肺间质性疾病的HRCT表现及相关病理研究

目的：分析肺间质性疾病的HRCT表现及其与病理学的关系。方法：38例经手术病理证实的肺间质纤维化患者和疾病对照组14例分别行HRCT扫描、组织病理学检查（包括HE、Masson氏三色染色）及免疫组化。结果：早期组中肺小叶间隔增厚81.25%，肺内渗出毛玻璃影18.75%，肺内小结节影66.67%，胸膜下曲线12.5%；中、晚期组中肺小叶间隔纡曲、僵直、变形85.71%，支气管血管束纡曲、僵直35.71%，范围较广的肺气肿32.14%，蜂窝肺28.57%，胸膜增厚39.29％。结论：HRCT是一种安全、反映准确、无创性的诊断ILD的手段，经与病理对照、毛玻璃影、小叶间隔增厚，肺内小结节影、网状影和胸膜下曲线是ILD早期征象；而肺小叶间隔纡曲、僵直、变形，支气管血管束纡曲、僵直，范围较广的肺气肿及蜂窝肺是中、晚期的征象。     

High-resolution CT of asbestosis and idiopathic pulmonary fibrosis

OBJECTIVE: We studied high-resolution CT of asbestosis and idiopathic pulmonary fibrosis to determine whether differences-other than the frequency of associated pleural changes-could be discerned between the two diseases. MATERIALS AND METHODS: High-resolution CT scans of 80 patients with asbestosis and 80 patients with idiopathic pulmonary fibrosis were retrospectively reviewed. Two chest radiologists assessed the type and distribution of parenchymal and pleural abnormalities on high-resolution CT. RESULTS: Subpleural dotlike or branching opacities (65/80), subpleural curvilinear lines (55/80), mosaic perfusion (39/80), and parenchymal bands (38/80) were more common in patients with asbestosis (p < 0.0001). Visible intralobular bronchioles (62/80), bronchiolectasis within fibrotic consolidations (47/80), and honeycombing (61/80) were more common in patients with idiopathic pulmonary fibrosis (p < 0.0001). The frequencies of interlobular septal thickening, ground-glass opacities, fibrotic consolidation, and emphysema were similar in both groups. Parenchymal bands and fibrotic consolidation were more commonly seen (p < 0. 05) in patients with asbestosis associated with pleural disease (n = 66) than in patients with asbestosis without pleural disease (n = 14). Also, statistically significant differences were noted between high-resolution CT findings of patients with asbestosis without pleural disease and those of patients with idiopathic pulmonary fibrosis, except for parenchymal bands. CONCLUSION: Specific combinations of high-resolution CT findings strongly suggest either asbestosis or idiopathic pulmonary fibrosis. We found that CT findings that might have represented bronchiolar obstruction in the subpleural region were more prominent in patients with asbestosis than in those with idiopathic pulmonary fibrosis, whereas bronchiolar dilatation was more prominent in patients with idiopathic pulmonary fibrosis than in those with asbestosis.     

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.     

Unilateral proximal interruption of the pulmonary artery in adults: CT findings in eight patients

PURPOSE: The authors retrospectively reviewed CT findings of unilateral proximal interruption of the pulmonary artery in eight adults. METHODS: Patient age ranged from 23 to 65 years (mean, 44 years), and three men and five women (six left-side affected and two right-side affected) comprised the study group. High resolution CT was obtained in five patients. Associated anomalies of great vessels included five cases of right aortic arch and one tetralogy of Fallot. RESULTS: On the affected side, complete defects of pulmonary arteries were seen in all patients. CT revealed serrated pleural thickening in six patients (75%), subpleural parenchymal bands in five (63%), and mosaic attenuation in three (38%) on the affected lung. Dilatation of bronchial arteries in five patients (71%), internal thoracic arteries in four (57%), and intercostal arteries in three (43%) were also seen. As for other parenchymal changes, cystic bronchiectasis and honeycombing were seen in two (25%) respective cases. On the unaffected lung, mosaic attenuation was seen in four (50%) patients. CONCLUSIONS: The main manifestations of unilateral proximal interruption of the pulmonary artery were complete defects of pulmonary arteries, enlarged bronchial arteries, and formed pleural thickening or some parenchymal changes of the lung.     

抗黑色素瘤分化相关基因5抗体阳性皮肌炎的临床和胸部CT表现

目的:探讨抗黑色素瘤分化相关基因5（MDA5）抗体阳性皮肌炎患者的临床表现及胸部损害的CT表现。方法:回顾性分析2017年2月至2019年10月在河南科技大学第一附属医院确诊的15例抗MDA5抗体阳性皮肌炎患者的临床表现、实验室检查及胸部CT表现。实验室检查指标主要包括抗MDA5抗体、抗Ro-52抗体、肌酸激酶等。胸部...     

High-resolution CT imaging of the lung for patients with primary Sjogren's syndrome

PURPOSE: To assess pulmonary abnormalities in patients with primary Sjogren's syndrome (PSS) using high-resolution computed tomography (HRCT). MATERIAL AND METHODS: The HRCT scans of 24 patients with the diagnosis PSS were retrospectively reviewed regarding the presence, extension and distribution of 16 pathological findings. RESULTS: Nineteen patients (79.2%) showed pathological findings and in five patients (21.8%) the HRCT scan was judged to be normal. A predominance of abnormalities in the lower lobes and subpleural areas was detected. The following pathologies were found: bronchiectasis, thin-walled cysts and small pulmonary nodules (46.2%), ground-glass attenuation and emphysema (37.8%), interlobular-septal thickening (29.4%), honeycombing (25.2%), bronchial wall thickening, tree-in-bud pattern (21.0%), mosaic perfusion (16.8%), architectural distortion (12.6%). Airspace consolidation, air trapping, large nodules (10-30mm) and masses (>30mm), mediastinal lymph node enlargement (>15mm) and free pleural fluid were seen each in 4.2%. In 7 of the 11 patients with thin-walled cysts areas of ground-glass attenuation were detected. CONCLUSION: HRCT seems is contributive to the characterization of the wide variety of lung abnormalities in PSS. Airway disease alone or in association with the presence of varying degrees of interstitial disease represents the main findings in accordance with earlier reports. Unexpectedly, almost half of the patients had thin-walled cysts on the HRCT scans, which etiology is unclear but could be associated with areas of ground-glass attenuation indicating LIP.     

Pulmonary high-resolution computed tomography findings in nephropathia epidemica

Purpose

To evaluate lung high-resolution computed tomography (HRCT) findings in patients with Puumala hantavirus-induced nephropathia epidemica (NE), and to determine if these findings correspond to chest radiograph findings.

Materials and methods

HRCT findings and clinical course were studied in 13 hospital-treated NE patients. Chest radiograph findings were studied in 12 of them.

Results

Twelve patients (92%) showed lung parenchymal abnormalities in HRCT, while only 8 had changes in their chest radiography. Atelectasis, pleural effusion, intralobular and interlobular septal thickening were the most common HRCT findings. Ground-glass opacification (GGO) was seen in 4 and hilar and mediastinal lymphadenopathy in 3 patients. Atelectasis and pleural effusion were also mostly seen in chest radiographs, other findings only in HRCT.

Conclusion

Almost every NE patient showed lung parenchymal abnormalities in HRCT. The most common findings of lung involvement in NE can be defined as accumulation of pleural fluid and atelectasis and intralobular and interlobular septal thickening, most profusely in the lower parts of the lung. As a novel finding, lymphadenopathy was seen in a minority, probably related to capillary leakage and overall fluid overload. Pleural effusion is not the prominent feature in other viral pneumonias, whereas intralobular and interlobular septal thickening are characteristic of other viral pulmonary infections as well. Lung parenchymal findings in HRCT can thus be taken not to be disease-specific in NE and HRCT is useful only for scientific purposes.     

High resolution computed tomographic features of pulmonary alveolar microlithiasis

BACKGROUND: Pulmonary alveolar microlithiasis (PAM) is a rare, chronic lung disease with unknown etiology and with a nonuniform clinical course. Nonuniformity of clinical course might be related to the degree of pulmonary parenchymal alterations, which can be revealed with high resolution computed tomography (HRCT). However, HRCT findings of PAM were not fully described in the current literature. AIM: The aim of this study was to interpret and to contribute to describe HRCT findings of PAM and to investigate a correlation between profusion of micro nodules (MN) and pulmonary parenchymal alterations in patients with PAM. MATERIAL AND METHODS: Ten male patients with PAM (mean age: 22+/-3.2) were included into the study. HRCT images were assessed for patterns, distribution, and profusion of pulmonary abnormalities. Dividing the lungs into three zones, profusion of abnormalities was assessed. A profusion score (1-4) was given and the scores of each zone were then summed to obtain a global profusion score for HRCT ranging from 0 to 12. Also a parenchymal alteration score (PAS) was defined with respect to profusion of abnormalities. Chest X-rays were also scored. RESULTS: All of ten patients with PAM had findings of interstitial lung disease in varying degrees on their HRCTs. HRCT findings of patients with PAM were as following: MN, parenchymal bands (PB), ground glass opacity (GGO) and, sub pleural interstitial thickening (SPIT) in 10 patients; interlobular septal thickening (ILST), in 9 patients; paraseptal emphysema (PSA) in 8 patients; centrilobular emphysema (CLA) in 7 patients; bronchiectasis (BE), confluent micro nodules (CMN) in 6 patients; peri bronchovascular interstitial thickening (PBIT) in 5 patients; panacinar emphysema (PANAA) in 3 patients; pleural calcification (PC) in 2 patients. A significant correlation between MN scores and PAS (r=0.68, p=0.031, MN scores and GGO scores (r=0.69, p=0.027) and, MN scores and CLA scores (r=0.67, p=0.034) was detected. We also found significant correlations between HRCT scores and results of pulmonary function tests (PFTs), HRCT scores and chest X-ray score (CXRS) and, CXRS and results of PFTs. CONCLUSION: We conclude that patients with PAM may have all findings of interstitial lung disease in varying degrees as well as MNs on their HRCTs. More importantly, this study suggests a proportional relationship between profusion of MNs and parenchymal alterations in patients with PAM. This study also suggests that the degree of parenchymal alterations closely related with the degree of pulmonary function loss in patients with PAM.     

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.     

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。     

High-resolution computed tomography in cystic fibrosis.

The sensitivity of high-resolution computed tomography (HRCT) in identifying the pulmonary lesions of cystic fibrosis (CF) was evaluated. Thirty-nine patients (16 males, 23 females; mean age 19.1 years) were examined by chest HRCT. According to Shwachman and Kulczycki criteria, the clinical score of the patients ranged from 40 to 95, thus covering most possible variations of lung disease severity. All the patients presented diffuse thickening of bronchial walls, expression of the characteristic CF bronchial inflammation. Bronchiectases were the second most common lung lesions: discrete dilatation of bronchi was observed in 87% of cases; the localization, pattern and extent of bronchiectasis were accurately detected by HRCT. Pleural thickening and hilar adenopathy were frequently identified (in 64% and 82% of the patients, respectively). Bronchoceles were seen in 64% of the patients; atelectasis (33%) and subpleural bullous dystrophic emphysema (28%) were observed less frequently. On HRCT, the localization of the disease processes within the secondary pulmonary lobule was possible in all patients. In agreement with international literature, the identification of these lesions confirms HRCT as the more sensitive technique for early visualization and location of the manifestations of CF bronchopathy. A larger range of experience coming from a systematic use of HRCT in chronic inflammatory lung diseases would increase our knowledge of pathogenetic processes and allow improvement of therapeutic perspectives.     

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.     

系统性红斑狼疮胸部CT短期随访研究(附64例分析)

目的:探讨系统性红斑狼疮(SLE)患者胸部CT征象的病变性质、病理基础。方法:回顾性分析64例SLE患者203次胸部CT检查[139次CT复查,每例行1～4次,平均(91.57±68.57)d复查1次]图像,计算各种病变CT征象的显示率,对各种病变的CT征象进行程度、范围积分,并作统计学对比处理。结果:在CT短期随访复查后发现胸部常见CT征象中肺实变(18例)、磨玻璃样影(57例)明显容易发生变化(好转或加重),其变化频率显著高于小叶间隔增厚(51例)、界面征(38例)、胸膜下线征(13例)、胸膜肥厚(34例)、心包肥厚(16例,P均<0.001),前两者、后五者之间差异均无统计学意义(P均>0.05)。此外,肺内蜂窝样改变(3例)、单个或多发肺囊肿样改变(8例)、胸膜腔积液和腹水(各3例)、纵隔和/(或)两腋下显示多发大小不等淋巴结(24例)在CT复查中无明显变化。SLE肺部磨玻璃样影、小叶间隔增厚、界面征病变的程度、范围差异无统计学意义(P均>0.05),但显著大于肺实变、胸膜下线征、胸膜肥厚和心包肥厚(P均<0.05);心包肥厚病变的程度、范围与肺实变相仿(P>0.05),但显著小于其他常见病变(P均<0.001)。磨玻璃样影的CT复查病变程度、范围变化显著大于肺实变及因病例数较少未纳入统计处理者以外的其他病变(P均<0.05)。结论:SLE患者胸部CT征象短期随访复查可以一定程度上反映其病理基础,有助于临床病情、疗效的判断。     

Lung findings on high resolution CT in early ankylosing spondylitis

OBJECTIVE: Ankylosing spondylitis (AS) is a chronic inflammatory disease mainly affecting the axial skeleton and pulmonary involvement is a well known feature of the disease. The aim of this study was to investigate the pulmonary high resolution computed tomography (HRCT) findings of patients with early AS. The relationship between pulmonary function tests (PFT) and HRCT findings was also determined. SUBJECTS AND METHODS: Twenty-eight patients with AS (mean age 30.8+/-7.4 and disease duration 7.0+/-2.6) were included in the study. Patients with a disease duration of >10 years or had other pulmonary diseases were excluded. All patients underwent plain chest radiography (posteroanterior and lateral views), thoracic HRCT and PFT. RESULTS: All chest radiographs were normal and HRCT revealed abnormalities in 18 patients. The most common abnormalities seen on HRCT were mosaic pattern (ten of 28), subpleural nodule (seven of 28) and parenchymal bands (five of 28). Seven of ten patients with mosaic pattern revealed air trapping areas on end expiratory scans. Twelve patients had abnormal PFT and all had restrictive type of involvement. Ten of these 12 patients had abnormal HRCT and the remaining two patients had normal HRCT. On the other hand, eight patients with normal PFT had abnormalities on HRCT. CONCLUSION: Patients with early AS frequently have abnormalities on HRCT, even though they have normal PFT and chest X-ray. Small airway involvement was found as frequent as interstitial lung disease in early AS.     

Conventional and high resolution computed tomography in the diagnosis of asbestos-related diseases

High resolution CT (HRCT) can image the fine structures of the lung parenchyma and the pleura. Analysis of supine and prone HRCT scans in 300 patients with asbestos exposure shows that asbestosis is characterized the following findings; (1) parenchymal bands, (2) increased interlobular septa, (3) increased intralobular core structures, (4) subpleural lines, and (5) dependent opacity. Pleural disease is well displayed on HRCT scans. Correlated studies with whole lung sections confirm the HRCT findings. Masses in asbestosis may be benign or malignant, and CT helps in their differentiation. HRCT correlates well with radiographic and clinical criteria for asbestosis and is more sensitive than either in detecting abnormalities.     

Comparison of initial high resolution computed tomography features in viral pneumonia between metapneumovirus infection and severe acute respiratory syndrome

Objective

To review and compare initial high resolution computed tomography (HRCT) findings in patients with metapneumovirus pneumonia and severe acute respiratory syndrome (SARS-Coronovirus).

Materials and methods

4 cases of metapneumovirus pneumonia (mean age of 52.3 years) in an institutional outbreak (Castle Peak Hospital) in 2008 and 38 cases of SARS-coronovirus (mean age of 39.6 years) admitted to Tuen Mun hospital during an epidemic outbreak in 2003 were included. HRCT findings of the lungs for all patients were retrospectively reviewed by two independent radiologists.

Results

In the metapneumovirus group, common HRCT features were ground glass opacities (100%), consolidation (100%), parenchymal band (100%), bronchiectasis (75%). Crazy paving pattern was absent. They were predominantly subpleural and basal in location and bilateral involvement was observed in 50% of patients. In the SARS group, common HRCT features were ground glass opacities (92.1%), interlobular septal thickening (86.8%), crazy paving pattern (73.7%) and consolidation (68%). Bronchiectasis was not seen. Majority of patient demonstrated segmental or lobar in distribution and bilateral involvement was observed in 44.7% of patients. Pleural effusion and lymphadenopathy were of consistent rare features in both groups.

Conclusion

Ground glass opacities, interlobular septal thickening and consolidations were consistent HRCT manifestations in both metapneumovirus infection and SARS. The presence of bronchiectasis (0% in SARS) may point towards metapneumovirus while crazy paving pattern is more suggestive of SARS.     

Pathologic-HRCT correlation of pneumoconiosis--a study on inflation-fixed lungs]

High resolution computed tomography (HRCT) findings were correlated with pathologic features of 14 inflation-fixed postmortem lungs with pneumoconiosis to evaluate the ability of HRCT to depict pneumoconiotic changes. The results are as follows: 1) Irregular peribronchiolar and interlobular fibrosis was the most constant pathologic feature in all lungs. This pathologic finding corresponded to an area of hazy increased density or reticular density on HRCT. The reticular density on HRCT became coarser with the progression of fibrosis. Mild fibrosis, confirmed by histologic procedures, could not be detected with HRCT. 2) Subpleural curvilinear line seen on HRCT in 5 lungs corresponded to band-like zone of fibrosis containing bronchioles or zone of collapsed alveoli with fibrotic thickening on histologic sections. A subpleural band-like zone of organized pneumonia was recognized in 2 cases. Subpleural patchy density was seen on HRCT in 8 cases. Five of them were histologically a focus of fibrosis and the other 3 were localized pulmonary edema, organized pneumonia, or atelectasis without fibrosis. 3) Pneumoconiotic nodules were located at centrilobular portion or along interlobular septa on histologic sections. These location were correspond to HRCT findings. They were round with irregular borders and were surrounded by a zone of enlarged air space. Overall 71% (182/256) of pathologically proved nodules were seen on HRCT, but 63% (52/83) of small "p" type nodules (smaller than 1.5 mm) could not be detected. Enlarged air space at the periphery of the nodules was seen on HRCT in 78% (122/156) of those pathologically proved. 4) A total of 12 lesions of progressive massive fibrosis was found in 5 lungs. An irregular border, seen on HRCT in all lesions, was pathologically based on the fibrosis extending into the surrounding alveoli and partially confluencing pneumoconiotic micronodules. Pleural indentation was seen in 8 lesions. Patent residual bronchi, spared from destructive fibrotic change, were seen as strand-like air density on HRCT in 4 of 6 lesions. 5) Focal emphysema was found pathologically in 9 of the 14 lungs. They appeared as non-peripheral, small low-attenuation area with a central dot on HRCT. The dot histologically corresponded to fibrosis around centriacinar bronchovascular bundle. The limit of visibility of this form of emphysema on HRCT was 2.0 mm in size. When emphysema was complicated by pneumonia, some showed honeycomb appearance on HRCT. 6) It is concluded that HRCT can detect and quantify the various pneumoconiotic changes of the lung and the HRCT-pathological correlation data presented here will be useful for the interpretation of the findings in clinical cases of pneumoconiosis.     

Asbestos-related pleural disease and asbestosis: a comparison of CT and chest radiography

High-resolution CT (HRCT) has the ability to demonstrate both asbestos-related pleural disease and parenchymal abnormalities consistent with asbestosis. The role of CT in the diagnosis of asbestosis can be defined by comparing it with radiography. We evaluated 60 men who had a history of occupational exposure to asbestos and whose outside chest radiographs were considered abnormal. Chest radiographs (inside films) and HRCT were performed in all patients at our institution and were interpreted independently by experienced radiologists. Outside film results were compiled from the submitted reports. The final conclusion regarding the interpretation of the radiologic examinations was determined by consensus when disagreements existed. Positive predictive values (the likelihood that a positive report is correct) for pleural disease were: outside films 56%, inside films 79%, HRCT 100%. The positive predictive values for parenchymal disease were: outside films 51%, inside films 83%, HRCT 100%. The addition of HRCT to chest radiography is most useful in eliminating false-positive diagnoses of asbestos-related pleural disease caused by subpleural fat and false-positive diagnoses of parenchymal asbestosis in patients with extensive plaques or emphysema obscuring lung detail. The interpretation of chest radiographs in patients exposed to asbestos is often extremely difficult and subjective, and we recommend that positive findings (except calcified plaques) be confirmed with HRCT.     

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。     

Metabolic lung disease: imaging and histopathologic findings

Metabolic lung disease includes pulmonary alveolar proteinosis (PAP), pulmonary amyloidosis, metastatic pulmonary calcification, dendritic pulmonary ossification, pulmonary alveolar microlithiasis, and storage diseases. In pulmonary alveolar proteinosis, CT demonstrates air-space consolidation with thickened interlobular septa, producing the so-called "crazy paving" appearance. Pulmonary amyloidosis can appear as parenchymal nodules (nodular parenchymal form), diffuse interstitial deposit (diffuse interstitial form), or submucosal deposits in the airways (tracheobronchial form). Metastatic pulmonary calcification may appear on high-resolution CT as numerous 3- to 10-mm diameter calcified nodules or, more commonly as fluffy and poorly defined nodular opacities. In pulmonary microlithiasis, high-resolution CT demonstrates diffuse punctuate micronodules showing slight perilobular predominance resulting in apparent calcification of interlobular septa. Niemann-Pick disease appears as ground-glass attenuation in the upper lung zone and thickening of the interlobular septa in the lower lung zone. Radiologic study including high-resolution CT will be helpful for the diagnosis and follow-up of these diseases.