以肺间质改变为主肺结核HRCT特征分析

【摘要】目的：探讨以肺间质改变为主的肺结核HRCT表现,提高其影像诊断水平。方法：回顾性分析 100例已确诊为肺结核患者的影像学资料,所有患者以肺间质改变为主,总结这类患者的HRCT特点。结果：100例中病变共累及361个肺段,右肺上叶尖段和后段（52例,14.4%）、左肺上叶尖后段（48例,13.3%）、右下叶基底段（53例,14.9%）和左下叶基底段（51例,14.1%）是主要受累部位。病变在双肺弥漫性分布35例。将所有病变按部位（好发部位和非好发部位）分为2组,好发部位组中病变沿叶段中央分布共151个肺段（44.9%）,叶间胸膜旁分布112个肺段（33.3%）,明显多于胸膜下分布的73个肺段（21.7%）;非好发部位组中沿叶段中央分布共86个肺段（31.5%）,叶间胸膜旁分布79个肺段（28.9%）,胸膜下分布108个肺段（39.6%）;两组间差异有统计学意义（χ2=24.037,P<0.001）。按间质类型分析：轴心间质异常69个肺段（23.7%）;周围间质异常125个肺段（42.9%）;间隔间质异常97个肺段（33.3%）。伴发改变：磨玻璃样影（GGO）48例,实变30例,支气管播散7例,微结节32例,空洞12例,肺大疱18例,气胸2例。本组病例中经规则抗结核治疗后间质病变明显吸收者31例（31%）,稍有吸收者23例（23%）,无明显吸收者46例（46%）。结论：以肺间质改变为主的肺结核的HRCT表现具有一定特征性。     

特发性肺间质纤维化的HRCT诊断

特发性肺间质纤维化（idiopathic intersitial pulmonary fibrosis以下简称IPF）系下呼吸道原因不明的慢性炎症性疾病，它以侵犯肺泡壁和肺间质为特征的慢性炎症，参与炎症反应的以吞噬细胞和中性粒细胞为主，尚有其他各种类型的细胞，产生纤维细胞增殖和胶元纤维的堆积。IPF临床症状缺乏特异性，影像上亦缺乏特异性，影像表现复杂，有些表现与其他肺部疾病的影像表现有相似之处，HRCT可以更好的显示病变，对于本病的诊断和鉴别诊断有重要作用，本文对35例IPF的HRCT表现进行回顾性分析，将结果报告如下。     

特发性肺间质纤维化的早期HRCT表现及其病理基础探讨

目的：总结特发性肺间质纤维化（IPF）的影像表现及动态变化,重点关注蜂窝影与磨玻璃密度影的表现及变化,并与病理结果对照。方法回顾性分析41例特发性肺间质纤维化（IPF）的HRCT表现,总结其各种征象的出现率和病变的分布情况,并与其中3例行病理检查的进行影像-病理对照观察。结果41例IPF中可见蜂窝影33例（80.5％）,磨玻璃密度影34例（82．9％）,牵拉性支扩35例（85．3％）,网状影37例（90．2％）小叶间隔增厚33例（80.5％）。动态观察中蜂窝影10例（100％）随访中范围增大,磨玻璃密度影中9例（52．9％,9/17）范围变小,相应区域出现蜂窝影。3例患者行肺叶切除病理表现符合普通型间质性肺炎,其中1例胸膜下区可见细支气管扩张。结论磨玻璃密度和网状影、小叶间隔增厚是纤维化的早期表现。其病理基础是肺泡间隔纤维增生,小叶间隔及小叶内间质增生。     

间质性肺疾病的HRCT表现及相关病理

目的:分析间质性肺疾病(ILD)的HRCT表现及与普通病理学和免疫病理学表现的关系。方法:19例经手术病理证实的肺间质纤维化病人和7例正常对照分别行HRCT扫描,组织病理学检查(包括HE、Masson氏三色染色)及免疫组化,分析其HRCT表现及相关病理学表现的关系。结果:ILD的HRCT基本征象及分期有其相应镜下病理表现,bFGF、TGF-β1、TNF-α与肺小叶间隔增粗、肺内渗出毛玻璃影、小叶核增粗、肺内异常线影及肺内小结节等HRCT征象中有较强的相关性。结论:HRCT是一种安全、有效、无创性的诊断ILD的手段,肺小叶间隔增粗、肺内渗出毛玻璃影、小叶核增粗、肺内异常线影及肺内小结节是间质性肺疾病较为可靠的HRCT征象。     

支气管扩张症的HRCT诊断及评价

分析支气管扩张症（以下简称支扩）的ＨＲＣＴ征象,评价ＨＲＣＴ在支扩症诊断中的价值。材料和方法：报告６９例支扩病例均行ＨＲＣＴ扫描,其中３４例同时给予了数字减影支气管碘水造影（ＤＳＢ）对照。结果：１）支扩的ＨＲＣＴ表现有８种征象,其中常见的征象为印戒征、轨道征、胸膜下征,肿块征及云雾征尚无文献报道。（２）ＨＲＣＴ与ＤＳＢ比较,两者在肺叶水平符合率为１００％,肺段水平为８５％￣１００％。结论：ＨＲＣＴ     

高分辨率CT在肺间质纤维化的诊断及应用

目的：探讨高分辨率CT（HRCT）在肺间质纤维化中的诊断价值及临床应用。方法：随机选择2010-01～2011-11间84例肺间质纤维化患者作为研究对象,行直接数字化X线摄影系统（CR）、电子计算机X线断层扫描技术（CT）进行检查。在此基础上对主动脉弓、支气管分叉、隆突下、右肺门、肺底膈上等区域的局灶性或弥漫性病变区行高分辨率CT扫描。对各项影像学检查结果进行分析和比较。结果：高分辨率CT检查结果显示双肺或单侧肺的基底部可见网织状阴影、磨玻璃样改变,密度较低,在阴影区内可见肺血管纹理。54例患者可见肺小叶间隔增厚,有43例患者可见胸膜增厚。28例患者肺部出现蜂窝状改变,小叶结构模糊。HRCT检查均被诊断为弥漫性间质性肺部纤维化。三种影像学检查方法对弥漫性肺间质性纤维化的检出率差异有统计学意义。结论：高分辨率CT在肺间质纤维化的诊断和鉴别诊断上具有较好的应用价值。     

全身性自身免疫性疾病的胸部平片和高分辨率CT表现

通过阐述自身免疫性疾病的胸部X线平片和HRCT表现，讨论了每一种疾病相关的临床症状和特点，并着重描述其在胸片和HRCT上的特征性表现。     

活动性肺结核肺间质病变的HRCT研究

目的 探讨活动性肺结核肺间质改变的HRCT表现.资料与方法 搜集肺部CT扫描以间质改变为主的活动性肺结核29例,分别在治疗前、治疗中和疗程结束时行HRCT检查,分析间质改变的影像特点及变化.结果 肺结核间质病变好发于两上肺野,主要表现为片状蔓延和沿支气管树分布两种形式.小叶内间质异常是肺结核间质改变的主要HRCT表现,包括小叶内细网织线影、微结节、磨玻璃影、树芽征等,其发生率分别为100%(29例)、100%(29例)、82.8%(24例)、69%(20例).此外可合并气道壁增厚、融合性实变、空洞、结节等征象.经抗结核治疗后间质病变吸收较缓慢,但在疗程结束时均大部分吸收.结论 小叶内细网织线影、微结节、磨玻璃影、树芽征为活动性肺结核间质的主要HRCT表现.     

系统性红斑狼疮肺间质病变TGF-β1基因单核苷酸多态性与肺HRCT表现相关性研究

目的 探讨转化生长因子-β1(TGF-β1)基因单核苷酸多态性(SNP)与系统性红斑狼疮肺间质病变(SLE-ILD)患者肺高分辨率计算机断层扫描(HRCT)影像学表现的关联.方法 搜集符合纳入标准的SLE-ILD患者共80例,按照HRCT影像学表现分为斑片状、磨玻璃影、网格状、条索状4类.采用Sequenom基因分型实...     

结缔组织病肺间质病变的高分辨CT表现及临床意义

目的探讨结缔组织病肺间质病变的高分辨CT表现及临床意义。方法分析26例结缔组织病合并肺间质病变的高分辨CT表现及临床意义。结果26例结缔组织病合并肺间质病变HRCT表现为磨玻璃影、小叶间隔增厚、胸膜下线状影、支气管血管束周围间质增厚、小叶内间质增厚、胸膜下间质增厚、界面征、牵引性支气管扩张、肺小叶变形、蜂窝状影等征象,经糖皮质激素及免疫抑制剂治疗后,部分病例磨玻璃影明显吸收,小叶间隔增厚、支气管血管束周围间质增厚、小叶内闻质增厚有所减轻,但蜂窝状影、牵引性支气管扩张、肺小叶变形无改变。结论磨玻璃影、小叶间隔增厚、胸膜下线状影、支气管血管束周围间质增厚、小叶内间质增厚、胸膜下间质增厚、以及界面征等征象可能为可逆改变,而牵引性支气管扩张、肺小叶变形、蜂窝状影为不可逆改变。结缔组织病合并肺间质改变的高分辨cT表现对早期诊断及临床治疗有重要意义。     

弥漫性间质性肺疾病130例

 目的 分析总结我院弥漫性间质性肺疾病(ILDs)的病种概率、临床特点,以期提高对ILDs的认识,加强对ILDs病因和基础疾病的分析,更好地治疗ILDs患者.[HTH〗方法 对我院自1995年1月～2006年12月临床诊断为ILDs病例进行临床回顾性分析研究,对比分析其病程、症状、体征及影像学[胸片、胸部高分辨 CT和(或)HRCT]、肺功能及血气分析结果 ,试图从中发现共性及各自的特点.结果 (1)11年间共收治130例ILDs患者,其中特发性肺纤维化(IPF)发病率最高(55/130,42.31%),其余发病率较多的依次为:慢性阻塞性肺气肿(COPD)、结缔组织病、充血性心力衰竭和肺癌合并ILDs, 分别占19.23%,10.77%,7.69%和7.69%.(2)不同病因的ILDs患者有ILDs的共同表现, 但在其临床发病年龄、病程、症状、体征、影像学征象和肺功能检查等方面又有各自的一些特点 .结论 认识ILDs的共性和个性对ILDs的病因诊断和针对性治疗,减少ILD s的漏诊和误诊大有裨益.     

Smoking-related interstitial lung diseases: histopathological and imaging perspectives

The present review focuses on the interstitial lung diseases related to smoking. Thus, the pathology and radiology of Langerhans cell histiocytosis, desquamative interstitial pneumonia, respiratory bronchiolitis and respiratory bronchiolitis-associated-interstitial lung disease are considered. The more tenuous association between pulmonary fibrosis and smoking is also discussed.     

Correlation between HRCT findings,pulmonary function tests and bronchoalveolar lavage cytology in interstitial lung disease associated with rheumatoid arthritis

A prospective study correlating high-resolution computed tomography (HRCT), lung function tests (PFT) and bronchoalveolar lavage (BAL) cytology in patients with interstitial lung disease (ILD) associated with rheumatoid arthritis (RA). Fifty-three RA patients with suspected ILD (19 men, 34 women) underwent 71 HRCT (14 of 53 with sequential HRCT, mean follow-up 24.3 months). The HRCT evaluation by two observers on consensus included a semi-quantitative characterisation of lesion pattern and profusion on representative anatomical levels. Fifty-two HRCT were followed by PFT and BAL. Agreement or discordance of HRCT-, PFT- and BAL findings were analysed with Pearsons correlation, score and McNemars test. Tobacco-fume exposure was estimated in pack years. Smoking/non-smoking groups were compared with Students t test. In 49 of 53 patients, HRCT was suggestive of ILD associated with RA (66 of 71 HRCT). Reticular lesions were found in 40 of 53 patients, in 15 of 40 presenting as mixed pattern with ground-glass opacities (GGO). Pure reticular patterns predominated in patients with long duration of ILD (p>0.01). Pure GGO were not observed. Lesion profusion was highly variable and correlated moderately negative with diffusion capacity (mean 88.2% (SD±20.9%); r=–0.54; p<0.001) and very weak with vital capacity and FEV1 (mean values 92.2% (SD±18.3%); r=–0.27; p<0.05 and 89.8% (SD±17.5%); r=–0.31; p<0.01). In patients with GGO, BAL differentials tended towards neutrophilia (=0.39; p=0.04; McNemar test p>0.2), but not towards lymphocytosis (=0.10; p=0.23; McNemar test p>0.2). Differences in smoking history were not significant (p>0.1). The HRCT appears most appropriate for the detection and follow-up of ILD associated with RA. The PFT and BAL correlate only partially with lesion profusion or grading on HRCT, but they contribute valuable information about dynamic lung function and differential diagnoses (pneumonia, medication side effects).     

间质性肺疾病的高分辨CT(HRCT)诊断

间质性肺疾病是由多种原因引起的以肺问质弥漫性渗出、浸润和纤维化为主要改变的一组临床综合征。其HRCT基本表现为网格状影、结节状影、肺密度增加或肺密度减低四种形式。网格状影以线状不透光影为特点，包括小叶间隔增厚、小叶间隔网格状影、支气管、血管周围间质增厚；结节状阴影可分为间质性结节和实质性结节，结节的分布情况对鉴别诊断有很大帮助；肺密度增加的HRCT表现包括磨玻璃样密度影和含气腔隙实变；肺密度降低包括蜂窝状影、肺囊状影。本文同时介绍了几种间质性病变的HRCT表现。     

肺撕裂伤的MSCT表现分析

目的：探讨肺撕裂伤的 MSCT表现。方法回顾性分析31例肺撕裂伤的 MSCT表现。结果31例肺撕裂伤共67个病灶,18例位于肺的背部,靠近或紧贴胸膜,单发11例,多发20例。肺气囊腔9例,肺气液囊腔17例,肺内血肿5例,31例均伴有不同程度的肺挫伤。动态随访肺气囊腔、肺气液囊腔及肺内血肿3种 MSCT表现可相互转换。结论 MSCT是诊断及动态观察肺撕裂伤的最佳检查方法,对临床治疗有重要的指导价值。     

18FDG uptake associated with CT density on PET/CT in lungs with and without chronic interstitial lung diseases

Objective  The dependent-density of computed tomography (CT) images of positron emission tomography (PET)/CT is sometimes difficult to distinguish from chronic interstitial lung disease (ILD) when it accompanies increased ¹⁸F-fluorodeoxy-d-glucose (¹⁸FDG) uptake. Though the possible utility of ¹⁸FDG-PET for the diagnosis of active ILD has been reported, the clinical relevance of mild lung ¹⁸FDG uptake in ILD cases without signs and symptoms suggesting acute progression has not been described. This study aimed to test relationships between ¹⁸FDG uptake and lung density on CT using PET/CT in patients with normal lung as well as clinically stable chronic ILD. Methods  Thirty-six patients with normal lungs (controls) and 28 patients with chronic ILD (ILD cases) without acute exacerbation were retrospectively selected from ¹⁸FDG-PET/CT scans performed in examination of malignant neoplasms. Elliptical regions of interest (ROIs) were placed on the lung. The relationships between CT density and ¹⁸FDG uptake between the control and ILD cases were tested. Results  The CT density and ¹⁸FDG uptake had a linear correlation in both the controls and the ILD cases without a difference in their regression slopes, and they were overlapped between the controls and the ILD cases with higher mean values in the ILD cases. Conclusions  Lung ¹⁸FDG uptake was considered to reflect a gravity-dependent tissue density in the normal lung. Though the lung ¹⁸FDG uptake as well as the CT density tended to be higher in chronic ILD patients, it may be difficult to distinguish them in normal dependent regions from those related to chronic ILD in some cases.     

Effects of pure and hybrid iterative reconstruction algorithms on high-resolution computed tomography in the evaluation of interstitial lung disease

ObjectivesTo compare image quality characteristics of high-resolution computed tomography (HRCT) in the evaluation of interstitial lung disease using three different reconstruction methods: model-based iterative reconstruction (MBIR), adaptive statistical iterative reconstruction (ASIR), and filtered back projection (FBP).MethodsEighty-nine consecutive patients with interstitial lung disease underwent standard-of-care chest CT with 64-row multi-detector CT. HRCT images were reconstructed in 0.625-mm contiguous axial slices using FBP, ASIR, and MBIR. Two radiologists independently assessed the images in a blinded manner for subjective image noise, streak artifacts, and visualization of normal and pathologic structures. Objective image noise was measured in the lung parenchyma. Spatial resolution was assessed by measuring the modulation transfer function (MTF).ResultsMBIR offered significantly lower objective image noise (22.24 ± 4.53, P < 0.01 among all pairs, Student's t-test) compared with ASIR (39.76 ± 7.41) and FBP (51.91 ± 9.71). MTF (spatial resolution) was increased using MBIR compared with ASIR and FBP. MBIR showed improvements in visualization of normal and pathologic structures over ASIR and FBP, while ASIR was rated quite similarly to FBP. MBIR significantly improved subjective image noise (P < 0.01 among all pairs, the sign test), and streak artifacts (P < 0.01 each for MBIR vs. the other 2 image data sets).ConclusionMBIR provides high-quality HRCT images for interstitial lung disease by reducing image noise and streak artifacts and improving spatial resolution compared with ASIR and FBP.