先天性支气管闭锁的多层螺旋CT和X线表现

目的分析先天性支气管闭锁的CT和X线表现，以提高对该病的认识和诊断。方法对11例支气管闭锁患者进行了多层螺旋CT（MSCT）扫描。其中3例经手术证实，6例有支气管镜结果，2例随诊1年以上。肺部常规10mm层厚扫描，在16层螺旋CT机进行1．25mm后处理重组，获得多平面重建（MPR）、最大密度投影（MIP）和最小密度投影（MinIP）图像，记录病变的部位和周围肺组织改变。结果11例病变CT均能显示黏液栓和周围气肿改变，其中3例黏液栓内含气体；x线平片亦能显示全部黏液栓，但仅显示8例气肿改变和2例黏液栓内的气液平。3例支气管闭锁位于左侧，8例位于右侧；发生于段支气管者10例，亚段1例；6例位于肺门旁，5例远离肺门。结论黏液栓和周围肺气肿改变是先天性支气管闭锁的典型表现，在先天性支气管闭锁诊断和鉴别诊断上，多层面螺旋CT能提供比x线平片更多的信息。     

Pseudoprominent aorta: radiographic findings and CT correlation

The presence of a persistent left-sided superior vena cava (LSVC) in the absence of a right-sided superior vena cava (RSVC) may be suspected on a posteroanterior (PA) chest radiograph because of a prominent-appearing ascending aorta, which results from the absence of the RSVC. In the absence of an RSVC, the right upper lobe abuts and outlines the course of the ascending aorta, allowing better demonstration of its profile. This report describes a patient with this finding on a PA chest radiograph. Computed tomographic correlation is presented.     

Paratracheal lymphadenopathy: radiographic findings and correlation with CT

Possible signs of paratracheal lymphadenopathy on the posteroanterior (PA) chest radiograph were assessed in 98 patients and correlated with computed tomography (CT). The nodes were normal in size in 62 patients and enlarged (greater than 15 mm) in 36. Among the latter group, widening of the right paratracheal stripe was seen in 11 (31%) and enlargement of the azygos node in 15 (42%). While the lateral contour of the superior vena cava (SVC) was convex in 46 patients (47%), 81 (83%) had an increased density in the region of the SVC. When all four parameters were combined, lymphadenopathy could be detected on the PA view in 87 patients (89%). CT demonstrated that the enlarged nodes were anterolateral rather than directly lateral to the trachea and also immediately posterior to the SVC, explaining the findings on the PA radiograph.     

Subcarinal lymph node enlargement: radiographic findings and CT correlation

Detection of subcarinal lymph node enlargement on the posteroanterior chest radiograph was assessed in 90 patients who also had computed tomography (CT). Sixty of the 90 patients had normal-sized and 30 had enlarged (greater than 15 mm diameter) subcarinal lymph nodes on CT. An abnormality in the contour of the azygoesophageal recess interface was present on plain radiographs in only 23% of patients with lymphadenopathy; increased subcarinal opacity was present in 40%. The external surface of the medial wall of the right main-stem bronchus and bronchus intermedius was visible in 87% of patients with normal-sized lymph nodes but in only 27% of patients with lymphadenopathy. CT showed that the medial wall of the right main-stem and intermediate bronchi normally is delineated laterally by air within the bronchus and medially by lung or subcarinal fat. Nonvisualization may be due to replacement of lung or fat by enlarged nodes or tumor and may be helpful in assessing patients with suspected subcarinal adenopathy.     

Pulmonary lymphangiomyomatosis: correlation of CT with radiographic and functional findings

In 14 patients with biopsy-proved lymphangiomyomatosis, disease extent at computed tomography (CT) was correlated with findings at chest radiography and pulmonary-function testing. The CT scans and chest radiographs were read independently by two chest radiologists. Disease extent was assessed on CT scans by using a visual score (0%-100% involvement of the lung parenchyma) and on radiographs by using an adaptation of the International Labour Office classification of the pneumoconioses. There was good concordance between the two observers for CT and radiographic scores (Kendall tau greater than or equal to .86, P less than .01). A significant but relatively low correlation was present between CT findings and radiographic severity of disease (r = .59, P less than .05). Impairment in gas exchange as assessed with the diffusing capacity correlated better with disease extent seen on CT scans (r = .69) than with chest radiographic findings (r = .59). Three patients had evidence of parenchymal disease on the CT scans but not on the radiographs. In one patient CT findings were negative despite a positive finding on chest radiographs. The authors conclude that CT is superior to chest radiography in the assessment of patients with lymphangiomyomatosis.     

High-resolution CT of benign asbestos-related diseases: clinical and radiographic correlation

We prospectively analyzed benign asbestos-related pleural and parenchymal abnormalities on high-resolution CT scans and correlated them with clinical diagnoses in 100 asbestos-exposed workers. All subjects had high-resolution CT scans in conjunction with conventional CT at the time of clinical evaluation. To evaluate for asbestosis, we ranked high-resolution CT scans as high, intermediate, or low probability of asbestosis on the basis of the multiplicity and extent of observed parenchymal changes. By linear regression analysis, the most distinctive high-resolution CT features of asbestosis included thickened nondependent interstitial short lines and parenchymal bands. In 45 subjects satisfying clinical criteria of asbestosis, high-resolution CT probability of asbestosis was high in 38 (84%), intermediate in five (11%), and low in two (4%). In 20 (36%) of 55 subjects without clinical asbestosis, parenchymal abnormalities indicative of a high probability of asbestosis were observed on high-resolution CT. High-resolution CT probability scores had a strong positive correlation with chest radiographic profusion scores (p less than .0001) and asbestos-related pleural thickening (p less than .0001). Significant inverse correlations were seen with forced vital capacity (p less than .006) and single-breath diffusing capacity (p less than .03), both functional measures of restrictive interstitial lung disease. Neither clubbing nor rales were sufficiently prevalent to have statistical correlation with high-resolution CT scores. High-resolution CT is sensitive in detecting both pleural and parenchymal abnormalities in the asbestos-exposed subject. Asbestos-related pleural changes are observed more frequently on high-resolution CT than on conventional CT or chest radiography. The probability of asbestosis based on high-resolution CT parenchymal features has a significant correlation with existing clinical determinants of disease, and high-resolution CT can detect abnormality when other methods are not diagnostic.     

The radiological imaging of bronchial atresia.

The clinical and radiological findings in three cases of bronchial atresia are presented. Bronchial atresia has a characteristic plain radiographic appearance in the majority of cases. Computed tomography may be required to confirm the diagnosis. The condition often presents to the radiologist as an incidental finding on the chest radiograph in a patient undergoing investigation for an unrelated problem.     

Sarcoidosis: correlation of extent of disease at CT with clinical, functional, and radiographic findings

Computed tomography (CT) was compared with chest radiography in the assessment of disease severity in 27 patients with sarcoidosis. The CT scans and radiographs were each read twice by two independent observers. Disease extent was assessed on CT scans by visual scoring (0%-100% involvement of the lung parenchyma) and on radiographs by using an adaptation of the International Labour Office classification. The severity of parenchymal changes on the CT scan and on the radiograph was significantly correlated with the severity of dyspnea (r = .61 and .58, respectively; P less than .001), diffusing capacity (r = -.62 and -.52, P less than .01), and vital capacity (r = -.49 and -.51, P less than .01). Patients with predominantly irregular opacities had more severe dyspnea and lower lung volumes than patients with predominantly nodular opacities (P less than .05). The authors conclude that in patients with sarcoidosis, the radiographic and CT assessments of disease severity show similar correlation with clinical and functional impairment.     

支气管动脉CTA:动脉直径与中心型肺癌的关系研究

目的:利用CTA探讨中心型肺癌与正常对照者支气管动脉(bronchial artery,BA)显示率、直径大小的差异及BA直径与原发肿块的关系。方法:对42例经病理证实的中心型肺癌患者和51例正常人的BA行CTA检查,采用MPR、MIP、VR等技术对BA进行观察和重建,比较2组之间BA的显示率和直径,对中心型肺癌组BA直径与原发肿块平均直径进行Pearson双变量相关分析。结果:中心型肺癌组与正常组BA显示率与直径比较差异均有统计学意义,中心型肺癌组BA直径与原发肿块平均直径相关系数为0.327,P值为0.034。结论:中心型肺癌BA直径大小与原发肿块大小呈正相关,即BA直径随原发病灶增大而增大。     

High-resolution CT in silicosis: correlation with radiographic findings and functional impairment

OBJECTIVE: To assess high-resolution computed tomography (HRCT) findings in silicosis and to better define the role of HRCT in early detection of parenchymal abnormalities in silica-exposed workers. METHODS: Forty-one stone carvers were evaluated with chest radiographs (CR), HRCT, and pulmonary function tests (PFT). Inter-reader agreement was calculated using the kappa statistic (k). Correlation between radiographic and HRCT profusion scores and PFT was assessed using the Spearman correlation coefficient. RESULTS: The most common HRCT findings were branching centrilobular structures, seen in 28/41 workers (68.3%). Nodules consistent with silicosis were detected in 53.7% workers on CR and in 56.1% workers on HRCT. Inter-reader agreement for diagnosis of silicosis was better on HRCT (k = 0.84) than on CR (k = 0.54). Small opacity profusion on HRCT correlated inversely with total lung capacity and FVC%. CONCLUSION: Profusion of opacities on HRCT correlates with functional impairment. The presence of branching centrilobular structures may be helpful in early recognition of silicosis.     

Slipped capital femoral epiphysis: a physeal lesion diagnosed by MRI, with radiographic and CT correlation

Objective. To define and compare early lesions associated with slipped capital femoral epiphysis (SCFE) on magnetic resonance imaging (MRI), computed tomography (CT) and radiography. Design and patients. Thirteen patients with 15 symptomatic hips due to SCFE underwent radiography and MRI; CT was performed in 12 patients. SCFE was graded on radiographs, head/neck angles and qualitative changes were evaluated on CT, and morphologic/signal abnormalities were determined on MRI. Results. Physeal widening, apparent on T1-weighted MRI, was evident in every case of SCFE, including one presumed “pre-slip.” T2-weighted images demonstrated synovitis and marrow edema but obscured physeal abnormalities. CT head/neck angles ranged from 4–57° for symptomatic to 0–14° for asymptomatic hips. Physeal and metaphyseal changes were variably identified on both radiographs and CT in all cases of SCFE, but not in the pre-slip. Conclusion. MRI clearly delineates physeal changes of both pre-slip and SCFE, and demonstrates very early changes at a time when radiographs and CT may appear normal.     

Intraarticular osteoid osteoma: sonographic findings in three patients with radiographic, CT, and MR imaging correlation.

OBJECTIVE: Intraarticular osteoid osteoma often has subtle radiographic findings and nonspecific clinical features; further diagnostic workup of unexplained joint pain may involve musculoskeletal sonography. We describe the sonographic features of intraarticular osteoid osteoma in three consecutive patients with radiographic, CT, and MR imaging correlation. CONCLUSION: The sonographic findings of painful cortical irregularity and focal synovitis should raise the possibility of intraarticular osteoid osteoma, prompting the search for characteristic findings on correlative imaging studies.     

Surgery of bronchial cancer and demands on radiology

The most important demand the surgeon can make in respect of the radiologist's work is earliest possible diagnosis of lung cancer. Secondly, the surgeon is always grateful for any pointer leading to diagnosis of the type (and status) of the tumor. This supplies decisive information for both operative planning and perioperative technique. For example, it is essential to know, if x-ray reveals a circular focus, whether this represents tuberculosis of a carcinoma. In case of tuberculosis, drug treatment will be prescribed perioperatively, and the site of operation is limited as much as possible, whereas bronchial carcinoma requires immediate surgery which should be as radical as possible.     

Conventional and hydrocolonic US of the appendix with CT correlation performed by on-call radiology residents

RATIONALE AND OBJECTIVES: The purpose of this study was to assess the feasibility and accuracy of emergent hydrocolonic ultrasonography (US) performed by on-call residents in patients suspected of having appendicitis. MATERIALS AND METHODS: Thirty-one patients with a clinically equivocal diagnosis of appendicitis were prospectively evaluated with conventional US, hydrocolonic US, and appendiceal computed tomography (CT). Midlevel radiology residents performed the US examinations while they were on call. Sensitivity, specificity, and accuracy for diagnosing appendicitis were calculated for conventional and hydrocolonic US by using clinical outcome as the standard. Results of US and CT of the appendix were also correlated. Residents recorded their diagnostic confidence for conventional and hydrocolonic US. All patients were able to hold the rectally administered contrast material until completion of both hydrocolonic US and appendiceal CT. RESULTS: The sensitivity for detecting appendicitis with conventional US, hydrocolonic US, and appendiceal CT was 50%, 75%, and 100%, respectively. Specificity was 96%, 93%, and 93%, respectively. Identification of the normal and abnormal appendix improved from 13% (four of 31 patients) with conventional US to 35% (11 of 31 patients) with hydrocolonic US. The radiology residents' diagnostic confidence increased from 0.74 with conventional US to 0.83 with hydrocolonic US. CONCLUSION: Hydrocolonic US is a feasible addition to conventional US examination for patients suspected of having appendicitis. It improves sensitivity, increases radiology residents' confidence, and is well tolerated by patients.     

Coal worker's pneumoconiosis: CT assessment in exposed workers and correlation with radiographic findings

To study the signs of coal worker's pneumoconiosis (CWP) at computed tomography (CT), the authors obtained thoracic CT scans in 170 coal-dust-exposed workers who were concomitantly evaluated with conventional posteroanterior and lateral radiography. The profusion and extent of disease was assessed by means of CT in two groups of miners: group 1 (n = 86), miners with worker's compensation and radiographic evidence of CWP, and group 2(n = 84), miners who had applied for compensation without radiographic evidence of CWP. The CT signs of CWP consisted of micronodules, nodules, and progressive massive fibrosis. The comparative analysis demonstrates the superiority of an optimal CT technique over chest radiography in the evaluation of simple silicosis, with improved sensitivity in the detection of small parenchymal opacities. CT provides additional information on the stage of the disease but also clarifies some ambiguities of the ILO classification of small opacities. CT was equivalent to radiography for complicated silicosis, except in the identification of necrosis. CT evaluations are complementary to plain radiography in the assessment of CWP, and the addition of high-resolution CT is useful in achieving a more accurate evaluation of the small parenchymal opacities.     

Lymphangiomyomatosis: CT, chest radiographic, and functional correlations

Eight patients with the diagnosis of lymphangiomyomatosis were evaluated with computed tomography (CT), chest radiography, and pulmonary function tests to determine the relationship between the extent of disease seen on imaging studies and functional status. Chest radiographic assessment included the subjective determination of disease extent and measurements of lung length and the arc of the right hemidiaphragm. Disease extent on CT scans was scored as a percentage of lung that was abnormal on the basis of visual assessment of the degree of cystic replacement of the lung parenchyma. Significant correlations were observed between CT scores and percentages of predicted forced expiratory volume in 1 second/forced vital capacity (r = -.92, P less than .002) and diffusing capacity of the lungs for carbon monoxide (r = -.80, P less than .017). No significant correlations were observed between subjective chest radiographic scores and pulmonary function tests, although measurements of lung length and percentage of predicted total lung capacity were correlated (r = .76, P less than .045). CT was more accurate than chest radiography in defining the presence and extent of parenchymal cysts and provided for greater morphologic-physiologic correlation. CT, particularly high-resolution CT, may be useful in the diagnosis and longitudinal evaluation of patients with this disease and may be more sensitive than pulmonary function tests in the early stages of lung damage.     

Intraabdominal panniculitis: clinical, radiographic, and CT features

Intraabdominal panniculitis, also known as lipodystrophy, is an inflammatory condition of adipose tissue that may result in development of large masses containing necrotic fat (nodular intraabdominal panniculitis). Symptoms are secondary to inflammation or mass effect on adjacent organs. Barium studies may show nonspecific inflammatory changes and displacement of bowel loops. Computed tomography (CT) demonstrates inhomogeneous masses containing fat and soft tissue density. The diagnosis of intraabdominal panniculitis has seldom been made prospectively. However, the CT findings are characteristic and can aid in the evaluation and management of patients with this disease.