胸片DR后处理在特发性肺间质纤维化诊断中的应用

目的分析胸片DR后处理功能在特发性肺间质纤维化(IPF)诊断中的作用.方法对经确诊为IPF的患者胸片在计算机上对图像进行一系列后处理后,由3位放射诊断医师对处理前后的胸片DR进行比较分析及评价.结果 IPF患者胸片DR后处理前影像表现:纤维化条索影21例(75.0%).云雾状磨玻璃16例(57.1%).粟粒状影10例(35.7%);结节状影12例(42.9%);网格状、蜂窝状影14例(50.0%);IPF患者胸片DR处理后影像表现:纤维化条索影26例(92.9%);云雾状磨玻璃23例(82%);粟粒状影22例(78.6%);结节状影13例(46.4%);网格状、蜂窝状影21例(75.0%).(p<0.001).结论运用胸部DR后处理软件进行分析,能提高IPF的征象显示率,有助于提高诊断.     

晚期日本血吸虫病若干病理问题的探讨：50例…

５０例晚期血吸虫病尸检回顾悸分析，发现并发乙型肝炎者１０例，远较一般肝炎尸检率为高；有轻度肾脏病变者７６％。肝脏肉眼除分叶型（８８．９％）外尚有少数结节型（占１１．１％）；肝表面多数有深沟纹；切面大门区虽纤维化但虫卵甚少；纤维带呈桥接状与肝输出静汲包膜连接。镜下发现“非塌隐性空网架样坏死”，认为其与纤维化机制有关。     

^99Tc^m-MIBI阳性显像诊断甲状腺癌的临床价值

目的 以临床病理学为基础，分析评价^99Tc^m-MIBI阳性显像诊断甲状腺癌的临床价值。方法 对105例甲状腺癌患者行早期和延迟甲状腺阳性显像，并对其影像学特征进行分析比较。结果 105例甲状腺癌中，^99Tc^m-MIBI阳性显像乳头状癌阳性有43例（82．7％），假阴性有9例（17．3％），灵敏度为82．7％；滤泡状癌阳性有37例（86．1％），假阴性有6例（14．0％），灵敏度为86．1％；其它类型阳性有5例（50．0％），假阴性有5例（50．0％），灵敏度为50．0％。其中乳头状癌组和滤泡状癌组灵敏度无明显差异（P〉0．05），但二者均高，于其它类型组（P〈0．05）。结论 ^99Tc^m-MIBI阳性显像对甲状腺癌诊断具有重要的临床价值。     

28例肾移植术后巨细胞病毒性肺炎的临床分析

目的探讨肾移植术后巨细胞病毒（CMV）性肺炎的临床特征及治疗方法。方法回顾性分析28例肾移植术后CMV肺炎患者的临床表现、x线特征和治疗方法。结果本组28例CMV肺炎患者均以发热为首发症状，并且体温均高于38．5℃，其中体温高于39．O℃者占67．9％，热型以稽留热为主。发热后3～7d出现咳嗽、气促、呼吸困难等，其中咳嗽以干咳为主，少数患者伴胸痛。随病情发展，出现逐渐加重的低氧血症，血氧饱和度低于85％的占60．7％，低于70％的占14．3％。X线表现呈逐渐加重趋势，多数患者出现毛玻璃影（78．6％），并多发小片状影（53．6％）或结节影（32．1％），8例（28．6％）患者出现胸腔积液。28例患者中治愈20例，治愈率为71．4％，好转3例，无效或死亡5例（17．9％）。结论肾移植术后CMV肺炎患者以高热为首发表现，进而发展为干咳、气促、呼吸困难，x线表现呈逐渐加重趋势，多数表现为毛玻璃影、小片状影及结节影，对该类患者需采取及时综合治疗方案。     

骨显像常见伪影因素分析

目的 分析全身骨显像常见伪影产生的因素。方法 9606例患者进行SPECT全身骨显像，并对1457例产生伪影的图像进行各因素的分析。结果 9606例图像中，产生伪影图像1457例，其中患者因素产生的伪影856例（占58．8％）；工作人员操作因素产生的伪影347例（占23.8％）；放射性核素显像荆因素产生的伪影254例（占17．4％）；机械因素产生的伪影0例，诸因素中，人为因素1203例（占82．6％）。结论 对骨显像产生伪影诸因素进行分析，为今后工作中避免或减少伪影的发生率从而提高图像的质量应从多方面加以注意和改善，把人为因素和药物的影响降到最低，以提高核医学影像的质量。     

以社区获得性肺炎为表现的肺结核的临床特点

目的分析肺结核以社区获得性肺炎为主要表现的特点,提高不典型肺结核诊断水平。方法对本院2000年1月至2006年6月收治的39例首诊为社区获得性肺炎最后诊断为肺结核病例的主要临床参数归纳整理并进行统计分析。结果高热79．49％（31／39）,中度发热7．69％（3／39）,低热7．69％（3／39）,体温正常5．13％（2／39）,发热者以午后和夜间为主者71．79％（28／39）,不规则发热23．08％（9／39）;痰涂阳性10例,阴性29例;胸片：尖后段12例（30．77％）,前段5例（12．82％）,中叶或舌叶2例（5．13％）,下叶背段15例（38．46％）．基底段8例（20．51％）。斑片影19例（48．72％）,多形态影12例（30．77％）,团块影8例（20．51％）,其中空洞2例（5．13％）。β内酰胺联合阿奇霉素改善4例、无改善2例、加重18例;影像加重83．3％（20／24）、改进8．33％（2／24）。氟喹诺酮类改善12例、加重2例;影像无变化57．89％（11／19）、加重42．11％（8／19）。抗结核1周体温正常21例,2周体温正常18例。1周复查胸片吸收8例、2周后吸收25例,抗结核1。2个月吸收6例,其中胸膜增厚2例。结论以肺炎为表现的不典型肺结核诊断困难,午后或夜间发热,结核好发部位,抗感染效果不佳需要警惕肺结核诊断,影像学尤其螺旋CT检查有利于结核的早期诊断。可疑结核慎用氟喹诺酮,可用β内酰胺和大环内酯类诊断性治疗。     

DR在支气管扩张症诊断中的应用研究

目的 探讨DR胸部影像中对支气管扩张症病灶进行计算机图像后处理的应用价值。方法 选取100例经临床或CT确诊的支气管扩张症的DR胸部影像。（1）采用影像对照方法，评价DR平片，影像增强片对支气管扩张病灶的显示能力。（2）对DR影像增强前后的囊状透光区进行灰度测量，比较其囊壁囊腔平均差值，观察其灰度轮廓的特征。结果 （1）DR平片，影像增强片对支气管病灶的显示，有显著差异。（2）DR胸片影像增强前后囊状病灶灰度轮廓线呈凹形城墙样曲线，而正常支气管管腔轮廓线无此改变，（3）DR胸片影像增强前后囊壁囊腔灰度平均差修正人显著差异。结论 DR胸片经数字化影像增强技术处理，对显示支气管扩张症的病灶明显优于处理前的DR平片，灰度轮廓线与影像增强技术有助于提高支气管扩张症的诊断准确率。     

系统性红斑狼疮并肺胸膜损害46例

目的：研究系统性红斑狼疮肺膜损害的特征和预后，方法：分析了89例SLE的X线胸片、临床和转归，结果：肺、胸膜改变46例（51．7％），包括胸膜炎16例（34．8％），网状或网状结节阴影26例（56．5％），片状浸润阴影12例（26．1％），肺不张1例（2．2％），病列率17．4％，结论：SLE肺胸膜损害常见，X线检查应作为SLE患者常规定期检查。     

腹腔镜胆囊切除术并发症的预防和处理

目的 探讨腹腔镜胆囊切除术（Laparoscopic Cholecystectomy，LC）常见并发症的发生原因、预防及处理。方法 回顾性总结分析本院从2001年1月-2005年1月行腹腔镜胆囊切除术病例，共计1450例。结果 胆管损伤3例（0．21％）；胆漏2例（0．14％）；气腹针穿刺致大网膜出血1例（0．07％），胆囊动脉后支撕脱出血转开腹止血术2例（0．14％）；肠管损伤1例；胆总管残余结石3例（0．21％）；皮下气肿6例（0．41％）；中转开腹胆囊切除术17例（1．17％）。结论 严格的培训和规范的手术程序，掌握并发症发生的机制及预防方法可大大减少腹腔镜胆囊切除术并发症的发生。     

低剂量螺旋CT扫描联合血清p16基因甲基化检测在肺癌早期诊断中的应用

目的研究在无症状的肺癌高危人群中利用低剂量CT（LDCT）联合血清p16基因甲基化检测进行肺癌早期诊断的可行性。方法肺癌高危人群入组标准：男性，年龄55～75岁；吸烟指数≥400支／年，目前仍在吸烟或戒烟不超过10年。共893例受检者被随机分为两组。一组为447例（LDCT—p16组），平均年龄66岁，进行LDCT联合血清p16基因甲基化检测；另一组为446例（CXR组），平均年龄67岁，接受后前位胸片检查。两组检查阳性病例将接受进一步组织病理学检查。并分别统计两组阳性结节检出率及肺癌检出率，并行X2检验。结果LDCT—p16组与CXR组分别有96．8％和92．8％的受检者完成了检查。LDCT—p16组中1113％病人可疑肺癌，明显高于CXR组的6．5％（P〈0．05）。其中LDCT—p16组中有7例，CXR组中有2例确诊为肺癌。LDCT—p16组肺癌检出率高于CXR组，但无统计学意义（P〉0．05）。结论低剂量CT联合血清p16基因甲基化检测是一种敏感、安全、可行的筛查早期肺癌的方法，能够取代胸片筛查早期肺癌。     

移动CR与移动DR在床旁胸部摄影中的应用比较

目的对比研究移动计算机X射线摄影（CR）与移动数字化X射线摄影（DR）在床旁胸部摄影中的临床应用价值。方法随机抽取移动CR与移动DR床旁胸部摄影胸片各200张,对2种摄影方式所摄胸片的图像质量及胸内各结构的显示进行对比研究。移动CR和移动DR各200张床旁胸部摄影胸片,以其CT检查为＂金标准＂进行对照,将两组床旁胸片显示的病灶清晰程度分为清晰、可见、模糊、隐约可见、未见5类。统计2组的例数,绘制接受者操作特征（ROC）曲线。结果图像质量：移动CR床旁胸部摄影所得胸片的甲级片率69.0%,乙级片率24.5%,丙级片率5.0%,废片率1.5%。移动DR床旁胸部摄影所得胸片的甲级片率83%,乙级片率16%,丙级片率1%,废片率0。对胸内各结构的显示：移动CR与移动DR床旁胸部摄影所得胸片对胸内各结构的显示率移动CR低于移动DR。对病灶的显示能力：200张移动CR胸片中,126例行CT检查,67例CT所显示的病灶中,移动CR能显示64例,3例未见病灶。200张移动DR胸片中,108例行CT检查,53例CT所显示的病灶中,移动DR能显示52例,1例未见病灶。移动CR与移动DR床旁胸部摄影ROC曲线下的面积分别为0.833和0.918。结论移动CR与移动DR床旁胸部摄影,移动DR摄影的影像质量、对胸内结构的显示及对病灶的显示能力均优于移动CR,在床旁胸部摄影中移动DR具有更高的应用价值。     

Clinical characteristics of idiopathic pulmonary fibrosis patients with diabetes mellitus: the national survey in Korea from 2003 to 2007

Evidence suggests that diabetes mellitus (DM) is associated with idiopathic pulmonary fibrosis (IPF). According to the new IPF guidelines, high-resolution computed tomography (HRCT) is an essential means of diagnosing IPF. We investigated the relationship between IPF and DM in patients treated between 2003 and 2007. Newly diagnosed IPF patients in large university teaching hospitals in Korea were enrolled from January 2003 to December 2007. We retrospectively analyzed 1,685 patients using the interstitial lung disease (ILD) registry. In total, 299 IPF patients (17.8%) also had DM. The mean age of our subjects was 68.0 ± 9.4 yr. HRCT showed significantly more reticular and honeycomb patterns in IPF patients with DM than in IPF patients without DM (P = 0.014, P = 0.028, respectively). Furthermore, significantly higher incidences of hypertension, cardiovascular diseases, and other malignancies (except lung cancer) were found in IPF patients with DM than in IPF patients without DM. In conclusion, IPF patients with DM are more likely to have the usual interstitial pneumonia (UIP) pattern, including reticular and honeycomb patterns, on HRCT than are those without DM.     

Hyperplastic epithelial foci in honeycomb lesions in idiopathic pulmonary fibrosis

Seventy-two cases of idiopathic pulmonary fibrosis (IPF) were examined from 2856 consecutive autopsy cases at the Japanese Red Cross Medical Center in Tokyo from 1973-1996. Primary lung cancer had arisen in 31 of 72 cases of IPF (43%), significantly higher than the incidence in cases without IPF (8.1%) and in the cases with non-IPF chronic lung diseases (11.9%). Hyperplastic epithelial foci in the honeycomb lesions of IPF cases were significantly more prominent in the lower than in the upper lobe, in cases with or without lung cancer, and they were more prominent in the lower lobe of IPF with than in those without cancer. The length of hyperplastic epithelial foci in the lower lobe of IPF cases was longer than that in interstitial pneumonia-associated with collagen vascular diseases. There was a higher PCNA labeling index of hyperplastic epithelial foci in IPF cases than in cases of interstitial pneumonia-associated with collagen vascular diseases. The PCNA labeling index was almost the same between smokers and nonsmokers with IPF. Overexpression of p53 was observed in hyperplastic epithelial foci in honeycomb lesion of IPF. DNA ploidy analysis of hyperplastic epithelial foci in the paraffin sections of 12 IPF cases revealed aneuploidy patterns in eight cases. These results strongly suggest that accelerated cell proliferation occurs in the honeycomb lesion of IPF, and that regenerative epithelia becomes susceptible to carcinogenic agents in addition to the smoking effect.     

特发性肺纤维化的16层螺旋CT表现特征及其解剖、病理基础

为明确特发性肺纤维化(idiopathic pulmonary fibrosis,IPF)的16层螺旋CT表现特征、合并症及其解剖的优势分布。对临床病理证实的IPF38例行16层螺旋CT检查,其中26例追加薄层CT扫描。观察IPF的CT征像和合并症,评价其CT征像在解剖中优势分布。其中蜂窝肺14例(36.8%),10例(71.4%)主要分布于中下肺的外带、以双肺下叶基底段显著,4例(28.6%)呈弥漫性分布,11例(78.6%)病程在3年以上。小叶内间质增厚16例(42.1%)、小叶间隔增厚20例(52.6%)及支气管血管束增粗9例(23.7%),分别优势分布于中下肺的外带、双肺下叶基底段,双肺下叶及右肺中叶中内带。磨玻璃样密度影15例(39.5%),优势分布于肺的外带,主要以双肺下叶基底段显著;其中10例(66.7%)病程在1年以下。结果表明IPF的16层螺旋CT征象能反映其病理变化,在解剖分布上有明显特点。     

Toxic Inhalational Injury-Associated Interstitial Lung Disease in Children

Interstitial lung disease in children (chILD) is a group of disorders characterized by lung inflammation and interstitial fibrosis. In the past recent years, we noted an outbreak of child in Korea, which is possibly associated with inhalation toxicity. Here, we report a series of cases involving toxic inhalational injury-associated chILD with bronchiolitis obliterans pattern in Korean children. This study included 16 pediatric patients confirmed by lung biopsy and chest computed tomography, between February 2006 and May 2011 at Asan Medical Center Children''s Hospital. The most common presenting symptoms were cough and dyspnea. The median age at presentation was 26 months (range: 12-47 months), with high mortality (44%). Histopathological analysis showed bronchiolar destruction and centrilobular distribution of alveolar destruction by inflammatory and fibroproliferative process with subpleural sparing. Chest computed tomography showed ground-glass opacities and consolidation in the early phase and diffuse centrilobular nodular opacity in the late phase. Air leak with severe respiratory difficulty was associated with poor prognosis. Although respiratory chemicals such as humidifier disinfectants were strongly considered as a cause of this disease, further studies are needed to understand the etiology and pathophysiology of the disease to improve the prognosis and allow early diagnosis and treatment.     

Alveolar epithelial cells in idiopathic pulmonary fibrosis display upregulation of TRAIL,DR4 and DR5 expression with simultaneous preferential over-expression of pro-apoptotic marker p53

Idiopathic pulmonary fibrosis (IPF) is a progressive, debilitating, and fatal lung disease of unknown aetiology with no current cure. The pathogenesis of IPF remains unclear but repeated alveolar epithelial cell (AEC) injuries and subsequent apoptosis are believed to be among the initiating/ongoing triggers. However, the precise mechanism of apoptotic induction is hitherto elusive. In this study, we investigated expression of a panel of pro-apoptotic and cell cycle regulatory proteins in 21 IPF and 19 control lung tissue samples. We reveal significant upregulation of the apoptosis-inducing ligand TRAIL and its cognate receptors DR4 and DR5 in AEC within active lesions of IPF lungs. This upregulation was accompanied by pro-apoptotic protein p53 overexpression. In contrast, myofibroblasts within the fibroblastic foci of IPF lungs exhibited high TRAIL, DR4 and DR5 expression but negligible p53 expression. Similarly, p53 expression was absent or negligible in IPF and control alveolar macrophages and lymphocytes. No significant differences in TRAIL expression were noted in these cell types between IPF and control lungs. However, DR4 and DR5 upregulation was detected in IPF alveolar macrophages and lymphocytes. The marker of cellular senescence p21^WAF1 was upregulated within affected AEC in IPF lungs. Cell cycle regulatory proteins Cyclin D1 and SOCS3 were significantly enhanced in AEC within the remodelled fibrotic areas of IPF lungs but expression was negligible in myofibroblasts. Taken together these findings suggest that, within the remodelled fibrotic areas of IPF, AEC can display markers associated with proliferation, senescence, and apoptotosis, where TRAIL could drive the apoptotic response. Clear understanding of disease processes and identification of therapeutic targets will direct us to develop effective therapies for IPF.     

Severity classification for idiopathic pulmonary fibrosis by using fuzzy logic

OBJECTIVE:

To set out a severity classification for idiopathic pulmonary fibrosis (IPF) based on the interaction of pulmonary function parameters with high resolution computed tomography (CT) findings.

INTRODUCTION:

Despite the contribution of functional and radiological methods in the study of IPF, there are few classification proposals for the disease based on these examinations.

METHODS:

A cross-sectional study was carried out, in which 41 non-smoking patients with IPF were evaluated. The following high resolution CT findings were quantified using a semi-quantitative scoring system: reticular abnormality, honeycombing and ground-glass opacity. The functional variables were measured by spirometry, forced oscillation technique, helium dilution method, as well as the single-breath method of diffusing capacity of carbon monoxide. With the interaction between functional indexes and high resolution CT scores through fuzzy logic, a classification for IPF has been built.

RESULTS:

Out of 41 patients studied, 26 were male and 15 female, with a mean age of 70.8 years. Volume measurements were the variables which showed the best interaction with the disease extension on high resolution CT, while the forced vital capacity showed the lowest estimative errors in comparison to total lung capacity. A classification for IPF was suggested based on the 95% confidence interval of the forced vital capacity %: mild group (≥92.7); moderately mild (76.9–92.6); moderate (64.3–76.8%); moderately severe (47.1–64.2); severe (24.3–47.0); and very severe (<24.3).

CONCLUSION:

Through fuzzy logic, an IPF classification was built based on forced vital capacity measurement with a simple practical application.     

普通型间质性肺炎的临床病理特征及其与特发性非特异性间质性肺炎的鉴别诊断

目的 探讨普通型间质性肺炎(UIP)的临床病理特征以及与特发性非特异性间质性肺炎(INSIP)的鉴别诊断。方法 对15例经电视胸腔镜或小切口开胸肺活检诊断为UIP的病例进行光镜观察和临床病理资料回顾性分析,治疗后随访,与11例病理诊断的INSIP进行比较分析。结果UIP多见于50岁以上的男性,临床主要表现为活动后气促、咳嗽咳痰、双下肺闻及吸气相爆裂音;高分辨CT表现为以中下肺和胸膜下为主的片状和网状阴影,8例有蜂窝肺。UIP的病理特征为病变进展不一致,间质的炎症、纤维化和蜂窝变与正常肺组织呈交替分布,轻重不一。纤维母细胞灶、肌硬化、镜下蜂窝肺、弥漫胶原沉积和肺泡结构改建的检出情况在UIP和INSIP分别是15/15和3/11(P<0.001)、12/15和4/11(P<0.05)、13/15和3/11(P<0.01)、15/15和6/11(P<0.01)、15/15和5/11(P<0.01)。两者对糖皮质激素的反应率分别为3/15和8/11(P<0.05)。结论 UIP和INSIP的一般临床表现差异不明显,高分辨CT对疑难病例的鉴别诊断有帮助,明确诊断依赖肺活检病理诊断;纤维母细胞灶、伴胶原沉积的瘢痕化和蜂窝变组成不同时相的病变共同构成诊断UIP的形态特征。     

Idiopathic pulmonary fibrosis: immunohistochemical analysis provides fresh insights into lung tissue remodelling with implications for novel prognostic markers

Aim

This study explored the cellular and biological interrelationships involved in Idiopathic Pulmonary Fibrosis (IPF) lung tissue remodelling using immunohistochemical analysis.

Methods and results

IPF and control lung tissues were examined for localisation of Epithelial Mesenchymal Transition (EMT), proliferation and growth factor markers assessing their relationship to key histological aberrations. E-cadherin was expressed in IPF and control (Alveolar type II) ATII cells (>75%). In IPF, mean expression of N-cadherin was scanty (<10%): however 4 cases demonstrated augmented expression in ATII cells correlating to histological disease status (Pearson correlation score 0.557). Twist was expressed within fibroblastic foci but not in ATII cells. Transforming Growth Factor- β (TGF-β) protein expression was significantly increased in IPF ATII cells with variable expression within fibroblastic foci. Antigen Ki-67 was observed within hyperplastic ATII cells but not in cells overlying foci. Collagen I and α-smooth muscle actin (α-SMA) were strongly expressed within fibroblastic foci (>75%); cytoplasmic collagen I in ATII cells was present in 3 IPF cases. IPF ATII cells demonstrated variable Surfactant Protein-C (SP-C).

Conclusions

The pathogenesis of IPF is complex and involves multiple factors, possibly including EMT. Histological analysis suggests TGF-β-stimulated myofib rob lasts initiate a contractile response within established fibroblastic foci while proliferating ATII cells attempt to instigate alveolar epithelium repair. Marker expression (N-cadherin and Ki-67) correlation with histological disease activity (as reflected by fibroblastic foci extent) may emerge as future prognostic indicators for IPF.