marrow transplantation (BMT), and to evaluate the differential diagnosis through high-resolution CT of the various pathogens responsible for pulmonary infections after BMT. PATIENTS AND METHODS: The study included 35 consecutive patients who had documented pulmonary infection, high-resolution CT of the chest performed within 24h of the beginning of symptoms, and proven diagnosis within 1 week of the onset of symptoms. The pulmonary infections were due to viruses (n=16), bacteria (n=9), fungi (n=9), and protozoa (n=1). Two radiologists analyzed the CT scans and reached final decisions regarding the findings by consensus. RESULTS: Four patients with confirmed pneumonia had normal high-resolution CT scans. Regarding the viral infections, the most frequent features were areas of ground-glass attenuation (43.7%) and small centrilobular nodules (31.2%). Airspace consolidation (88.9%), small centrilobular nodules (22.2%) and ground-glass attenuation (22.2%) were the most frequent findings in patients with bacterial pneumonia following BMT. Large nodules were seen in 66.7% of the patients with fungal pneumonia, and in only one case of virus infection. The "halo sign" (n=5) was seen only in patients with fungal pneumonia. CONCLUSION: In conclusion, the main causes of pulmonary infection in paediatric patients following BMT share similar high-resolution CT findings. Large nodules and "halo sign" are more common in patients with fungal infections.     

Mycoplasma pneumoniae pneumonia: radiographic and high-resolution CT features in 28 patients

OBJECTIVE: The aim of the study was to compare the radiographic and the high-resolution CT findings of Mycoplasma pneumoniae pneumonia. MATERIALS AND METHODS: The chest radiographs and 1.5-mm collimation CT scans obtained in 28 patients with serologically proven M. pneumoniae pneumonia were retrospectively reviewed. The radiographs and CT scans were analyzed independently by two observers. RESULTS: The most common finding on radiography was the presence of air-space opacification (n = 24), which was patchy and segmental (n = 9) or nonsegmental (n = 15) in distribution. On high-resolution CT, areas of ground-glass attenuation were seen in 24 patients (86%) and air-space consolidation in 22 (79%). In 13 patients (59%), the areas of consolidation had a lobular distribution evident on CT. Nodules were seen more commonly on high-resolution CT (25 of 28 patients, 89%) than on radiography (14 patients, 50%) (p < 0.01, chi-square test). In 24 (86%) of the 28 patients, the nodules had a predominantly centrilobular distribution on CT. Thickening of the bronchovascular bundles was identified more commonly on CT (23 of 28 patients, 82%) than on radiography (five patients, 18%) (p < 0.01, chi-square test). CONCLUSION: The lobular distribution, centrilobular involvement, and interstitial abnormalities in M. pneumoniae pneumonia are often difficult to recognize on radiography but can usually be seen on high-resolution CT.     

Transient radiographic progression during initial treatment of pulmonary tuberculosis: CT findings

PURPOSE: A study was undertaken to describe the thin-section CT features of transient radiographic progression during initial treatment of active pulmonary tuberculosis. METHOD: The CT scans of 13 patients who developed transient radiographic progression during initial treatment of pulmonary tuberculosis were evaluated and compared with those of 10 patients with true progression of pulmonary tuberculosis. Two patients underwent transbronchial lung biopsy for pathologic evaluation of new lesion. RESULTS: Eight patients had increased opacity at the site of their original lesion, whereas five had new opacities elsewhere: ipsilateral (n = 3) or contralateral (n = 1) to the original lesion or both (n = 1). Relatively extensive areas of ground-glass attenuation were concomitantly depicted in three of the eight patients with progression in the area of the original lesion. In those with progression ipsilateral or contralateral to the lesion, the character of the new lesions was ground-glass opacity and/or consolidation mainly in the subpleural region. Transbronchial lung biopsy specimens obtained from two patients showed intraluminal organizing exudates and thickened alveolar septa with lymphocyte infiltration, whereas the dominant CT findings of true progression of pulmonary tuberculosis were nodules (n = 8) or centrilobular nodules (n = 7). CONCLUSION: Thin-section CT may be useful to differentiate transient radiographic progression from true progression of pulmonary tuberculosis.     

Lung diseases in patients with common variable immunodeficiency: chest radiographic, and computed tomographic findings

OBJECTIVE: To evaluate chest radiographic and computed tomographic (CT) findings of lung disease related to common variable immunodeficiency. METHODS: Thirty-five chest radiographs and 30 CT scans of 46 patients were assessed. Lung parenchymal abnormalities that were evaluated included airspace consolidation, ground-glass attenuation, nodules, bronchiectasis, and air trapping. RESULTS: On CT, ground-glass attenuation and nodules were the most frequent findings, observed in 60% (n = 18/30) and 83% (n = 25/30), respectively. Three major CT patterns were identified: airway disease (n = 13), nodules (n = 8), and parenchymal opacification (n = 6). All 13 patients with airway disease showed centrilobular opacities. One patient with peribronchial nodules showed lymphoid interstitial pneumonia, and 1 with randomly distributed nodules showed noncaseating granulomas. Patients with a CT pattern of parenchymal opacification showed lower lung predominance; surgical biopsies showed organizing pneumonia in 1 patient and lymphoid interstitial pneumonia with nonnecrotizing granulomas in another. CONCLUSIONS: Common variable immunodeficiency is associated with 3 major CT patterns: airway disease, nodules, and parenchymal opacification.     

Rhodococcus equi pneumonia in AIDS: high-resolution CT findings in five patients

The aim of this study was to describe the high-resolution CT scan findings in five patients with AIDS and pulmonary infection due to Rhodococcus equi. The study included five patients with AIDS and proven R. equi infection. The CT scans were reviewed by two observers. The patients included four men and one woman ranging from 39 years to 49 years in age (mean 42 years). The findings included areas of consolidation (n=5) with single (n=1) or multiple cavitation (n=4), ground-glass opacities (n=5), centrilobular nodules (n=3), small centrilobular nodular opacities (n=3) and "tree in bud" opacities (n=3). None of the patients had pleural effusion or lymph node enlargement. The most common high-resolution CT manifestations of R. equi infection consist of areas of consolidation with cavitation, ground-glass opacities, nodules and a tree-in-bud pattern.     

Specific high-resolution computed tomography findings associated with sputum smear-positive pulmonary tuberculosis

OBJECTIVES: This study aimed to evaluate whether high-resolution computed tomography (HRCT) could predict the results of a sputum smear in patients with active pulmonary tuberculosis. METHODS: Forty-eight patients with active pulmonary tuberculosis were divided into 2 groups: sputum smear-positive (n = 25) and -negative (n = 23). The HRCT findings were retrospectively reviewed, focusing on the presence or absence of features previously reported to indicate active pulmonary tuberculosis, including ground-glass opacity, cavitation, centrilobular opacity, and air space consolidation. RESULTS: Although air space consolidation was the least common feature overall, it occurred significantly more frequently in the smear-positive group than in the smear-negative group. This feature also had the highest specificity and positive predictive value. Cavitation and ground-glass opacity also occurred significantly more frequently in the smear-positive group. The frequency of centrilobular opacity did not differ between the 2 groups. CONCLUSIONS: The present study suggested that the HRCT findings of air space consolidation, cavitation, and ground-glass opacity are significantly associated with smear-positive pulmonary tuberculosis.     

Follicular bronchiolitis: thin-section CT and histologic findings.

PURPOSE: To evaluate the thin-section computed tomographic (CT) findings of follicular bronchiolitis and compare them with the histologic findings. MATERIALS AND METHODS: Thin-section CT scans obtained in 12 patients (age range, 24-77 years; mean age, 47 years) with follicular bronchiolitis proved at open lung biopsy were reviewed by two observers. Underlying conditions included rheumatoid arthritis (n = 8), mixed collagen vascular disorders (n = 2), autoimmune disorder (n = 1), and acquired immunodeficiency syndrome (n = 1). All patients had thin-section CT scans (1.0-1.5-mm collimation, 11 patients; 3.0-mm collimation, one patient; high-spatial-frequency reconstruction algorithm) obtained at 10-mm intervals through the chest. RESULTS: The main CT findings included bilateral centrilobular (n = 12) and peribronchial (n = 5) nodules. All 12 patients had nodules smaller than 3 mm in diameter; six patients also had nodules 3-12 mm in diameter. Areas of ground-glass opacity were present in nine (75%) patients. Histologically, all patients had lymphoid hyperplasia along the bronchioles; eight had peribronchiolar lymphocytic infiltration. CONCLUSION: The cardinal CT feature of follicular bronchiolitis consists of small centrilobular nodules variably associated with peribronchial nodules and areas of ground-glass opacity.     

Cytomegalovirus Pneumonia: High-Resolution CT Findings in Ten Non-AIDS Immunocompromised Patients

Objective

To describe the HRCT findings of cytomegalovirus (CMV) pneumonia in non-AIDS immunocompromised patients.

Materials and Methods

This retrospective study involved the ten all non-AIDS immunocompromised patients with biopsy-proven CMV pneumonia and without other pulmonary infection encountered at our Medical Center between January 1997 and May 1999. HRCT scans were retrospectively analysed by two chest radiologists and decisions regarding the findings were reached by consensus.

Results

The most frequent CT pattern was ground-glass opacity, seen in all patients, with bilateral patchy (n = 8) and diffuse (n = 2) distribution. Other findings included poorly-defined small nodules (n = 9) and consolidation (n = 7). There was no zonal predominance. The small nodules, bilateral in eight cases and unilateral in one, were all located in the centrilobular region. Consolidation (n = 7), with patchy distribution, was bilateral in five of seven patients (71%). Pleural effusion and bilateral areas of thickened interlobular septa were seen in six patients (60%).

Conclusion

CMV pneumonia in non-AIDS immunocompromised patients appears on HRCT scans as bilateral mixed areas of ground-glass opacity, poorly-defined centrilobular small nodules, and consolidation. Interlobular septal thickening and pleural effusion are frequently associated.     

High-resolution CT findings of respiratory syncytial virus pneumonia after bone marrow transplantation

OBJECTIVE: The aim of this study was to describe the high-resolution CT findings of respiratory syncytial virus pneumonia in 20 patients who had undergone allogeneic bone marrow transplantation. MATERIALS AND METHODS: The study included 20 consecutive patients who developed respiratory syncytial virus pneumonia after bone marrow transplantation and who had high-resolution CT of the chest performed within 24 hr after the onset of symptoms. The CT scans were reviewed by two chest radiologists who assessed the pattern and distribution of findings. RESULTS: Bone marrow transplantation was performed on 12 male and eight female patients ranging from 3 to 48 years old (mean age, 25 years) for treatment of various forms of leukemia (n = 12), severe aplastic anemia (n = 6), Fanconi's syndrome (n = 1), and paroxysmal nocturnal hemoglobinuria (n = 1). Sixteen patients (80%) had abnormal CT findings. The predominant patterns of abnormality on high-resolution CT scans were small centrilobular nodules (10/20, 50%), air-space consolidation (7/20, 35%), ground-glass opacities (6/20, 30%), and bronchial wall thickening (6/20, 30%). The abnormalities were distributed in the central and peripheral areas of the lungs in nine cases, only in the periphery in five cases, and only in the central regions in two cases. The abnormalities were bilateral and asymmetric in distribution in 13 patients, bilateral and symmetric in two patients, and unilateral in one patient. CONCLUSION: The most common high-resolution CT findings in patients with respiratory syncytial virus pneumonia after bone marrow transplantation consist of small centrilobular nodules and multifocal areas of consolidation and ground-glass opacities in a bilateral asymmetric distribution.     

Radiographic and high-resolution CT findings of influenza virus pneumonia in patients with hematologic malignancies

OBJECTIVE: We sought to describe the radiographic and high-resolution CT findings of influenza virus pneumonia in patients with hematologic malignancies. CONCLUSION: Radiologic findings of influenza virus pneumonia in immunocompromised patients consist of patchy or confluent consolidation and nodular opacities on chest radiography and ground-glass attenuation, consolidation, centrilobular nodules, and branching linear opacities on high-resolution CT.     

Respiratory bronchiolitis, respiratory bronchiolitis-associated interstitial lung disease, and desquamative interstitial pneumonia: different entities or part of the spectrum of the same disease process?

OBJECTIVE: Our objective was to assess high-resolution CT findings of respiratory bronchiolitis, respiratory bronchiolitis-associated interstitial lung disease, and desquamative interstitial pneumonia and to determine whether these three entities could be reliably differentiated by radiologic criteria. MATERIALS AND METHODS: CT scans (1- to 3-mm collimation) were reviewed in 40 patients with pathologically proven respiratory bronchiolitis (n = 16), respiratory bronchiolitis-associated interstitial lung disease (n = 8), or desquamative interstitial pneumonia (n = 16). All patients with respiratory bronchiolitis and respiratory bronchiolitis-associated interstitial lung disease were cigarette smokers, and 85% of the patients with desquamative interstitial pneumonia had a history of smoking. CT scans were independently reviewed by two radiologists who assessed the pattern and distribution of abnormalities. RESULTS: The predominant abnormalities in respiratory bronchiolitis were centrilobular nodules (12 [75%] of 16 patients) and ground-glass attenuation (six [38%] of 16). No single abnormality predominated in the respiratory bronchiolitis-associated interstitial lung disease group; findings included ground-glass attenuation (four [50%] of eight), centrilobular nodules (three [38%] of eight), and mild fibrosis (two [25%] of eight). All patients with desquamative interstitial pneumonia showed ground-glass attenuation, and 10 (63%) of the 16 showed evidence of fibrosis. CONCLUSION: The significant overlap between the CT findings of respiratory bronchiolitis, respiratory bronchiolitis-associated interstitial lung disease, and desquamative interstitial pneumonia is consistent with the concept that they represent different degrees of severity of small airway and parenchymal reaction to cigarette smoke.     

Quantification of ground-glass opacity on high-resolution CT of small peripheral adenocarcinoma of the lung: pathologic and prognostic implications.

OBJECTIVE: The purpose of our study was to correlate the high-resolution CT findings of small peripheral adenocarcinoma of the lung with underlying histopathology and to evaluate the prognostic implications of the CT findings. MATERIALS AND METHODS: The high-resolution CT findings of small peripheral adenocarcinoma of the lung in 224 patients were analyzed by two independent observers for location, size, marginal characteristics, and extent of ground-glass opacity and necrosis. The pathologic specimens were reviewed by an experienced lung pathologist. RESULTS: One hundred and thirty-two patients had bronchioloalveolar carcinoma and 92 had adenocarcinoma. The extent of ground-glass opacity was greater in bronchioloalveolar carcinomas (mean +/- SD, 29% +/- 31.6%) than in other adenocarcinomas (8% +/- 13.3%) (p < 0.001). The extent of ground-glass opacity was significantly greater in patients without recurrence (p = 0.020) and those without nodal (p = 0.017) or distant (p = 0.007) metastases than in patients with nodal or distant metastases or in whom the carcinoma had recurred. CONCLUSION: The extent of ground-glass opacity in a nodule is greater in bronchioloalveolar carcinomas than in other adenocarcinomas. Greater extent of ground-glass opacity also correlates with improved prognosis.