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。     

慢性中耳炎的HRCT诊断

探讨慢性中耳炎的ＨＲＣＴ征象，诊断及鉴别诊断。材料与方法；对手术证实的１７例慢性中耳炎患者术前进行ＨＲＣＴ扫描并与手术病理结果对照分析。结果；胆脂瘤８例表现为中耳腔内团块状影，周围低密度环包绕，听骨明显破坏及鬓 扩大，骨缘硬化。４例肉芽肿多呈片状，条索状或网状，听骨破坏较轻。     

老年肺结核与肺癌并存的CT诊断

目的：探讨肺结核与肺癌并存CT诊断。方法：GE检查使用美国GE公司机器，层厚10mm，连续扫描，先平扫后增强扫描。结果：肺结核与肺癌并存时临床及CT表现多样化且不典型，可表现为浸润性病灶、肺不张，空洞性病灶，肺门扩大，胸腔积液等。同时运用多种检查方法有助于肺结核与肺癌并存的早期发现。     

HRCT技术在肺部螺旋CT扫描中的应用

医学影像技术的不断发展，使高分辨率CT技术广泛应用于临床，CT高分辨率扫描成像简称（High Resolation CT），简单地说是结合1—2mm层厚和像素大小为0．2—0．3mm的重建图像的一种技术。     

活动性肺结核的HRCT诊断

MSCT在肺结核的诊断中发挥着重要的作用,其中高分辨力CT（HRCT）在鉴别结核灶的活动性方面的诊断价值尤为突出。本文重点总结了与肺结核病灶活动性相关的文献,对常见征象包括结节和微结节、粟粒结节、树芽征、实变和空洞等的发病机制、病理与HRCT对照等进行分析并对各个征象出现时对活动性结核诊断的特异性和敏感性及其影像因素进行总结,旨在探讨HRCT在诊断活动性结核中的价值。     

慢性中耳炎的HRCT诊断

目的探讨慢性中耳炎的HRCT特征、诊断及鉴别诊断.方法回顾性分析105例慢性中耳炎患者术前临床和HRCT检查资料,并与手术病理结果对照.结果36例胆脂瘤型中耳炎HRCT表现为鼓室或/及鼓窦内团块状软组织影和骨质改变,包括听骨硬化、移位、破坏,盾板破坏及中耳腔扩大,有的还伴有乙状窦、天盖、水平半规管的破坏.69例渗出肉芽型中耳炎HRCT表现多呈斑片状、条索状或网状软组织影,部分可见液平,听骨移位及破坏较轻.结论依据中耳腔内软组织影的分布、形态及骨质改变等特点,大多数慢性中耳炎可籍HRCT做出诊断或鉴别诊断.     

畸形性骨炎HRCT诊断

畸形性骨炎 ,又称Ｐａｇｅｔ’ｓ病 ,在欧美洲较常见 ,多发生于老年人 ,国内较少见 ,关于其ＣＴ表现报道较少。近期笔者遇到5例 ,均行Ｘ线及高分辨率ＣＴ(ＨＲＣＴ)检查 ,结合文献 ,初步探讨ＨＲＣＴ的诊断价值。1　材料与方法5例中 ,男 3例 ,女 2例 ,年龄 5 8～ 72岁 ,平均 6 5岁。 1例近 5年来头颅逐渐增大 ,以双眼视力下降就诊 ,在本院行视神经管减压术证实 ;1例出现髋内翻多年 ,并随年龄增大逐渐加重 ,临床随访证实 ;1例出现腰背痛 2年 ,摔伤后检查发现第 3及第 4腰椎骨质硬化 ;1例咳嗽、喘憋 10年 ,近 5天加重 ,胸透发现右侧第 6、9及…     

高分辨率CT诊断早期和(或)活动性肺结核

目的　评价抗结核化疗前后早期和 (或 )活动性肺结核的高分辨率CT(HRCT)征象。方法　总结了 2组共 10 0例肺结核病例的HRCT检查所见。活动性肺结核诊断依据痰抗酸杆菌染色阳性 (75例 )及治疗期间获得的一系列胸部影像学改变 (2 5例 )。对另 5例死于肺结核的尸体肺予以病理 影像对照。结果　在初诊组 (6 6例 )与复发组 (34例 )肺结核HRCT检查中 ,小叶中心病变 (93例 ,占 93.0 % )、树芽状 (76例 ,占 76 .0 % )及支气管管壁增厚 (70例 ,占 70 .0 % )均为检出率较高的征象 ,与其他征象检出率相比差异有非常显著性意义 (P <0 .0 0 1)。结论　小叶中心病变是早期和 (或 )活动性肺结核最常见并较有特征性的HRCT征象 ,若再与其他有较高特异性的HRCT征象及临床资料相结合 ,则有助于早期和 (或 )活动性肺结核的诊断和鉴别诊断。     

周围型肺错构瘤的HRCT诊断

目的探讨周围型肺错构瘤的HRCT特征,并与常规胸部CT表现比较,提高诊断准确率。方法回顾性分析经手术及穿刺病理证实的15例肺错构瘤患者的CT资料。结果15例肺错构瘤发生于右肺者6例,左肺9例,均为单发,病灶大小自0.9cm×1.0cm～3.8cm×4.5cm不等。12例(80%)病灶靠近胸膜,呈圆形或椭圆形结节灶,边缘光滑清楚,多表现为均匀软组织密度,CT值平均为(39.6±13.2)HU,其中6例(40%)有脂肪成分,8例(33.3%)可见钙化。结论利用CT和HRCT可正确诊断具有一定特征表现的周围型肺错构瘤。     

High resolution chest CT in patients with pulmonary tuberculosis: characteristic findings before and after antituberculous therapy

OBJECTIVE: The purpose of this study was (a) to describe HRCT findings for pulmonary tuberculosis before and after treatment, and (b) to evaluate the possible use of HRCT to assess disease activity. PATIENTS AND METHODS: We prospectively studied 52 patients with newly diagnosed pulmonary tuberculosis that was proven bacteriologically. HRCT scans were performed before and after treatment. RESULTS: Micronodules, nodules, tree-in-bud appearance, consolidation, and cavities were the most common HRCT findings seen in active pulmonary tuberculosis. The disappearance of tree-in-bud appearance, pleural effusion and the presence of fibrotic change appear to be indications of the effectiveness of treatment. HRCT can differentiate old fibrotic lesions from newly active tuberculous lesions. CONCLUSIONS: HRCT may be helpful in the diagnosis of pulmonary tuberculosis and may be useful in the assessment of the efficacy of anti-tuberculous treatment.     

Evaluation of pulmonary changes due to biomass fuels using high-resolution computed tomography

Biomass fuels are frequently used in rural areas of the world for cooking and heating frequently. It has been reported that the use of these fuels causes hazardous effects on the lungs. In this study, we evaluated the pulmonary changes due to the use of biomass fuels in a female population that lives in our territory by high-resolution computed tomography (HRCT). The study analyzed three groups of women. The first group comprised those subjects who were exposed to biomass without respiratory symptoms (group 1; n=32). The second group comprised those individuals that were exposed to biomass and showed respiratory symptoms, such as cough, sputum production, and dyspnea (group 2; n=30). The third group was composed of women who were not exposed to biomass and also had no respiratory symptoms (group 3; n=30). Women with a history of concomitant pulmonary diseases were excluded from the study. All groups were examined with HRCT. Groups 1 and 2 (individuals exposed to biomass fuels) had more pathologic findings than group 3 (not exposed to biomass fuels). Ground-glass appearance was seen in 71.9% in group 1, 23.3% in group 2, and 3.3% in group 3. The difference between the groups was statistically significant (p<0.05). Fibrotic bands were seen 50% in group 1, 63.3% in group 2, and only 6.7% in group 3 (p<0.001). Exposure to biomass fuels was the cause or predisposing factor for many pulmonary diseases, ranging from chronic bronchitis to diffuse lung diseases. We believe that these pathological changes due to biomass fuels can be detected earlier by HRCT and the diseases might be prevented or treated earlier.     

Interobserver variation in the diagnosis of bronchiectasis on high-resolution computed tomography

The purpose of our study was to determine interobserver variation in the analysis of high-resolution computed tomography (HRCT) in the lungs of patients with clinically suspected bronchiectasis. HRCT scans of 88 patients were analysed independently by three radiologists with variable experience in thoracic radiology using a subjective scoring system to record bronchi as normal, mildly abnormal or severely abnormal. The presence, severity and distribution of bronchial dilatation and bronchial wall thickening were recorded. Kappa values were calculated for assessment of interobserver agreement. Agreement between the three readers was good for the detection of bronchiectasis (kappa 0.78) and assessment of its severity (0.68), detection of bronchial wall thickening (0.64) and moderately good for the assessment of its severity (0.58) on a per-patient basis. When individual lobes were analysed, agreement was moderately good for the detection of abnormal bronchi (0.59). Agreement on the extent of abnormal bronchi using five categories was only fair (0.39), but was good when differences of one category were ignored (0.63). Interobserver variation with HRCT in suspected bronchiectasis appears satisfactory for comparative studies.     

Detection of pulmonary nodules by multislice computed tomography: improved detection rate with reduced slice thickness

The purpose of this study was to find out if the use of 1.25-mm collimated thin-slice technique helps to detect more small pulmonary lung nodules than the use of 5 mm. A total of 100 patient examinations that allowed a reconstruction of 1.25-mm slice thickness in addition to the standard of 5-mm slices were included in a prospective study. Acquisition technique included four rows of 1-mm slices. Two sets of contiguous images were reconstructed and compared with 1.25- and 5-mm slice thickness, respectively. Two radiologists performed a film-based analysis of the images. The size and the confidence of the seen nodules were reported. We did not perform a histological verification, according to the normal clinical procedure, although it would be optimal regarding research. Statistical analysis was performed by using longitudinal analysis described by Brunner and Langer [10]. In addition, sensitivity, specificity, negative predictive value and positive predictive value were calculated for each reader using the 1.25-mm sections as the gold standard. As an index for concordance the kappa value was used. A value of p<0.05 was regarded as significant. In 37 patients pulmonary nodules were detected. Twenty-four patients showed more than one nodule; among these, 7 patients had disseminated disease and were excluded from the study. Pulmonary nodules larger than 10 mm in size were equally well depicted with both modalities, whereas lesions smaller than 5 mm in size were significantly better depicted with 1.25 mm (p<0.05). Using 1.25 mm as the gold standard, sensitivity for 5-mm reconstruction interval was 88 and 86% for observers A and B, respectively. No false-positive results were reported for 5-mm sections. Interobserver agreement for nodule detection determined for 1.25-mm reconstruction intervals showed a k value of 0.753, indicating a good agreement, and 0.562 for 5-mm reconstruction intervals, indicating a moderate agreement. Brunner and Langer [10] analysis showed significant differences for slice thickness and no significant difference between the observers. Reduced slice thickness demonstrated an improvement of small nodule detection, confidence levels, and interobserver agreement. Application of thin-slice multidetector-row CT may raise the sensitivity for lung nodule detection, although the higher detection rate of smaller nodules has to be evaluated from a clinical perspective and remains problematic about how the detection of small nodules will effect patient outcome.     

肺动脉瘤的MSCTA

目的：探讨多层螺旋CT血管成像（MSCTA）诊断肺动脉瘤（PAA）的价值。方法：回顾性分析7例经临床确诊的PAA临床及影像资料。所有病例均行64层螺旋CT扫描,所获数据传输至工作站进行三维后处理。结果：7例PAA均累及肺动脉干,其中2例为单纯肺动脉干动脉瘤,4例同时累及左、右肺动脉,1例累及左肺动脉。MSCTA表现为肺动脉干及分支的瘤样扩张。结论：MSCTA可简单明确诊断PAA,并将逐步取代肺动脉造影成为诊断PAA的可靠有效检查方法。     

The role of dual-energy computed tomography in the assessment of pulmonary function

The assessment of pulmonary function, including ventilation and perfusion status, is important in addition to the evaluation of structural changes of the lung parenchyma in various pulmonary diseases. The dual-energy computed tomography (DECT) technique can provide the pulmonary functional information and high resolution anatomic information simultaneously. The application of DECT for the evaluation of pulmonary function has been investigated in various pulmonary diseases, such as pulmonary embolism, asthma and chronic obstructive lung disease and so on. In this review article, we will present principles and technical aspects of DECT, along with clinical applications for the assessment pulmonary function in various lung diseases.     

Effect of contrast-enhanced computed tomography on diagnosis and management of acute abdomen in adults

AIM: To determine the impact of computed tomography (CT) on the diagnosis and treatment plan in patients with acute abdominal pain. MATERIALS AND METHODS: A prospective study was undertaken in 125 adult patients presenting with acute abdominal pain (74 men and 51 women; 40.2 +/- 19.3 years; range, 18-92). Changes in diagnosis, gain in percentage diagnostic certainty and changes of treatment plan of the surgeons in the emergency department before and after CT were evaluated. Pre- and post-CT diagnoses were compared with the final diagnoses. RESULTS: CT findings changed the initial diagnosis in 40 (32.0%) patients. The diagnostic certainty was 58.3 +/- 22.9% before CT, and its gain after CT was 21.9 +/- 18.5 points (P < 0.0001). Post-CT diagnoses were consistent with the final diagnosis in 116 patients (92.8%), while pre-CT diagnoses were correct in 89 patients (71.2%; P < 0.0001). Initial treatment plans were changed in 31 (24.8%) patients after CT. In 57 (45.6%) patients, CT information changed diagnoses and/or treatment plans. No significant differences were observed in the diagnosis, diagnostic certainty and treatment plan among four surgeons. CONCLUSION: Contrast-enhanced CT frequently changed the clinical diagnoses with increased diagnostic certainty and the initial treatment plans.     

Multislice computed tomography perfusion imaging for visualization of acute pulmonary embolism: animal experience

The purpose of our animal study was to evaluate a new computed tomography (CT) subtraction technique for visualization of perfusion defects within the lung parenchyma in subsegmental pulmonary embolism (PE). Seven healthy pigs were entered into a prospective trial. Acute PE was artificially induced by fresh clot material prior to the CT scans. Within a single breath-hold, whole thorax CT scans were performed with a 16-slice multidetector-row CT scanner (SOMATOM Sensation 16; Siemens, Forchheim, Germany) before and after intravenous application of 80 ml of contrast medium with a flow rate of 4 ml/s, followed by a saline chaser. The scan parameters were 120 kV and 100 mAs_eff, using a thin collimation of 16×0.75 mm and a table speed/rotation of 15–18 mm (pitch, 1.25–1.5; rotation time, 0.5 s). Axial source images were reconstructed with an effective slice thickness of 1 mm (overlap, 30%). A new automatic subtraction technique was used. After 3D segmentation of the lungs in the plain and contrast-enhanced series, threshold-based extraction of major airways and vascular structures in the contrast images was performed. This segmentation was repeated in the plain CT images segmenting the same number of vessels and airways as in the contrast images. Both scans were registered onto each other using nonrigid registration. After registration both image sets were filtered in a nonlinear fashion excluding segmented airways and vessels. After subtracting the plain CT data from the contrast data the resulting enhancement images were color-encoded and overlaid onto the contrast-enhanced CT angiography (CTA) images. This color-encoded combined display of parenchymal enhancement of the lungs was evaluated interactively on a workstation (Leonardo, Siemens) in axial, coronal and sagittal plane orientations. Axial contrast-enhanced CTA images were rated first, followed by an analysis of the combination images. Finally, CTA images were reread focusing on areas with perfusion deficits indicating PE on the color-coded enhancement display. Subtraction was feasible for all seven studies. In one animal, opacification of the pulmonary arteries was suboptimal owing to heart insufficiency. In the remaining six pigs, a total of 37 perfusion defects were clearly assessable downstream of occluded subsegmental arteries, showing lower or missing enhancement compared with normally perfused lung parenchyma. Indeterminate findings from CTA showed typical PE perfusion defects in four out of six cases on CT subtraction. Additionally, 22 peripheral triangular-shaped enhancement defects were delineated. Nine of these findings were reclassified as definitely being caused by PE on second reading of the CTA data sets. Our initial results have shown that this new subtraction technique for perfusion imaging of PE is feasible, using routine contrast delivery. Dedicated examination protocols are mandatory for adequate opacification of the pulmonary arteries and for optimization of data sets for subsequent subtraction. Perfusion imaging allows a comprehensive assessment of morphology and function, providing more accurate information on acute PE.This paper contains data on behalf of the Amersham Health Research Fellowship Grant, ECR 2003.     

Dynamic computed tomography of cerebral parenchymal tuberculomata

Summary The technique of intravenous dynamic cranial computed tomography has been applied to our patient population in Saudi Arabia in which parenchymal tuberculomata make up approximately 10–15% of all cerebral mass lesions. A spectrum of perfusion patterns was observed in tuberculosis progressing from presentation, through treatment, to resolution. These patterns reflect the microscopic vascular evolution of tuberculomata and parallel at least in part the effects of treatment. The method of dynamic scanning further demonstrates its value in improving the specificity of computed tomography in the evaluation of cerebral masses, thereby enhancing patient-beneficial triage.Presented at the 7th Meeting of the Pan African Association of Neurological Sciences: 27–30 April, 1986, Abidjan, Ivory Coast     

Cost effectiveness of high resolution computed tomography with interferon-gamma release assay for tuberculosis contact investigation

Background

Tuberculosis contact investigation is one of the important public health strategies to control tuberculosis worldwide. Recently, high resolution computed tomography (HRCT) has been reported as a more accurate radiological method with higher sensitivity and specificity than chest X-ray (CXR) to detect active tuberculosis. In this study, we assessed the cost effectiveness of HRCT compared to CXR in combination with QuantiFERON^®-TB Gold In-Tube (QFT) or the tuberculin skin test (TST) for tuberculosis contact investigation.

Methods

We constructed Markov models using a societal perspective on the lifetime horizon. The target population was a hypothetical cohort of immunocompetent 20-year-old contacts with smear-positive tuberculosis patients in developed countries. Six strategies; QFT followed by CXR, QFT followed by HRCT, TST followed by CXR, TST followed by HRCT, CXR alone and HRCT alone were modeled. All costs and clinical benefits were discounted at a fixed annual rate of 3%.

Results

In the base-case analysis, QFT followed by HRCT strategy yielded the greatest benefit at the lowest cost ($US 6308.65; 27.56045 quality-adjusted life-years [QALYs])[year 2012 values]. Cost-effectiveness was sensitive to BCG vaccination rate.

Conclusions

The QFT followed by HRCT strategy yielded the greatest benefits at the lowest cost. HRCT chest imaging, instead of CXR, is recommended as a cost effective addition to the evaluation and management of tuberculosis contacts in public health policy.