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。     

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.     

鹦鹉热衣原体肺炎的胸部CT影像表现

目的:探讨鹦鹉热衣原体肺炎的胸部CT影像表现。方法:回顾性分析22例鹦鹉热衣原体肺炎患者的临床及胸部CT资料,分析肺内病变的影像学特点及肺外影像表现。结果:22例鹦鹉热衣原体肺炎中,15例肺内病变表现为大叶性肺炎,5例表现为斑片结节,2例表现为支气管肺炎,常见伴随征象包括：小叶间隔增厚(12例)、小叶内网状影(11例)、铺路石征(6例),少数可见晕征(3例)、反晕征(1例)、小叶中心性结节(1例)、支气管壁增厚(2例)、支气管牵引性扩张(1例)。所有病变均未见坏死或空洞。肺内病变分布：累及单肺19例,双肺3例;累及上肺区6例,下肺区13例,上、下肺区同时受累3例;外周分布12例,支气管血管周围分布4例,弥漫分布6例。10例合并胸腔积液,3例伴纵隔淋巴结增大。结论:鹦鹉热衣原体肺炎的影像表现以大叶性肺炎最多见,典型者表现为斑片状实变伴空气支气管征,多合并磨玻璃密度影,常伴小叶间隔增厚、小叶内网状影及铺路石征等间质受累表现,可见胸腔积液、纵隔淋巴结增大。     

急性间质性肺炎的CT表现及其病理学基础

目的 :探讨急性间质性肺炎(acute interstitial pneumonia,AIP)的CT影像特征,分析其影像与病理的联系。方法 :回顾性分析我院经肺活检及临床综合诊断证实的AIP患者8例的临床资料。结果:8例中,早期病变5例,病理以渗出性改变为主,影像表现为双肺的弥漫磨玻璃影及小叶间隔增厚影,并以双肺外侧带为主;中晚期3例,病理以肺间质渗出与机化共存为主,影像表现为双肺弥漫的磨玻璃影,实变影、支气管扩张及蜂窝状影。结论:AIP早期CT影像学表现没有特征性,中晚期以支气管扩张和蜂窝状影较为特殊,但诊断仍需结合临床动态观察。     

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。     

闭塞性细支气管炎伴机化性肺炎的高分辨CT表现

目的探讨闭塞性细支气管炎伴机化性肺炎的高分辨CT表现,并与慢性嗜酸性肺炎和寻常型间质性肺炎进行鉴别。方法结合相关文献回顾性分析12例闭塞性细支气管炎伴机化性肺炎高分辨CT表现。结果12例闭塞性细支气管炎伴机化性肺炎的高分辨CT表现如下:(1)肺内多发斑片状肺实变影和磨玻璃影(n=8),其中肺实变影中见支气管充气征(n=5)。(2)肺内多发小结节影和不规则线状影(n=7)。(3)肺内多发斑片状肺实变影和磨玻璃影伴小结节影和不规则线状影(n=3)。(4)细支气管扩张、壁增厚伴周围肺实变影(n=6)。(5)肺内肺实变影和磨玻璃影呈游走性(n=3)。结论高分辨CT可以更好地显示闭塞性细支气管炎伴机化性肺炎的病理改变,并使其能与慢性嗜酸性肺炎和寻常型间质性肺炎在影像上进行鉴别,也为纤维支气管镜下肺活检提供准确的定位。     

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.     

吸烟与小气道病变CT表现

吸烟的肺部表现为微小结节、磨玻璃密度影象、肺气肿及呼吸性细支气管炎、支气管扩张、支气管壁增厚和支气管内粘液栓。肺内微小结节也可见于结节病，硬皮病，癌性淋巴管炎。小叶中心磨玻璃影象可见于感染性经支气管或血行播散病变、过敏性肺泡炎及剥脱性间质性肺炎。     

电焊工尘肺CT表现分析

【摘要】目的：分析电焊工尘肺CT表现,提高对电焊工尘肺的诊断水平。方法：回顾性分析2015年1月-2020年12月按职业病诊断标准诊断为Ⅰ期及Ⅱ期的电焊工尘肺患者共103例。对其临床资料及影像特征进行总结分析。结果：本组电焊工尘肺CT表现为小叶中心磨玻璃密度微小结节影44例,小叶分支线状影63例,其中小叶分支线状影合并小叶中心磨玻璃密度微小结节影共20例;腺泡磨玻璃结节影7例,弥漫性磨玻璃改变10例,致密微小结节影6例,伴有肺间质纤维化6例、纤维灶10例、肺结核6例、肺气肿15例、肺大泡14例、支气管扩张1例、淋巴结肿大9例、胸膜增厚19例。结论：电焊工尘肺的CT具有特征性的影像表现,小叶中心磨玻璃密度微小结节影及小叶分支线状影为其特征的CT表现,结合职业病史,可做出明确诊断。     

SARS患者康复过程中的胸部CT表现

目的　探讨严重急性呼吸综合征 (SARS)患者康复期的CT表现。方法　随访观察 6 5例确诊为SARS的康复者 ,根据病史分为重症 2 1例 ,轻症 4 4例 ,进行多层螺旋CT和高分辨率CT扫描、肺功能等检查。结果　 2 8例CT扫描未见异常。其余CT表现为 :(1)磨玻璃样密度灶 35例 ,包括 :局限斑片状磨玻璃样密度病灶 11例 ;多叶多段磨玻璃样密度灶 19例 ;双肺弥漫磨玻璃样密度病灶 5例。 (2 )小叶内间质及小叶间隔增厚 30例。 (3)胸膜下弧线影 9例。 (4 )不规则纤维索条影 19例。(5 )牵拉性细支气管扩张 3例。 (6 )结节状气腔实变病灶 2例。 (7)空洞病灶 1例。未见明显纵隔淋巴结肿大和胸腔积液。多次复查肺内影像及肺功能均有好转。比较重症组和轻症组CT表现及肺功能指标差异有显著意义 (P <0 0 5 )。结论　部分SARS康复期患者肺部表现基本正常 (2 8/ 6 5 ,占 4 3 1% )。磨玻璃样密度病灶为康复期的主要CT表现 (35 / 6 5 ,占 5 3 8% ) ,并伴有程度不等的肺间质增生。重症组较轻症组患者肺内表现严重 ,肺功能差。随着时间的延长 ,肺内病变及肺功能逐渐好转。     

Drug-induced pneumonitis: thin-section CT findings in 60 patients

PURPOSE: To describe thin-section computed tomographic (CT) findings in patients with drug-induced pneumonitis, to compare these CT findings, and to correlate them with arterial oxygen tension level. MATERIALS AND METHODS: Thin-section CT scans obtained in 60 patients with drug-induced pneumonitis were evaluated retrospectively. The patients had 31 cases of antineoplastic agent-induced pneumonitis and 29 cases of nonneoplastic agent-induced pneumonitis (antibiotic agent, 20 cases; herbal medicine [sho-saiko-to], four cases; antirheumatic agent, three cases; phenytoin, one case; disodium cromoglycate, one case). CT scans were reviewed by two chest radiologists in consensus. Correlation between arterial oxygen tension level and the extent of disease at CT was available in 21 patients. These two factors were compared by using the Spearman rank correlation coefficient. RESULTS: The predominant findings in antineoplastic agent-induced pneumonitis were diffuse or multifocal ground-glass opacities with intralobular interstitial thickening. The predominant CT findings in antibiotic agent-induced pneumonitis were patchy ground-glass opacities with centrilobular opacities and interlobular septal lines. The predominant CT findings in herbal medicine-induced pneumonitis were diffuse ground-glass opacities with patchy consolidation. Interlobular septal lines and centrilobular opacities were observed more frequently in antibiotic agent-induced pneumonitis, and intralobular interstitial thickening was observed more frequently in antineoplastic agent-induced pneumonitis. A significant correlation was established between arterial oxygen tension level and extent of disease at CT (r = -0.84, P <.05). CONCLUSION: In addition to ground-glass opacities and interlobular septal lines, the most common thin-section CT findings were intralobular interstitial thickening, observed in antineoplastic agent-induced pneumonitis, and centrilobular opacities, observed in antibiotic-induced pneumonitis.     

High-resolution computed tomography features of nonspecific interstitial pneumonia and usual interstitial pneumonia

OBJECTIVE: To assess the accuracy of high-resolution computed tomography (HRCT) in the diagnosis of nonspecific interstitial pneumonia (NSIP). We hypothesized that the computed tomography (CT) features of NSIP could be distinguished from those of usual interstitial pneumonia (UIP). METHODS: The HRCT images of 47 patients with surgical lung biopsy-proven NSIP (n = 25) and UIP (n = 22) were independently reviewed by 2 thoracic radiologists. Predominant imaging patterns, most likely diagnosis, and diagnostic level of confidence were recorded. A confident HRCT diagnosis of NSIP was based on the presence of spatially uniform, bilateral, basal-predominant ground-glass and/or reticular opacities with little if any honeycombing, whereas UIP was confidently diagnosed if a spatially inhomogeneous, bilateral, peripheral, basal-predominant pattern of reticular opacities and honeycombing with little if any ground-glass attenuation was identified. RESULTS: A predominant pattern of ground-glass and/or reticular opacity with minimal to no honeycombing was demonstrated in 48 (96%) of 50 readings in patients with NSIP. Conversely, the presence of honeycombing as a predominant feature had a predictive value of 90% for UIP (P < 0.001). Usual interstitial pneumonia was more likely than NSIP to be subpleural and patchy (P < 0.001). A confident CT diagnosis of NSIP and UIP was correct in 73% and 88% of cases, respectively. The correctness of a CT diagnosis made at intermediate or high confidence was 68% and 88%, respectively. The kappa value for distinction of NSIP from UIP was 0.72. CONCLUSION: In contrast to previous reports, NSIP can be separated from UIP in most cases. The presence of honeycombing as a predominant imaging finding is highly specific for UIP and can be used to differentiate it from NSIP, particularly when the distribution is patchy and subpleural predominant. The presence of predominant ground-glass and reticular opacity is highly characteristic of NSIP, but there is a subset of patients with UIP who have this pattern and may require biopsy for differentiation from NSIP.     

Asbestosis: high-resolution CT-pathologic correlation

High-resolution computed tomography (HRCT) was performed in seven inflated and fixed postmortem lungs from seven asbestos-exposed patients with pathologically proved asbestosis. The parenchymal abnormalities seen at in vitro HRCT included thickened intralobular lines (n = 7), thickened interlobular lines (n = 7), pleural-based opacities (n = 7), parenchymal fibrous bands (n = 5), subpleural curvilinear shadows (n = 4), ground-glass appearance (n = 4), traction bronchiectasis (n = 4), and honeycombing (n = 2). The thickened intralobular lines were shown histologically to be due to peribronchiolar fibrosis. Thickened interlobular lines were due mainly to interlobular fibrotic thickening in four lungs and edema in three. The peribronchiolar fibrosis was most severe in the subpleural lung regions, creating curvilinear line shadows and pleural-based areas of opacity. Some subpleural fibrosis extended proximally along the bronchovascular sheath to create bandlike lesions. Areas of ground-glass appearance on HRCT scans were shown to be the result of mild alveolar wall and interlobular septal thickening due to fibrosis or edema. Postmortem HRCT findings were similar to premortem HRCT findings and correlated well with the pathologic findings of asbestosis.     

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.     

Pulmonary sarcoidosis: changes on follow-up CT examination.

OBJECTIVE. To determine serial changes in the pattern, distribution, and extent of disease over time, and to determine if any specific findings could be used to predict prognosis in patients with pulmonary sarcoidosis, we reviewed the CT scans of 18 patients with pulmonary sarcoidosis. MATERIALS AND METHODS. The study included 18 patients with biopsy-proved sarcoidosis and pulmonary abnormalities who had two serial high-resolution CT examinations (1.5-mm collimation, high-spatial-frequency reconstruction algorithm) 4-49 months apart. Initial and follow-up CT scans were evaluated independently and then directly compared with each other by two observers. Scans were assessed for the presence, extent, and severity of ground-glass, nodular, and irregular linear opacities; interlobular septal thickening; cystic air spaces; and architectural distortion. If a finding was predominant, it was noted. RESULTS. Reversible findings included ground-glass, nodular, and irregular linear opacities and septal thickening. Irreversible findings included cystic air spaces and architectural distortion. Follow-up CT showed overall improvement in 12 of 18 patients, progression in five, and no change in one. A predominant pattern of disease could be determined for each patient. Fourteen patients had predominant nodular opacities; of these, 11 had improved by follow-up. Four had predominant irregular linear opacities; of these, three showed progression of disease on follow-up. The presence of any other specific abnormalities, including ground-glass opacities, was not helpful in predicting improvement or worsening of disease on the follow-up examination. CONCLUSION. In pulmonary sarcoidosis, ground-glass, nodular, and irregular linear opacities and interlobular septal thickening represent potentially reversible disease, while cystic air spaces and architectural distortion are irreversible findings. Follow-up CT usually shows improvement in patients with predominant nodular opacities, while disease tends to progress in patients with predominant irregular opacities.     

Can acute interstitial pneumonia be differentiated from bronchiolitis obliterans organizing pneumonia by high-resolution CT?

PURPOSE: In the early stages, clinical and chest radiographic findings of acute interstitial pneumonia (AIP) are often similar to those of bronchiolitis obliterans organizing pneumonia (BOOP). However, patients with AIP have a poor prognosis, while those with BOOP can achieve a complete recovery after corticosteroid therapy. The objective of this study was to identify differences in high-resolution CT (HRCT) findings between the two diseases. METHODS: The study included 27 patients with AIP and 14 with BOOP who were histologically diagnosed [open-lung biopsy (n=7), autopsy (n=17), transbronchial lung biopsy (n=17)]. The frequency and distribution of various HRCT findings for each disease were retrospectively evaluated. RESULTS: Traction bronchiectasis, interlobular septal thickening, and intralobular reticular opacities were significantly more prevalent in AIP (92.6%, 85.2%, and 59.3%, respectively) than in BOOP (42.9%, 35.7%, and 14.3%, respectively) (p<0.01). Parenchymal nodules and peripheral distribution were more prevalent in BOOP (28.6% and 57.1%, respectively) than in AIP (7.4% and 14.8%, respectively) (p<0.01). Areas with ground-glass attenuation, air-space consolidation, and architectural distortion were common in both AIP and BOOP. CONCLUSION: For a differential diagnosis of AIP and BOOP, special attention should be given to the following HRCT findings: traction bronchiectasis, interlobular septal thickening, intralobular reticular opacities, parenchymal nodules, pleural effusion, and peripheral zone predominance.     

胸部结节病的CT诊断

目的:分析胸部结节病的CT表现,提高对本病的认识和诊断水平。方法:回顾性分析经活检病理证实或临床治疗观察符合诊断标准的26例胸部结节病的CT表现。结果:26例结节病中,肺门、纵隔淋巴结肿大23例(88.5%),其中肺门或/和纵隔淋巴结肿大8例(30.7%),肺门或/和纵隔淋巴结肿大伴有肺内病变15例(57.7%),仅见肺部浸润性改变而无淋巴结肿大1例(3.8%),肺纤维性改变2例(7.7%)。肺内主要表现为结节影15例,支气管血管束增粗7例,小叶间隔增厚4例,实变影1例,磨玻璃影1例。结论:双侧肺门对称性淋巴结肿大和/或纵隔淋巴结肿大以及沿支气管血管束分布的结节影是胸部结节病的特征性表现;不典型者需密切结合临床检查及治疗后随访。     

Organizing pneumonia: perilobular pattern at thin-section CT

PURPOSE: To describe the appearance and frequency of a perilobular pattern at thin-section computed tomography (CT) in patients with organizing pneumonia. MATERIALS AND METHODS: Thin-section CT scans of 21 consecutive patients with cryptogenic organizing pneumonia were retrospectively reviewed. Two thoracic radiologists in consensus recorded the presence and distribution of the CT abnormalities (consolidation, ground-glass opacification, nodules, bandlike opacities, interlobular septal thickening, and findings of fibrosis), with a particular focus on the presence and predominant location of the perilobular pattern, that is, a poorly defined arcadelike or polygonal appearance. RESULTS: The perilobular pattern was present in 12 (57%) of 21 patients, 10 of whom had five or more perilobular opacities. Other CT features were consolidation (20 patients, 95%), which was predominantly a subpleural and/or peribronchial distribution in 17 patients, and ground-glass opacification (18 patients, 86%). Bandlike opacities and interlobular septal thickening were observed in four patients and one patient, respectively. The perilobular pattern abutted the pleural surface in 10 of 12 patients and was surrounded by aerated lung parenchyma in 11 of 12 patients. There was no obvious relationship between perilobular opacities and CT findings indicative of established fibrosis. CONCLUSION: A perilobular pattern was present in more than half of the patients, along with the expected thin-section CT features of organizing pneumonia.     

Swine-origin influenza A (H1N1) viral infection: thoracic findings on CT

OBJECTIVE: The purpose of this article is to illustrate and describe various CT manifestations of swine-origin influenza A (H1N1) viral infection. CONCLUSION: The imaging findings seen in patients with H1N1 infection include consolidations, ground-glass opacities, interlobular septal thickening, small nodules, and findings suggestive of small airways disease, among others. Definitive diagnosis is based on correlation of the CT findings with the clinical symptoms and laboratory test results.