肺泡微石症的影像学诊断

目的：探讨肺泡微石症的影像学特征。方法;报道肺泡微石症6例,全部病例均行胸部X线检查,2例行常规CT,1例行HRCT。并对全部影像学表现进行了回顾性分析。结果：6例胸片表现为弥漫粟粒样微细结节（2例）。“鱼子样”或“暴风沙样”（2例）、“白肺样”（1例）及高密度“面纱样”改变（1例）,CT可明确肺内微细结节的钙化密度,肺尖部气肿样改变及支气管血管束增粗并呈钙化密度,HRCT则可进一步显示肺野磨砂玻璃样改变,小叶间隔,叶间胸膜及支气管血管束钙化密度与串珠状增厚,小叶中心分布的微细结节与胸膜下蜂窝,结论：肺泡微石症是一种罕见病,其影像学表现具有特征性,影像学检查尤以HRCT检查对该病的诊断有决定性作用。     

Pulmonary fibrosis and emphysema: Is the emphysema type associated with the pattern of fibrosis?

AIM: To investigate whether the predominant emphysema type is associated with the high resolution computed tomography (HRCT) pattern of fibrosis in combined pulmonary fibrosis and emphysema (CPFE). METHODS: Fifty-three smokers with upper lobe emphysema and lower lobe pulmonary fibrosis on - HRCT - were retrospectively evaluated. Patients were stratified into 3 groups according to the predominant type of emphysema: Centrilobular (CLE), paraseptal (PSE), CLE = PSE. Patients were also stratified into 3 other groups according to the predominant type of fibrosis on HRCT: Typical usual interstitial pneumonia (UIP), probable UIP and nonspecific interstitial pneumonia (NSIP). HRCTs were scored at 5 predetermined levels for the coarseness of fibrosis (Coarseness), extent of emphysema (emphysema), extent of interstitial lung disease (TotExtILD), extent of reticular pattern not otherwise specified (RetNOS), extent of ground glass opacity with traction bronchiectasis (extGGOBx), extent of pure ground glass opacity and extent of honeycombing. HRCT mean scores, pulmonary function tests, diffusion capacity (DLCO) and systolic pulmonary arterial pressure were compared among the groups. RESULTS: The predominant type of emphysema was strongly correlated with the predominant type of fibrosis. The centrilobular emphysema group exhibited a significantly higher extent of emphysema (P < 0.001) and a lower extent of interstitial lung disease (P < 0.002), reticular pattern not otherwise specified (P < 0.023), extent of ground glass opacity with traction bronchiectasis (P < 0.002), extent of honeycombing (P < 0.001) and coarseness of fibrosis (P < 0.001) than the paraseptal group. The NSIP group exhibited a significantly higher extent of emphysema (P < 0.05), total lung capacity (P < 0.01) and diffusion capacity (DLCO) (P < 0.05) than the typical UIP group. The typical UIP group exhibited a significantly higher extent of interstitial lung disease, extent of reticular pattern not otherwise specified, extent of ground glass opacity with traction bronchiectasis, extent of honeycombing and coarseness of fibrosis (0.039 > P > 0.000). Although the pulmonary arterial pressure was higher in typical UIP group relative to the NSIP group, the difference was not statistically significant. CONCLUSION: In CPFE patients, paraseptal emphysema is associated more with UIP-HRCT pattern and higher extent of fibrosis than centrilobular emphysema.     

Serial high resolution CT findings in nonspecific interstitial pneumonia/fibrosis

PURPOSE: The purpose of this work was to evaluate the radiographic and serial high resolution CT (HRCT) findings in patients with nonspecific interstitial pneumonia/ fibrosis (NSIP). METHOD: We identified 15 patients with biopsy-proven NSIP. Radiography and initial and follow-up CT findings were reviewed. RESULTS: Predominant radiographic findings were bilateral infiltrates distributing in the middle and lower lung zones and decreased lung volumes. At initial CT, predominant patterns were peribronchovascular interstitial thickening (n = 6), parenchymal bands (n = 8), intralobular interstitial thickening (n = 12), and traction bronchiectasis (n = 14). Mixed pattern of ground-glass opacity and consolidation (n = 11) were predominant findings of increased lung opacity. At follow-up CT in 14 cases, the abnormalities had disappeared completely in 3, improved in 9, persisted in 1, and worsened in 1. CONCLUSION: The pulmonary abnormalities observed in NSIP on HRCT can disappear or be diminished in most cases after corticosteroid therapy. Intralobular interstitial thickening and traction bronchiectasis, which have been considered to be indicators of irreversible fibrosis, also show favorable responses.     

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.     

High-resolution CT in chronic pulmonary changes after mustard gas exposure

PURPOSE: To identify the findings of high-resolution CT (HRCT) of the lung in patients with previous sulfur mustard gas exposure, and to correlate these findings with clinical and chest X-ray (CXR) results. MATERIAL AND METHODS: 50 consecutive patients were studied prospectively. The clinical data were recorded. Standard p.a. CXR and HRCT of the lung and spirometry were performed. The findings of CXR, HRCT and clinical and spirometry results were scored between 0 and 3 according to the severity of the findings. RESULTS: HRCT abnormality was detected in all 50 patients (100%), while CXR was abnormal in 40 patients (80%). The most common HRCT findings was airway abnormalities (bronchial wall thickening in 100% of cases). Other important findings were suggestive of interstitial lung disease (ILD) (80%), bronchiectasis (26%), and emphysema (24%). A statistically significant correlation was found between the severity of clinical presentation and that of the HCTR scores in patients with bronchiectasis, bronchitis and ILD (p< 0.05), but not with severity scores of HRCT in patients with emphysema. No significant correlation was found between severity scores of CXR findings. HRCT evidence of bronchial wall thickening and with a lower frequency ILD were present despite normal CXR in 20% of the patients. CONCLUSION: The results of this study suggest that bronchial wall thickening, ILD and emphysema are common chronic pulmonary sequelae of sulfur mustard injury. HRCT of the chest should be considered as the imaging modality of choice in chemical war injury.     

Drug-induced lung disease: high-resolution CT and histological findings

AIM: To compare the parenchymal high-resolution computed tomography (HRCT) appearances with histological findings in patients with drug-induced lung disease and to determine the prognostic value of HRCT. MATERIALS AND METHODS: Drug history, HRCT features, histological findings and outcome at 3 months in 20 patients with drug induced-lung disease were reviewed retrospectively. The HRCT images were assessed for the pattern and distribution of abnormalities and classified as most suggestive of interstitial pneumonitis/fibrosis, diffuse alveolar damage (DAD), organizing pneumonia (OP) reaction, or a hypersensitivity reaction. RESULTS: On histopathological examination there were eight cases of interstitial pneumonitis/fibrosis, five of DAD, five of OP reactions, one of hypersensitivity reaction and one of pulmonary eosinophilia. The most common abnormalities on HRCT were ground-glass opacities (n = 17), consolidation (n = 14), interlobular septal thickening (n = 15) and centrilobular nodules (n = 8). HRCT interpretation and histological diagnosis were concordant in only nine (45%) of 20 patients. The pattern, distribution, and extent of HRCT abnormalities were of limited prognostic value: all eight patients with histological findings of OP, hypersensitivity reaction, or eosinophilic infiltrate improved on follow-up compared to only five of 13 patients with interstitial pneumonitis/fibrosis or DAD. CONCLUSION: In many cases of drug-induced lung injury HRCT is of limited value in determining the histological pattern and prognosis.     

High-Resolution CT Findings of Re-Expansion Pulmonary Edema

Objective

To describe the high-resolution CT (HRCT) findings of re-expansion pulmonary edema (REPE) following a thoracentesis for a spontaneous pneumothorax.

Materials and Methods

HRCT scans from 43 patients who developed REPE immediately after a thoracentesis for treatment of pneumothorax were retrospectively analyzed. The study group consisted of 41 men and two women with a mean age of 34 years. The average time interval between insertion of the drainage tube and HRCT was 8.5 hours (range, 1-24 hours). The patterns and distribution of the lung lesions were analyzed and were assigned one of the following classifications: consolidation, ground-glass opacity (GGO), intralobular interstitial thickening, interlobular septal thickening, thickening of bronchovascular bundles, and nodules. The presence of pleural effusion and contralateral lung involvement was also assessed.

Results

Patchy areas of GGO were observed in all 43 patients examined. Consolidation was noted in 22 patients (51%). The geographic distribution of GGO and consolidation was noted in 25 patients (58%). Interlobular septal thickening and intralobular interstitial thickening was noted in 28 patients (65%), respectively. Bronchovascular bundle thickening was seen in 13 patients (30%), whereas ill-defined centrilobular GGO nodules were observed in five patients (12%). The lesions were predominantly peripheral in 38 patients (88%). Of these lesions, gravity-dependent distribution was noted in 23 cases (53%). Bilateral lung involvement was noted in four patients (9%), and a small amount of pleural effusion was seen in seven patients (16%).

Conclusion

The HRCT findings of REPE were peripheral patchy areas of GGO that were frequently combined with consolidation as well as interlobular septal and intralobular interstitial thickening.     

Bronchiolitis obliterans following exposure to sulfur mustard: chest high resolution computed tomography

BACKGROUND: Pulmonary complications are known to occur in over half of the patients exposed to sulfur mustard (SM). Chemical weapons of mass destruction (WMD) including SM were used by Iraq during Iran-Iraq war between 1983 and 1989. We undertook this study to evaluate the chest high resolution computerized tomography (HRCT) as a diagnostic tool in patients with documented exposure to SM and chronic respiratory symptoms. METHOD: The medical records of 155 patients exposed to SM during Iran-Iraq war and suffered respiratory complications were reviewed. Chest HRCTs of these patients were examined. Ten healthy controls with no history of exposure to HD were matched for age, gender, and chest HRCT protocol applied. RESULTS: Fifty chest HRCTs of these patients were randomly selected for this study. The most frequent findings were; air trapping 38 (76%), bronchiectasis 37 (74%), mosaic parenchymal attenuation (MPA) 36 (72%), irregular and dilated major airways 33 (66%) bronchial wall thickening (BWT) 45 (90%), and interlobular septal wall thickening (SWT) 13 (26%), respectively. Air trapping in one patient (10%) was the only positive finding in the control group. CONCLUSIONS: Chest HRCT findings of bronchiectasis, air trapping, MPA, SWT, and BWT were seen in our patients 15 years after exposure to HD. These findings suggest the diagnosis of bronchiolitis obliterans (BO). We did not encounter chest HRCT features consistent with pulmonary fibrosis.     

白血病肺部浸润的CT表现

目的：探讨白血病胸部浸润的CT表现，评价白血病肺部浸润的CT诊断价值。方法：回顾性分析我院确认的12例白血病患者的胸部白血病细胞浸润的CT(HRCT)表现。结果：白血症患者发生胸部浸润的CT表现多种多样，主要为小叶间隔增厚、外周支气管血管间质增厚、结节影，毛玻璃状改变，气腔实变等。这些表现与白血病细胞浸润肺的途径相一致，但不具特异性。结论：白血病患者出现胸部症状时，应考虑到肺浸润的可能，CT有助于肺浸润的诊断，但应与其他并发症如感染相鉴别。     

Lung parenchyma changes in ankylosing spondylitis: demonstration with high resolution CT and correlation with disease duration

OBJECTIVE: To analyze the spectrum of the lung parenchyma changes in ankylosing spondylitis (AS) with high resolution computed tomography (HRCT) and correlate the findings with disease duration. MATERIAL AND METHODS: Twenty patients (18 male, 2 female) with the diagnosis of AS according to New York criteria were included in the study. None of the patients had history of tuberculosis, prolonged inorganic dust exposure and hospitalization for pneumonia. Seven of the patients were smokers, three patients were ex-smokers, and 10 patients were nonsmokers. The patients were assigned to three groups depending on disease duration. Group 1: patients with disease duration or=6 years but or=11 years (N: 12 patients). HRCT and pulmonary function tests (PFT) were performed in all patients. RESULTS: HRCT demonstrated pathology in 17 patients (85%). Two patients in group 1, 4 patients in group 2 and 11 patients in group 3 had pulmonary parenchyma changes. Emphysema (9/20), septal thickening (9/20) and pleural thickening (9/20) were the most common changes followed by nodule (8/20) and subpleural band formation (7/20). Three patients had apical fibrosis (AF). Septal and pleural thickening (both 4/10) were the most common changes when only nonsmokers were considered. Among nine patients with emphysema three were nonsmokers. CONCLUSION: There is a wide spectrum in pulmonary parenchyma changes in AS. These changes begin in early stages of the disease and increase with disease duration. Although smoking complicates the spectrum of changes in pulmonary parenchyma, they are predominately in the form of interstitial inflammation.     

High-definition computed tomography in the study of the pulmonary parenchyma. The author's own experience]

High-resolution CT (HRCT) scans were performed on 156 patients, using a bone-reconstruction algorithm, 1.5 collimation at 4 cm intervals from apex to base of the lungs and a 512 x 512 matrix. The patients appeared to have a pathologic condition on chest film, or else they presented positive clinical symptoms--i.e., cough, dyspnea, fever--and questionable/negative chest films. Since HRCT is capable of showing the secondary lobule, we employed it to study both its anatomy and the alterations that can modify its normal morphology--i.e., thickening of interlobular septa, reticular pattern, nodular pattern, high-density areas, sub-pleural lines, honeycomb pattern. HRCT findings in secondary lobules, airways, and pleura were examined. They were: lymphangitic spread of carcinoma, pulmonary fibrosis, sarcoidosis, pneumoconiosis, interstitial edema, phlogosis, bronchiectasis, emphysema, and bullae. Even though some limitations still exist due to the aspecificity of HRCT findings, the latter is the best method currently available to recognize and locate interstitial conditions and, sometimes, to make a diagnosis--e.g., of lymphangitic spread of carcinoma, interstitial edema, fibrosis, emphysema, bronchiectasis. Moreover, HRCT can accurately locate pathologic areas for lung biopsy and can be used instead of chest radiographs in the follow-up.     

Quantitative assessment of change in regional disease patterns on serial HRCT of fibrotic interstitial pneumonia with texture-based automated quantification system

Objectives

To evaluate the usefulness of a texture-based automated quantification system (AQS) for evaluating the extent and interval change of regional disease patterns on initial and follow-up high-resolution computed tomographies (HRCTs) of fibrotic interstitial pneumonia (FIP).

Methods

Eighty-nine patients with clinically and/or biopsy confirmed usual interstitial pneumonia (UIP) (n?=?71) and non-specific interstitial pneumonia (NSIP) (n?=?18) were included. An AQS to quantify five disease patterns (ground-glass opacity [GGO], reticular opacity [RO], honeycombing [HC], emphysema [EMPH], consolidation [CONS]) and normal lung was developed. The extent and interval changes of each disease pattern, FS (fibrosis score), TA (total abnormal lung fraction) of entire lung on initial and 1-year follow-up HRCTs were quantified. The agreement between the results of AQS and two readers was assessed. Results of AQS were correlated with forced vital capacity (FVC) and carbon monoxide diffusing capacity (DLco).

Results

The Intraclass correlation coefficient (ICC) study revealed acceptable agreement between visual assessment and AQS (r?=?0.78, 0.66 for HC; 0.76, 0.61 for FS; 0.64, 0.68 for TA, initial and follow-up HRCTs, respectively). Linear regression analysis revealed the extent of HC, TA on initial CT, interval changes of FS contributed negatively to DLco, and interval changes of FS, TA contributed negatively to FVC.

Conclusions

Our AQS is comparable with visual assessment for evaluating the disease extent and the interval changes of FIP on HRCT.

Key Points

? HRCT is widely used to assess fibrotic interstitial pneumonia ? An automated quantification system matched well with visual assessment of HRCT ? Abnormal lung fraction on HRCT correlated with the decrease in diffusion capacity ? Automated quantification of HRCT images is useful in assessing fibrotic interstitial pneumonia     

高分辨率CT上肺细网状影的形态分析及病理基础

目的 探讨HRCT上肺细网状影的形态学表现及病理基础.方法 搜集本院2004年8月至2007年2月107例在HRCT上有细网状影患者临床病例资料进行细网状影形态学及动态变化分析研究.搜集24例病理证实充气标本进行影像与病理的对照研究.用X~2检验进行统计学分析.结果 细网状影网间隙直径一般≤3 mm,为圆形或不规则形,网间隙内为肺实质密度.网壁光滑或粗糙,厚度约≤1 mm.107例临床患者细网状影的伴随征象有磨玻璃密度影(GGO)(68.2%,73例)、铺路石征(23.4%,25例)、小叶间隔增厚(84.1%,90例)、肺气肿(32.7%,35例)、界面征(58.9%,63例)、牵拉性支气管扩张(41.1%,44例)及蜂窝征(26.2%,28例).纤维化患者与肺炎患者在蜂窝、牵拉性支气管扩张、小叶间隔增厚、界面征及铺路石征方面差异有统计学意义(P均＜0.01).肺炎大片状GGO合并细网状影形成铺路石征;癌性淋巴管炎细网状影合并小叶间隔增厚,并见串珠样结节影;特发性肺纤维化(IPF)细网状影多镶嵌在蜂窝之间;结缔组织病(CTD)并肺间质纤维化早期以细网状影为主,蜂窝影少见,及时治疗后可完全或部分吸收;慢性支气管炎细网状影合并肺气肿.58例随访患者中26例网状影增加,22例网状影减少或消失,10例无变化.24例肺标本细网状影病理基础主要为小叶内间质纤维增生、炎性细胞及肿瘤细胞浸润、渗出液充填、煤尘沉积等.结论 细网状影是由小叶内间质增厚形成,可由炎症、间质增生、肺纤维化和肿瘤引起,有助于提示这些疾病的存在,诊断价值需结合其他CT表现及动态变化.     

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.     

肺泡微石症的CT诊断

目的探讨肺泡微石症的ＣＴ表现及诊断价值。方法回顾性分析９例经活检病理证实或临床综合确诊的肺泡微石症ＣＴ表现。结果常规ＣＴ表现：肺窗示肺实质内有无数细小散在的粟粒结节，以中下肺的外周部密集，其ＣＴ值为２００～４００ＨＵ，多合并不同程度的肺气肿及间质纤维化；纵隔窗示细结节影最密集区常呈沿胸膜的线带状或散在的点簇状钙化，形成“火焰征”及“白描征”。高分辨率ＣＴ（ＨＲＣＴ）表现：肺野似磨玻璃样，结节大小稍有区别，沿支气管血管束分布偏多及小叶间隔增厚。结论ＣＴ尤其ＨＲＣＴ能更准确地反映本病的综合病理特点及病程，在诊断及鉴别诊断中起决定性作用。     

肺磨玻璃密度高分辨率CT的诊断和鉴别诊断意义

目的 通过对34例在高分辨率CT（HRCT）上表现有磨玻璃密度的肺部疾病病例作回顾分析,以探讨该征象HRCT的诊断和鉴别诊断意义。方法 对34例肺部疾病病的HRCT表现作回顾分析,观察磨玻璃密度阴影的分布范围、边界和伴随的其他征象。34例中经肺穿刺活检确诊7例,经气管镜和实验室检查确诊7例,其余病例经临床确诊。结果 34例中,以间质病变为主的疾病20例,磨玻璃密度阴影以外周分布为主,边界多模糊,均伴有间质病变征象。以实质病变为主的疾病8例,磨玻璃密度阴影多为限局性分布,其边界也常常是清楚的。慢性阻塞性肺疾病6例,磨玻璃密度阴影可呈外周或中央性分布,一般都有马赛克样分布和病灶区小血管增粗的表现。结论 虽然在HRCT上肺磨玻璃密度影是一种非和持异性征象,可见于间质性和实质性病变以及通气－血流障碍性疾病,但通过对其形态学特点的分析并结合临床资料有助于缩小拟诊范围,并对确定磨玻璃密度影的性质有所提示。     

肺泡蛋白沉着症X线胸片及高分辨率CT表现与肺功能的关系

目的 探讨肺泡蛋白沉着症X线胸片及胸部高分辨率CT(HRCT)影像表现及其与肺功能检查的相关性.方法 回顾性分析19例肺泡蛋白沉着症患者的X线胸片、胸部HRCT及肺功能检查[肺总量、一氧化碳弥散量(DLCO)、第一秒用力肺活量(FEV1)及一秒率(FEV1/FVC)],根据肺部阴影的程度、范围、严重程度及网格阴影范围进行影像学评分,将X线胸片及HRCT的影像评分与肺功能指标进行相关性分析.结果 X线胸片以双侧对称的自肺门向外放射的"蝶翼征"表现为主,胸部HRCT特征性的表现为两肺弥漫性分布的斑片状磨玻璃样气腔实变影,伴小叶间隔增厚及网格影,这种"铺路石"样病变呈地图样分布.19例患者的肺功能结果 为DLCO占预计值百分比:(54.49±16.78)%;FEV1/FVC:(86.00±6.70)%.X线胸片的范围评分及严重度评分与DLCO占预计值百分比呈负相关(r=-0.661,P＜0.01;r=-0.475,P＜0.05).HRCT严重度评分为(16.47±5.26)分,在HRCT的各项评分中严重度评分与限制性通气功能障碍(FEV1/FVC升高)及弥散功能障碍(DLCO占预计值百分比下降)的相关性最好(DLCO占预计值百分比r=-0.809,P＜0.01;FEV1/FVC r=0.573,P＜0.05);HRCT的范围评分比程度评分与肺功能的相关性更好,而HRCT的网格范围评分只与弥散功能障碍相关.结论 肺泡蛋白沉着症X线胸片、胸部HRCT与肺功能相关性良好,HRCT比X线胸片更能准确反映肺功能受损情况.     

Interstitial lung disease in systemic sclerosis

PURPOSE: To evaluate high-resolution CT (HRCT) parameters of inflammation and fibrosis in systemic sclerosis (SSc), for correlation with lung function, skin scores and exercise tolerance. MATERIAL AND METHODS: 45 SSc patients (40 women, 48.5+/-13.4 years), underwent thoracic HRCT, lung function assessment, and modified Rodnan skin scores. Exercise tolerance was also graded. HRCT were scored for extent of 4 HRCT patterns of interstitial lung disease (ILD): ground glass opacification (GGO), reticular, mixed and honeycomb pattern in each lobe. Total HRCT score, inflammation index (GGO and mixed score) and fibrosis index (reticular and honeycomb scores) were correlated with lung function and clinical parameters. RESULTS: ILD was present in 39/45 (86.7%) patients. Abnormal (<80% predicted) forced vital capacity (FVC), total lung capacity (TLC) and carbon monoxide diffusion factor (DLco) were detected in 30%, 22% and 46% of patients. Total HRCT score correlated with FVC (r=-0.43, p=0.008), FEV1 (forced expiratory volume) (r=-0.37, p=0.03), TLC (r=-0.47, p=0.003), and DLCO (r=-0.43, p=0.008); inflammatory index with DLCO (r=-0.43, p=0.008) and exercise tolerance (r=-0.39, p < 0.05); and fibrosis index with FVC (r=-0.31, p=0.05) and TLC (r=-0.38, p=0.02). Higher total HRCT score, and inflammation and fibrosis indices were found in patients with abnormal lung function. CONCLUSION: Qualitative HRCT is able to evaluate inflammation and fibrosis, showing important relationships with diffusion capacity and lung volume, respectively.     

长期吸烟者肺小气道损害的功能性HRCT与肺功能测定对照研究

目的：探讨功能性HRCT及肺功能测定对长期吸烟者肺小气道损害的临床诊断价值。方法：非吸烟组25例和吸烟组45例，行吸气末和呼气末HRCT扫描与肺功能测定，并分析其结果。结果：吸烟组中30例HRCT表现为小叶中心型肺气肿、全小叶型肺气肿、间隔旁型肺气肿、肺实质微结节、磨玻璃样密度影、小叶间隔线、空气潴留；这30例中肺功能测定正常27例，阻塞型通气功能障碍3例。非吸烟组19例行肺功能测定，结果全部正常；HRCT有阳性表现5例。结论：吸气末和呼气末HRCT先于肺功能测定发现吸烟对肺小气道的损害。     

Respiratory symptoms in rheumatoid arthritis: relation between high resolution CT findings and functional impairment

PURPOSE: The objectives of this study were to analyze the high resolution computed tomography (HRCT) findings in rheumatoid arthritis (RA) patients with respiratory symptoms and to evaluate the relation between the extent of HRCT findings and functional impairment as assessed by spirometry. MATERIALS AND METHODS: HRCT examination of the thorax and pulmonary function tests (PFTs) were performed in 34 RA patients with respiratory symptoms. Patients with smoking history or with emphysema evident on HRCT were excluded from the study. CT findings were assessed for the presence and pattern of abnormalities. Extent was scored based on the number of pulmonary segments involved. PFTs included forced expiratory flows (FEFs) and forced vital capacity (FVC). RESULTS: Bronchial wall thickening was detected in 29 of 34 RA patients (85%), small nodules in 24 patients (71%), and bronchial dilatation in 21 patients (62%). The extent of bronchial wall thickening correlated with FEF25-75, FEF75, and FEF50 (p<0.0001, respectively) (Spearman's rank correlation). Extent of small nodules correlated with FEF25-75, FEF50, and FEF25 (p<0.01, respectively). Stepwise regression analysis showed independent correlations of bronchial wall thickening with decreases in FEF25-75 and FEF75 (p<0.0001, both). Bronchial dilatation was also independently associated with a decrease in FVC (p<0.05). CONCLUSION: The most common HRCT findings in RA patients with respiratory symptoms are bronchial wall thickening and small nodules, and the extent of these findings correlates significantly with functional impairment.