螺旋CT血管造影对中央型肺癌纵隔、肺门血管肿瘤侵犯的评价

目的：利用螺旋CT血管造影（CTA），对中央型肺癌（CLC）纵隔、肺门血管肿瘤侵犯进行评价并与横断面图像对比，以探讨其临床应用价值。方法：46例CLC患者行前瞻性的CT检查，采用直接增强扫描，在莫斯科上得到纵隔，肺门血管CTA多平面重建（MPR）和容积再现技术（VRT）图像。纵隔、肺门血管肿侵犯的诊断标准分为5级。盲法阅片，对比影像诊断结果与手术及病理结果，利用SPSS软件进行统计学分析。结果：横断面图像和CTA对评价纵隔、肺门血管肿瘤侵犯的敏感度分别为84.0％和97.3％，差异有非常显著性意义（x^2=7.878,P=0.005）.特异度分别为89.3％和91.1％，差异无显著性意义（x^2=0.101,P=0.751）。准确度分别为86.3％和94.7％，差异有显著性意义（x^2=5.532,P=0.019）。结论：CTA判断CLC纵隔、肺门血管肿瘤侵犯的敏感度、准确度高于横断面图像，特异度略高于横断面图像，CTA应成为CLC术前检查，确定手术方案的必要手段，特别是对于拟行保留肺功能的非全肺切除手术及体外循环的患者。目的：分析亚急性或慢性过敏性肺泡炎高分辨率 CT(HRCT)的影像特征，以期进一步提高其HRCT诊断的准确性。方法：21例亚急性或慢性过敏性肺泡炎患者行肺功能、支气管肺泡灌洗、经支气管镜肺活检、胸部X线平片和HRCT.结果：HRCT图像上16例表现出数量不等的边界模糊的小叶中心结节，13例可见磨玻璃样密度，4例有密度减低区，5例显示局限性的空气残留（airtrapping）并形成“马赛克”样灌注，2例出现散在的小叶中心性气肿、2例发生肺纤维化。结论；HRCT可以清晰显示过敏性肺泡炎病变的类型及分布。HRCT图像上表现为弥漫性边界模糊的小叶中心性结节或小叶中心结节与磨玻璃样祺及密度减低区同时存在时，应考虑亚急性或慢性过敏性肺泡炎的诊断。     

外源性过敏性肺泡炎的HRCT诊断价值

目的 :评价高分辨率 CT(HRCT)对外源性过敏性肺泡炎的诊断价值。方法 :回顾性分析经纤维支气管镜检查和肺泡灌洗术证实的 16例外源性过敏性肺泡炎的 HRCT表现 ,急性期 2例 ,亚急性期 10例 ,慢性期 4例。结果 :外源性过敏性肺泡炎HRCT主要表现为 :微结节和 /或结节 ,气腔实变 ,磨玻璃样变 ,小叶间隔增厚及蜂窝状改变。发病的不同时期其主要改变各异。结论 :HRCT是诊断外源性过敏性肺泡炎最有价值的无创性检查 ,根据本病的 HRCT特征 ,结合临床病史 ,可不依赖支气管镜或肺活检而明确诊断     

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。     

壹期电焊工尘肺肺部HRCT表现及病理学对照

目的探讨壹期电焊工尘肺肺部不同HRCT表现的病理学基础。方法对比分析15例确诊为壹期电焊工尘肺的肺部HRCT资料和经支气管肺活检的病理资料。HRCT检查和经支气管肺活检的间隔时间在3～50天。15例中男性13例,女性2例,平均年龄(35±6.8)岁,电焊工工龄(8.8±3.5)年。将标本粉尘的量分为无、少量、中量和大量,将纤维化的程度分为无、轻度、中度和重度。结果 HRCT上7例主要表现为小叶中心小叶核影的增大、增多,呈分支状线影;3例表现为小叶中心的磨玻璃密度的结节影,约4～8mm大小;5例表现为磨玻璃结节与分支状线影混合存在。其中5例有轻度小叶间隔增厚,6例可见小叶中央型肺气肿。病理学表现为呼吸性细支气管及其肺泡群内大量尘斑,并可见肉芽组织和少量的胶原纤维,支气管粘膜下肺组织和肺泡间隔纤维组织弥漫增生,胶原纤维沉积。偏光镜和普鲁士蓝铁染色证明尘斑中铁颗粒存在。弥漫性以分支状线影为主要表现的纤维化程度重于弥漫性磨玻璃密度结节为主的病例(t=9.00,P=0.00),但粉尘量以磨玻璃密度结节为主的病例较重(t=-4.71,P=0.001)。结论 HRCT可以显示电焊烟尘所致的肺内尘斑及其纤维化的程度。     

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。     

间质性肺疾病的高分辨CT(HRCT)诊断

间质性肺疾病是由多种原因引起的以肺问质弥漫性渗出、浸润和纤维化为主要改变的一组临床综合征。其HRCT基本表现为网格状影、结节状影、肺密度增加或肺密度减低四种形式。网格状影以线状不透光影为特点，包括小叶间隔增厚、小叶间隔网格状影、支气管、血管周围间质增厚；结节状阴影可分为间质性结节和实质性结节，结节的分布情况对鉴别诊断有很大帮助；肺密度增加的HRCT表现包括磨玻璃样密度影和含气腔隙实变；肺密度降低包括蜂窝状影、肺囊状影。本文同时介绍了几种间质性病变的HRCT表现。     

弥漫型肺泡癌的高分辨CT特征分析

目的 :回顾性分析弥漫型肺泡癌的高分辨CT(HRCT)表现特征。方法 :总结 12例经临床和病理证实的弥漫型肺泡癌HRCT表现。结果 :12例弥漫型肺泡癌可见磨玻璃影者 11例 ,实变 9例 ,多发结节 7例 ,“碎石路样”表现者 2例 ,其中 11例为混合表现。 6例有支气管气像 ,9例病变呈均匀或不均匀低密度 ,2例出现“血管造影征” ,2例伴少量胸腔积液 ,1例纵隔淋巴结肿大。结论 :弥漫型肺泡癌的HRCT表现多种多样 ,最常见的表现是多发结节、实变和磨玻璃影的混合影。HRCT片上出现实变和结节共存、伴磨玻璃影的小叶中心结节和远离实变的磨玻璃影时 ,则强烈提示弥漫型肺泡癌。     

肺内孤立性小结节的HRCT分型与病理对照

目的探讨肺孤立性小结节HRCT分型。方法搜集经手术切除的肺内孤立小结节(直径≤20mm)39例(41个),术前均行螺旋CT和HRCT扫描。将孤立肺结节的HRCT表现分为2型:Ⅰ型,含磨玻璃密度结节(包括纯磨玻璃密度结节、低密度不均匀结节、中心高密度伴周边磨玻璃密度结节);Ⅱ型,单纯实性密度结节。并与病理对照。结果41个病灶的HRCT表现分型:Ⅰ型为14个病灶,其中肺泡癌9个、腺癌3个、炎性肉芽肿1个、腺瘤1个;Ⅱ型27个,其中腺癌13个、肺泡癌4个、鳞癌3个、小细胞癌1个、腺瘤2个、结核瘤2个、炎性肉芽肿1个、错构瘤1个。经统计学分析含磨玻璃密度的结节在手术切除的孤立肺结节中,肺泡癌组中高于非肺泡癌组(P=0.002),而在肿瘤与非肿瘤组、腺癌与非腺癌组差别无显著性(P=0.282和P=0.146)。结论根据手术切除的肺孤立结节HRCT表现,含磨玻璃密度结节多见于肺泡癌。     

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。     

磨玻璃密度阴影

本文分析玻璃密度阴影共２４例，其中特发性肺间质纤维化１０例，慢性支气管炎伴间质纤维化３例，胶原病３例（类风湿、干燥综合征及皮肌炎各１例），癌性淋巴管炎，结节病及细菌性肺炎各２例，过敏性肺泡炎及肺泡蛋白沉着症各１例。磨玻璃密度阴影可见于实质性和持间性病变，磨玻璃密度阴影本身无特异中，中央型磨玻璃密度阴影见于癌性淋巴管炎、结节病及过敏性肺泡炎。外围型磨玻璃密度阴影见于类风湿、干燥综合征、皮肌炎、特发性     

Chronic hypersensitivity pneumonitis: use of CT in diagnosis.

OBJECTIVE. In its subacute or chronic form, hypersensitivity pneumonitis is often difficult to distinguish clinically and physiologically from other idiopathic diffuse lung diseases. The aim of this study was to identify high-resolution CT features that allow distinction of chronic hypersensitivity pneumonitis from other chronic diffuse parenchymal lung diseases. MATERIALS AND METHODS. Six patients with chronic hypersensitivity pneumonitis were examined with pulmonary function testing, bronchoalveolar lavage, lung biopsy, chest radiography, and high-resolution CT. The chest radiographs and high-resolution CT scans were reviewed independently by three observers without knowledge of the patients' clinical status. Discrepancies between the observers were resolved by consensus. RESULTS. The chest radiographs revealed normal lung volumes with a combination of abnormalities: a mixed alveolar/interstitial pattern in five cases, peribronchiolar thickening in three, a diffuse granular pattern in one, and a linear fibrotic pattern in one. In general, the high-resolution CT scans showed more abnormalities than were apparent on the plain chest radiographs. High-resolution CT revealed centrilobular, peribronchiolar, indistinct nodular opacities, of various numbers, in all cases. Four cases had areas of ground-glass density, three cases had lobular areas of hyperlucency, and one case had areas of pulmonary fibrosis and honeycombing. CONCLUSION. We confirm that high-resolution CT can most clearly show the type and distribution of parenchymal abnormalities in patients with hypersensitivity pneumonitis. Importantly, although not pathognomonic, the high-resolution CT finding of centrilobular, peribronchiolar, indistinct nodules should suggest the diagnosis of chronic hypersensitivity pneumonitis.     

磨玻璃样改变的HRCT检查及其对弥漫性肺疾病的诊断价值

评价肺部磨玻璃样改变的高分辨率ＣＴ（ＨＲＣＴ）检查、病理基础以及它在弥漫性肺疾病（ＤＰＤ）中的诊断价值。材料和方法：一组连续的经病理学检查或临床综合其它各种检查而明确诊断的弥漫性肺疾病，经普通Ｘ线、ＣＴ和ＨＲＣＴ检查，ＨＲＣＴ采用层厚为１－１．５ｍｍ，间隔为１０ｍｍ，高空间频率重建算法。有病理学结果者则与之对照。结果：本组ＤＰＤ包括７３例，ＨＲＣＴ显示磨玻璃样改变征象１６例，分别为过敏性肺炎５例、淋巴瘤ｌ例、皮肌炎２例、特发性肺纤维化３例、类风湿性肺炎２例、放射性肺炎１例和肺水肿２例。普通Ｘ线仅显示９例（Ｐ＜０．０１）。病理学上磨玻璃样改变由肺泡腔内渗出、肺泡间隔增厚所致。结论：ＨＲＣＴ是显示肺部早期异常表现——磨玻璃样改变十分有效的方法，但对弥漫性肺疾病的鉴别诊断缺乏特异性。     

Hypersensitivity pneumonitis: sensitivity of high-resolution CT in a population-based study.

OBJECTIVE. Hypersensitivity pneumonitis refers to a group of pulmonary disorders caused by inhalation of organic or inorganic particulates by sensitized persons. The diagnosis relies on a constellation of findings: exposure to an offending antigen, characteristic signs and symptoms, abnormal chest findings on physical examination, and abnormalities on pulmonary function tests and radiographic evaluation. In population-based studies, the sensitivity of chest radiography for detection of this disease is relatively low. The aim of this study was to determine the sensitivity of high-resolution CT (HRCT) for detection of hypersensitivity pneumonitis diagnosed in a population of swimming-pool employees. SUBJECTS AND METHODS. Thirty-one symptomatic employees of a recreation center who were referred because of possible hypersensitivity pneumonitis were examined by using chest radiography, HRCT, and fiberoptic bronchoscopy with bronchoalveolar lavage and transbronchial biopsy. Hypersensitivity pneumonitis was diagnosed in subjects who had two or more work-related signs or symptoms, abnormal results on transbronchial biopsies, and abnormal lymphocytosis as shown by examination of bronchoalveolar lavage fluid. The chest radiographs and HRCT scans were interpreted by consensus by two observers who were unaware of the clinical diagnosis. RESULTS. Only one of 11 subjects with a diagnosis of hypersensitivity pneumonitis had abnormal findings on a chest radiograph. Five had abnormal HRCT findings. The abnormality in each case consisted of small, poorly defined centrilobular nodules with variable profusion. No subject without the disease had abnormal HRCT findings. Those who had granulomas shown by lung biopsy were more likely to have abnormal HRCT findings than were those who had more subtle histologic abnormalities. CONCLUSION. The sensitivity of HRCT for the detection of hypersensitivity pneumonitis in a population-based study is greater than that of chest radiography. The finding of poorly defined centrilobular nodules on HRCT scans should prompt consideration of this disease.     

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.     

Pulmonary cholesterol granulomas in patients with pulmonary artery hypertension: chest radiographic and CT findings

OBJECTIVE: We describe the chest radiographic and CT findings of pulmonary cholesterol granulomas in patients with pulmonary artery hypertension. CONCLUSION: Histopathologic evidence of cholesterol granulomas was found in five (25%) of 20 patients with severe pulmonary hypertension. In three of these five patients, the granulomas manifested on chest radiographs and CT as small centrilobular nodules mimicking the appearance of sarcoidosis, bronchiolitis, hypersensitivity pneumonitis, or aspiration.     

脓毒性肺栓塞的高分辨CT表现初探

目的探讨脓毒性肺栓塞(SPE)的高分辨CT(HRCT)表现。资料与方法回顾分析11例SPE患者的胸部HRCT表现。结果11例SPE的HRCT表现为实变及磨玻璃影、结节、楔形阴影、空洞、胸膜改变(如胸腔积液)等征象。其中52%结节影及37%楔形阴影可见滋养血管。7例经治疗后肺部改变消失。结论周围性分布的结节影、楔形阴影,结节影、楔形阴影内空洞形成以及与结节影及楔形阴影相连的血管影是SPE较为特征性的HRCT表现,对早期诊断及指导临床治疗有重要意义。     

Hypersensitivity pneumonitis: spectrum of high-resolution CT and pathologic findings

OBJECTIVE: The purpose of this article is to illustrate the spectrum of pathologic and high-resolution CT features of hypersensitivity pneumonitis (HP). CONCLUSION: High-resolution CT plays an important role in the diagnosis of HP. A confident diagnosis of subacute HP is based on the presence of ground-glass opacities, poorly defined centrilobular nodules, and mosaic attenuation on inspiratory images and of air trapping on expiratory CT images. Chronic HP is characterized on high-resolution CT by the presence of reticulation due to fibrosis superimposed on findings of subacute HP. Histologically, subacute HP is characterized by the presence of cellular bronchiolitis, noncaseating granulomas, and bronchiolocentric lymphocytic interstitial pneumonitis. Areas of organizing pneumonia also may be seen. The high-resolution CT and pathologic features of chronic HP frequently overlap with those of nonspecific interstitial pneumonia and usual interstitial pneumonia. Awareness of the various manifestations of HP is important for early diagnosis and management.     

Chronic hypersensitivity pneumonitis: high-resolution CT and radiographic features in 16 patients.

To evaluate the manifestations of chronic hypersensitivity pneumonitis at radiography and high-resolution computed tomography (HRCT), findings in 16 patients with this disease were reviewed. To ensure objectivity, 50 patients with other chronic infiltrative lung diseases (fibrosing alveolitis [n = 29], sarcoidosis [n = 16], and miscellaneous conditions [n = 5]) were included. All patients had chronic disease with evidence of fibrosis at HRCT, as indicated by irregular linear areas and architectural distortion. Radiographs and HRCT scans were reviewed separately, in random order, and without knowledge of diagnosis. On radiographs and HRCT scans, the fibrosis in cases of hypersensitivity pneumonitis was situated predominantly in the middle lung zones or showed no zonal predominance. Lung apices and bases were relatively spared in all cases. The distribution of fibrosis in the transverse plane was random in seven cases, subpleural in six, and peri-bronchovascular in three. The distribution of fibrosis can allow distinction of chronic hypersensitivity pneumonitis from other causes of fibrosis in many cases.     

CT signs and patterns of lung disease.

The ground-glass pattern is a common but nonspecific finding on CT. In certain clinical circumstances, it can suggest a specific diagnosis, indicate a potentially treatable disease, and guide a clinician to an appropriate area for biopsy. A pattern of centrilobular ground-glass nodules is fairly specific for the diagnosis of hypersensitivity pneumonitis with the appropriate clinical history. The tree-in-bud pattern indicates disease affecting the small airways. The differential diagnosis is lengthy; however, the most common process leading to this CT appearance is infection. Although commonly associated with M. tuberculosis, many infectious organisms can produce this pattern. When honeycombing is seen on HRCT, a confident diagnosis of lung fibrosis can be made. The most common causes of interlobular septal thickening on HRCT are pulmonary edema, pulmonary hemorrhage, and lymphangitic spread of cancer, and smooth thickening is characteristic of all three. Diffuse lung cysts in patients who are not immunocompromised generally signify Langerhans' cell histiocytosis, lymphangioleiomyomatosis, or centrilobular emphysema. Centrilobular emphysema can be diagnosed when the centrilobular artery is seen as a small nodular opacity in the center of the cyst. Langerhans' cell histiocytosis is often associated with parenchymal nodules, helping to distinguish it from lymphangioleiomyomatosis. When a nodular pattern is seen on HRCT, the differential diagnosis is very long, but can be narrowed by noting whether the nodules are random, centrilobular, or perilymphatic in distribution. A mosaic pattern of lung attenuation can represent an infiltrative, small airway, or vascular process. The distinction can often be made by noting the size of the pulmonary vessels in the abnormal areas of lung, and whether air trapping is present on expiratory scanning. Computed tomographic signs can be useful indicators of a specific disease process. For instance, the air bronchogram sign indicates that an opacity is intrapulmonary in location, and signals the possibility of two types of neoplasm: lymphoma and bronchioloalveolar cell carcinoma. An air crescent sign indicates recovery of the immune system in an immunocompromised patient with invasive pulmonary aspergillosis. The fallen lung sign is diagnostic of a bronchial transection in the correct clinical setting. The gloved finger sign is very suggestive of allergic bronchopulmonary aspergillosis. The halo sign is highly suggestive of early angioinvasive pulmonary aspergillosis in patients with acute leukemia. When a split pleura sign is seen, the diagnosis is often empyema, although other causes of pleuritis can lead to a similar CT appearance.     

Cytomegalovirus pneumonia after bone marrow transplantation: high resolution CT findings

Cytomegalovirus (CMV) pneumonia is one of the most common pulmonary complications after bone marrow transplantation (BMT). We describe the high resolution CT (HRCT) findings of 13 patients with CMV pneumonia diagnosed after allogenic BMT. The study included 13 consecutive patients who developed CMV pneumonia after BMT and who had HRCT of the chest performed within 24 h of the onset of symptoms. HRCT scans were reviewed by two radiologists who assessed pattern and distribution of findings. There were nine male and four female patients, ranging from 9 years to 56 years of age (mean age 33 years). BMT was performed for treatment of chronic myelogenous leukaemia (54%), severe aplastic anaemia (23%), acute myelogenous leukaemia (15%) and Fanconi's anaemia (8%). The time elapsed until diagnosis ranged from +18 days to +405 days (median of 54 days, mean +81.6 days). The predominant patterns of abnormality on HRCT scans were ground-glass opacities (69%), small centrilobular nodules (69%) and air-space opacities (54%). The abnormalities were distributed in the central and peripheral zones of the lungs in six cases, only in the periphery in four cases, and only in the central zone in three cases. In all cases the lung lesions were bilateral, and asymmetry was observed in seven cases. The authors conclude that the most common HRCT findings in patients with CMV pneumonia after BMT consist of bilateral asymmetric ground-glass, air-space opacities and small centrilobular nodules.