实变型肺癌与结核性肺实变CT影像对照分析

目的探讨实变型肺癌与肺结核实变的CT影像的差异，减少误诊率。方法回顾性分析1998年1月至2005年8月50例肺叶肺段实变表现的肺癌与同期50例肺结核实变的CT影像资料。分别对两组实变的分布、密度、空洞、支气管充气征、磨玻璃征、血管造影征、叶裂膨出征以及其他肺野不同特点的播散病变进行统计分析并进行卡方检验。结果有显著统计学意义的影像包括，多发肺叶肺段实变（肺癌22例，结核9例）、单发下叶肺实变（肺癌17例，结核10例），均匀肺实变（肺癌36例，结核17例）、实变伴液化（肺癌4例，结核33例）、空洞或囊腔（肺癌10例，结核28例），实变内充气支气管管腔狭窄（肺癌18例，结核7例）、管腔扩张（肺癌4例，结核15例），实变周围边界清楚的磨玻璃征（肺癌7例，结核0）。结论实变的密度、好发部位、病变多叶多段分布、是否易于形成液化空洞、环绕于实变周围分界清楚的磨玻璃征及多种性质弗存的气道播散病变影像等对鉴别诊断有一定价值，但仍需综合各种征象及临床资料进行诊断。     

实变型肺癌与结核性肺实变CT影像对照分析

目的探讨实变型肺癌与肺结核实变的CT影像的差异，减少误诊率。方法回顾性分析1998年1月至2005年8月50例肺叶、肺段实变表现的肺癌与同期50例肺结核实变的CT影像资料。分别对两组实变的分布、密度、空洞、支气管充气征、磨玻璃征、血管造影征、叶裂膨出征以及其他肺野不同特点的播散病变进行统计分析并进行卡方检验。结果有统计学意义的影像包括，多发肺叶、肺段实变（肺癌22例，结核9例）、单发下叶肺实变（肺癌17例，结核10例），均匀肺实变（肺癌36例，结核17例）、实变伴液化（肺癌4例，结核33例）、空洞或囊腔（肺癌10，结核28例），实变内充气支气管管腔狭窄（肺癌18例，结核7例）、管腔扩张（肺癌4例，结核15例），实变周围边界清楚的磨玻璃征（肺癌7例，无结核病例）。结论实变的密度、好发部位、病变多叶多段分布、是否易于形成液化空洞、环绕于实变周围分界清楚的磨玻璃征及多种性质并存的气道播散病变影像等对鉴别诊断有一定价值，但仍需综合各种征象及临床资料进行诊断。     

肺炎型肺癌的影像学特征及其病理学基础(附27例报告)

回顾性分析27例肺炎型肺癌患者的临床、病理及影像学检查资料。其影像学特点为单纯磨玻璃密度影,磨玻璃密度影与结节共存,单纯肺叶、肺段实变阴影,肺叶、肺段实变并空泡及蜂窝状阴影,混合阴影。磨玻璃密度影的病理学基础是癌细胞沿肺泡壁匍匐生长及其分泌的黏液在肺泡腔中部分充填。实变阴影的病理基础为癌细胞大部分或完全充填肺泡腔并沿肺泡孔及细支气管播散、蔓延;癌细胞分秘的黏液在气腔中完全充填;细小癌组织周围伴有出血及肺炎。空泡影的病理学基础是实变影内的充气支气管断面像。蜂窝影的病理学基础是癌细胞侵犯间质及癌组织纤维增生。认为肺炎型肺癌的影像学表现有一定特征性,在一定程度上可反映其病理学特点,可对肺炎型肺癌的诊断和治疗提供有价值的依据。     

重症甲型H1N1流感并肺炎的CT表现

目的探讨甲型H1N1流感并肺炎的CT表现。方法 5例临床确诊甲型H1N1流感的重症患者共8次胸部CT扫描(复查3例)资料。结果 5例中均为双肺多叶、多段实变灶,无明显肺叶、肺段或特定体位分布趋势;大片肺实变表现为双侧沿支气管树分布的肺段实变;内有明显的空气支气管征;相邻肺段实变融合或在叶间裂处相邻的肺叶实变扩展,于影像接触部位融合,形成更大片实变影;肺内小病灶均为双肺多发,呈类圆形或棉团状,沿肺纹理分布最多见;大片肺实变可呈均匀致密实变、磨玻璃样变、蜂窝状实变,小病灶与大片实变灶一致,磨玻璃样变可出现在初诊和吸收期病例;反应性胸膜增厚及胸膜积液常见;无纵膈、肺门淋巴结肿大。结论 CT改变提示:甲型H1N1重症病例并肺炎在病程发展阶段,病变有经支气管肺泡系播散的特点。     

肺炎型肺癌的影像诊断与病理对照分析研究

目的探讨肺炎型肺癌的特征与病理对照及诊断价值。方法分析32例经病理证明的肺炎型肺癌的临床、病理、影像资料。结果 32例肺炎型肺癌中,支气管肺泡癌25例,7例腺癌。影像学分为6型:单纯磨玻璃影肿块6例,磨玻璃伴结节影响9例,6例为肺叶及肺段分布实变影,5例为肺叶及肺段实变伴空泡及蜂窝状影,5例为肺炎变并纤维化及肿块,1例为混合阴影。影像学特点:病变范围逐渐增大及病变形态由磨玻璃或实变影逐渐进展为结节、纤维化、蜂窝及肿块,以及出现淋巴及远处转移。结论肺炎性肺癌影像学表现多样性,动态观察影像学具有一定特征性。     

46例炎症型肺癌CT影像分析

目的 进一步认识“炎症型”肺癌的CT表现，减少临床误诊率。方法回顾性分析46例临床证实以实变为主要表现的“炎症型”肺癌患者的临床及CT资料，探讨CT对“炎症型”肺癌的诊断价值。结果46例患者中多发肺实变20例（43．5％），单发肺实变26例（56．5％），其中位于上叶6例、中叶4例、下叶16例；密度均匀29例（63．O％），合并单发或多发含气囊腔样病变14例（30．4％），局限低密度液化3例（6．5％）；实变内充气支气管征41例（89．1％），其中充气支气管狭窄25例（61．0％）；实变周围磨玻璃征40例（87．O％），边界模糊或清晰；15例（32．6％）可见多发结节及斑片，沿小叶中心及细支气管中心分布。30例行CT增强扫描，23例（76．7％）强化明显，7例强化不明显并出现“血管造影”征。结论实变密度均匀、以下叶分布为主、实变内充气支气管狭窄、边界清楚的“磨玻璃”征、血管造影征等特点有助于炎症型肺癌的诊断，但一部分炎症型肺癌的CT表现不具有特征性，仍需结合临床特征进行综合判断。     

20例艾滋病病人免疫重建中合并结核相关性重建炎性综合征的胸部CT影像特点

目的探讨艾滋病(AIDS)病人在免疫重建过程中,合并与肺结核相关重建炎性综合征的胸部计算机层析成像(CT)影像特点。方法采用回顾性分析的方法,对20例AIDS病人免疫重建过程中,合并结核相关性重建炎性综合征的胸部CT影像进行分析。结果 20例AIDS免疫重建合并肺结核相关重建炎性综合征病人的胸部CT影像,表现为急性血行播散型肺结核与继发型肺结核,急性血行播散型肺结核9例(45.0%,9/20),继发型肺结核11例(55.0%,11/20)。病灶分布3个肺叶及以上者7例(35.0%,7/20),病灶局限于1～2个肺叶者4例(20.0%,4/20)。病变形态为粟粒影、结节影、肺段与亚段实变影,分别为13例(65.0%,13/20)、9例(45.0%,9/20)、5例(25.0%,5/20),肺空洞3例(15.0%,3/20)。胸部CT影像出现纵隔淋巴结肿大伴液化坏死17例(85.0%,17/20),胸腔积液15例(75%,15/20)。结论 AIDS免疫重建合并肺结核相关重建炎性综合征时,胸部CT影像特点是病变呈弥漫、多肺叶分布,粟粒影、结节影、肺段与亚段实变影为肺部病变主要形态,纵隔淋巴结肿大伴液化坏死、胸腔积液常见。其发生机制与重新激活的异常免疫应答相关。在高效抗反转录病毒治疗同时,积极给予抗结核治疗后,病变吸收明显。     

肺癌肺内转移的多形性CT影像表现

目的 评价肺癌肺内转移在CT影像上的各种形态表现。方法 对194例肺癌肺内转移的影像学表现进行描述，其中男106例，女88例，平均45岁。原发肿瘤包括鳞癌56例(28．9％)，腺癌(包括肺泡癌和黏液腺癌)107例(55．2％)，小细胞肺癌26例(13．4％)和腺鳞癌5例(2．6％)。对20个转移病灶进行增强扫描。结果 肺癌肺内血行转移主要以实性结节最为常见，其少见影像可表现为空洞转移、磨玻璃转移、转移病灶边缘毛糙和／或胸膜凹陷征以及转移灶内可见含气支气管气像，并主要见于肺腺癌；淋巴道转移表现为支气管血管束不规则结节状增厚，小叶间隔增厚呈串珠状或胸膜下多角形细线结构。转移结节强化明显。结论 肺癌肺内转移可呈多形性影像表现，对确诊肺癌的病例如肺内出现空洞结节、磨玻璃结节、新出现病灶边缘毛糙和／或胸膜凹陷征以及转移灶内可见含气支气管气像等少见征像均应考虑转移瘤可能。     

肺结核患者的不典型CT表现

目的 探讨和分析肺结核患者的不典型CT表现特点。 方法 回顾性分析我院2010年1月至2012年9月CT表现不典型的肺结核患者73例,根据其图像特点进行分类并分析。 结果 所有患者按图像特点分为6型,其中多空洞型7例,表现为肺内多发空洞,无结核播散灶;肺间质型20例,表现为肺内大片细网织样密度增高影,与周围正常肺组织分界清晰,病变区内部分病灶融合实变,并可见多发垂直于胸膜的小叶间隔增厚影;雪花型16例,4例合并间质型,表现为多发腺泡样结节沿小支气管及其分支周围分布,受累各级支气管管腔充盈,内形成多发“小树芽征”及小叶性实变;肿块型29例,病灶边缘可见光滑、深分叶、长毛刺及胸膜凹陷征,未见短毛刺征,病灶平扫为等密度,其中3例肿块呈薄壁或厚环形强化,7例有不同程度的强化;肺门及纵隔淋巴结结核并假性动脉瘤型1例,表现为环形强化的淋巴结内出现假性动脉瘤;实变型4例,为多发段、叶实变,段、叶支气管腔内无异常改变。 结论6种肺结核的不典型CT表现中,肺间质型、雪花型和肺门及纵隔淋巴结结核并假性动脉瘤型有一定特异性,但所有类型需结合临床、化验检查等做出诊断。     

肺结核之肺切除术

目的总结肺结核肺切除术的手术适应症及经验。方法2000年-2006年,252例肺结核患者接受手术治疗,其中全肺切除术17例,复合肺叶切除术10例,肺叶切除术148例,局限性肺切除术77例;空洞性病变86例,结核球或干酪灶115例,支气管病变或肺不可逆病变32例,毁损肺19例。结果手术死亡2例,痰菌阴转率92．9％,一次手术治愈率92．5％,复发率4．0%,术后发生支气管胸膜瘘11例（4．4％）,结核播散6例（2．4％）。结论肺切除术是治疗特殊类型肺结核的有效手段,但应准确掌握手术适应症、把握手术时机。     

Computed tomography halo sign in pulmonary nodules: frequency and diagnostic value

On computed tomography (CT) scanning, a ground-glass opacity zone surrounding a pulmonary nodule has been named the computed tomography (CT) halo sign. To investigate the frequency and diagnostic value of the CT halo sign, the authors reviewed the CT examinations of 305 patients with proven diseases producing solitary or multiple nodules. The CT halo sign was seen in 22 patients (7%). Eleven patients had a solitary nodule; five patients had multiple nodules; and six patients had nodules associated with areas of pulmonary consolidation, or ground-glass opacity, or both. Solitary nodules were the result of bronchioloalveolar carcinoma (n = 5), tuberculoma (n = 2), squamous cell carcinoma, non-Hodgkin lymphoma, myxovirus infection, and metastasis (n = 1 each). Multiple nodules were the result of metastasis (n = 2), Kaposi sarcoma (n = 2), and Wegener granulomatosis (n = 1). Nodules associated with areas of consolidation or ground-glass opacity were the result of metastasis (n = 2), bronchioloalveolar carcinoma, bronchiolitis obliterans organizing pneumonia, eosinophilic pneumonia, and invasive pulmonary aspergillosis (n = 1 each). The data showed that the CT halo sign is a nonspecific finding. It is known that in immunocompromised patients the CT halo sign should suggest invasive pulmonary aspergillosis, Kaposi sarcoma, and lymphoproliferative pulmonary disorders. However, in immunocompetent patients, the authors found that a solitary nodule with the CT halo sign and pseudocavitations has a high likelihood of being a bronchioloalveolar carcinoma.     

免疫功能低下疾病患者肺结核的影像分析

目的探讨几种免疫功能低下疾病的肺结核患者的X线和CT所见。方法回顾分析糖尿病患者68例,肾病综合症患者20例,SLE患者12例,8例AIDS患者合并肺结核的X线及胸部CT所见。结果X线和CT表现,糖尿病肺结核:大片浸润病灶45例,浸润病灶内多发空洞40例,散在大小不等浸润病灶可不按肺段分布23例,支气管播散病灶21例;部分病例合并胸水10例。肾病综合症或SLE肺结核:急性血行播散性肺结核15例,大小不等浸润病灶17例,合并肺门及纵膈淋巴结肿大4例;AIDS肺结核:肺内斑片阴影合并有淋巴结肿大5例,急性血行播散性肺结核合并有淋巴结肿大3例。结论免疫功能低下疾病患者的肺结核,肺内结核病灶容易形成大片干酪病灶并合并空洞,结核肺内播散,急性血行播散性肺结核,肺门及纵膈淋巴结肿大及非结核好发部位发生浸润结核灶。     

原发性肺隐球菌病52例临床及影像学表现和病理特征

目的 探讨原发性肺隐球菌病(pulmonary cryptococcosis,PC)的临床表现、病理特征、影像学特点及术前误诊原因.方法 回顾分析1998-2008年上海市中山医院收治的52例PC患者的临床、影像学及病理资料.结果 52例PC患者中,男36例,女16例,年龄17～80岁,中位年龄48岁.临床症状较轻,首发症状依次为咳嗽、咳痰及胸痛等.52例中13例既往有慢性疾病或肿瘤病史,其中肝癌并肝移植术后、糖尿病、结核及慢性活动性肝炎各2例,垂体瘤及结节病各1例,糖尿病合并肝痛及肺结核、糖尿病合并结核性胸膜炎及糖尿病合并高血压各1例.45例患者行胸部CT扫描,其中单发或多发结节团块37例,空洞4例,大叶实变3例,弥漫混合性病变1例;CT诊断为恶性肿瘤27例,肺炎15例,结核3例.49例光镜下表现为肉芽肿性病变,3例表现为纤维结缔组织病灶,Grocott六胺银及黏液卡红染色病灶内均可见新型隐球菌.结论 免疫功能正常者亦有发生PC的可能;临床及影像学表现缺乏特征性,且临床症状与影像学表现不符,易误诊为肺癌、肺炎或肺结核;诊断有赖于病理组织学检杳;CT引导下经皮肺穿刺等非开胸肺切除的方法有助于该病的早期诊断.     

Thoracic manifestation of Churg-Strauss syndrome: radiologic and clinical findings

STUDY OBJECTIVES: To describe the radiologic and clinical findings of Churg-Strauss syndrome (CSS) and its thoracic manifestations. DESIGN: We used retrospective analysis to review and characterize the radiographic, thin-section CT, and clinical findings of CSS. PATIENTS: The study involved nine patients with CSS. The patients included four men and five women, whose ages ranged from 18 to 60 years (median, 35 years). Thin-section CT scans and chest radiographs were retrospectively analyzed by three radiologists in consensus. Clinical data were obtained by chart review. Histologic samples were available in eight patients. RESULTS: All patients had a history of asthma averaging 28 months (range, 4 to 72 months) prior to the initial symptom of vasculitis and marked peripheral blood eosinophilia (mean peak count, 8,726/microL; range, 3,000 to 32,000/microL; mean differential count, 41%; range, 19 to 67%). All patients had systemic vasculitis involving the lung and two to four extrapulmonary organs, most commonly the nervous system (n = 8) and skin (n = 7). Chest radiographs showed bilateral nonsegmental consolidation (n = 5), reticulonodular opacities (n = 3), bronchial wall thickening (n = 3), and multiple nodules (n = 1). The most common thin-section CT findings included bilateral ground-glass opacity (n = 9); airspace consolidation (n = 5), predominantly subpleural and surrounded by the ground-glass opacity; centrilobular nodules mostly within the ground-glass opacity (n = 8); bronchial wall thickening (n = 7); and increased vessel caliber (n = 5). Other findings were hyperinflation (n = 4), larger nodules (n = 4), interlobular septal thickening (n = 2), hilar or mediastinal lymph node enlargement (n = 4), pleural effusion (n = 2), and pericardial effusion (n = 2). CONCLUSIONS: In CSS, thoracic organs are invariably involved with additional diverse manifestations. The possibility of CSS should be raised in patients with a history of asthma and hypereosinophilia who present with thin-section CT findings of bilateral subpleural consolidation with lobular distribution, centrilobular nodules (especially within the ground-glass opacity) or multiple nodules, especially in association with bronchial wall thickening.     

继发性初治涂阳与涂阴活动性肺结核CT影像对比分析

目的探讨初治涂阳与涂阴活动性肺结核的CT影像特征。方法收集2008年住院治疗的初治涂阳与涂阴肺结核各100例,对比观察两组CT征象的异同点以诊断活动性肺结核有价值的征象。结果小叶中心结节、磨玻璃影、树芽征、空洞征、气道壁增厚、亚段以上实变,涂阳组／涂阴组CT检出率依次为：91％／81％、65％／32％、59％／40％、55％／13％、52％／31％、38％／15％、（P〈0．05）,小叶样实变、小叶间内质异常两组为75％／63％、28％／17％,（P〉0．05）;涂阴肺结核病变累及单叶肺为主,涂阳组以多叶受累为主（P〈0．01）;涂阳组各种征象的检出率均明显高于涂阴组。结论涂阴与涂阳活动性肺结核的CT征象没有质的区别,但有量的差异,并需结合临床。     

低剂量CT扫描在评价老年菌阴性肺结核患者抗结核治疗效果中的应用

目的 采用低剂量CT扫描对老年菌阴性肺结核患者抗结核治疗效果进行评价.方法 对47例菌阴性肺结核抗结核治疗后1～12个月复查的老年患者采用低剂量CT扫描(120 kV,20 mAs),通过与治疗前常规CT(120 kV,200～280 mAs)扫描影像学结果的比较,对老年菌阴性肺结核患者抗结核治疗效果进行评价.结果 老年菌阴性肺结核患者初诊CT征象最常见的为腺泡实变融合和肺叶/肺段实变,其发生率分别为100.0和76.6%,而空洞的发生率相对较少;1～3个月复查好转的征象主要为树芽征,而腺泡融合实变和肺叶/肺段实变的好转主要发生于4～9个月,空洞性病变显效较慢,持续时间为6～12个月.结论 低剂量CT扫描能较好地反映老年菌阴性肺结核的不同影像学征象及抗结核治疗后的影像学,适合对老年菌阴性肺结核患者治疗后的效果进行评价.

Abstract：

Objective To evaluate the therapeutic effect of antituberculosis therapy in elderly patients with smear-negative pulmonary tuberculosis by low-dose computed tomography (CT).Methods Forty-seven elderly patients diagnosed as smear-negative pulmonary tuberculosis were rechecked with low-dose chest CT scan (120 kV, 20 mAs) after 1-12 months of antituberculous therapy respectively. These images were compared with common CT before treatment (120 kV, 200-280 mAs). Results In the elderly patients with smear-negative pulmonary tuberculosis, the most common CT signs before treatment were acinus consolidation (100%) and lobar or segmental consolidation (77%), but the cavity was seen less. After effective antituberculous therapy, tree-inbud was improved after one to three months, the acinus consolidation and lobular or segmental consolidations were improved after four to nine months, and the cavitations were slowly improved after six months. Conclusions Low-dose CT can provide sufficient information for the therapeutic effects of antituberculous therapy of smear-negative pulmonary tuberculosis in the elderly and could be used for rechecking.     

Churg-Strauss syndrome: high resolution CT and pathologic findings

OBJECTIVES: The purpose of this study was to evaluate high-resolution CT findings in 7 patients with Churg-Strauss syndrome and to compare the CT with the histopathologic findings. MATERIALS AND METHODS: High-resolution CT scans of 7 asthmatic patients (4 women, 3 men, age range, 34-62 years, mean 49 years) with Churg-Strauss syndrome were reviewed by 2 observers. Histologic specimens of lung obtained at surgical (n = 3) or transbronchial (n = 3) biopsy or autopsy (n = 1) were reviewed by an expert lung pathologist. The diagnosis of Churg-Strauss was based on clinical, laboratory, and histologic findings. RESULTS: Parenchymal and airway abnormalities included ground-glass opacities (n = 5), areas of air-space consolidation (n = 4), centrilobular nodules (n = 5), nodules 1-3 cm in diameter (n = 3), interlobular septal thickening (n = 4), bronchial wall thickening (n = 4), and areas of atelectasis (n = 1). Surgical biopsy (n = 3) and autopsy (n = 1) specimens demonstrated airspace disease in 3 patients, interlobular septal thickening in 3 patients, and airway abnormalities in 2 patients. Histologically, the airspace disease included eosinophilic pneumonia (n = 2) and small foci of organizing pneumonia (n = 1). The septal thickening was due to edema combined with numerous (n = 2) or few (n = 1) eosinophils. The airway abnormalities (n = 2) included muscle hypertrophy and large airway wall necrosis (n = 1) and eosinophilic infiltration of the airway walls (n = 1). Transbronchial biopsy (n = 3) demonstrated increased eosinophils. CONCLUSION: The main high-resolution CT findings of Churg-Strauss syndrome consist of airspace consolidation or ground-glass opacities, septal lines, and bronchial wall thickening. These reflect the presence of eosinophilic infiltration of the airspaces, interstitium, and airways, and interstitial edema.     

以磨玻璃样密度影为表现的早期肺癌并发肺结核患者的诊治分析

目的 分析以磨玻璃样密度影(ground-glass opacity,GGO)为表现的早期肺癌并发肺结核患者的临床特点,以达到早期识别及治疗的目的。方法 对山东大学附属山东省胸科医院自2013年1月至2018年2月确诊的14例以GGO为首要表现的肺癌并发肺结核患者的临床表现、CT扫描征象、手术方式、病理类型等进行回顾性分析。结果 以GGO为表现的早期肺癌并发肺结核以查体时发现多见(9/14),CT表现为陈旧性结核病灶并发混合密度GGO(mGGO) 12例;GGO与结核病灶位于同侧同叶4例。术前对患者进行规范抗结核药物治疗9例,术后继续行规范抗结核药物治疗6例。术前有3例患者行CT引导下肺穿刺活检确诊肺癌,其余11例为术中冰冻切片病理检查证实。行肺叶切除加纵隔淋巴结清扫10例,肺叶(GGO病灶所在处)切除加同侧异叶肺结核瘤局部切除2例,肺段切除1例,楔形切除1例。肺结核病灶标本经病理检查确诊10例,另4例依据病史及影像学表现符合陈旧性肺结核诊断;表现为GGO的早期肺癌病灶标本经病理检查确诊腺癌11例,鳞癌1例,腺鳞癌1例,大细胞癌1例。纵隔淋巴结病理检查均未见转移。本组患者术后均顺利康复,短期随访未见肿瘤复发、转移及结核复燃等。结论 GGO为表现的早期肺癌并发肺结核患者其临床表现无特异性,薄层CT扫描加动态观察有利于诊断。手术方式需在肺癌切除的基础上兼顾结核病灶的处理,规范的抗结核药物治疗加手术切除治疗效果满意。     

肺间质改变为主的继发性肺结核的CT诊断价值与疗效评价

目的 探讨以肺间质改变为主的继发性肺结核的CT表现特点及其在抗结核治疗后疗效评价的价值。 方法 收集CT扫描图像上以肺间质改变为主,且经过临床或病理证实的继发性肺结核患者43例,男23例,女20例,年龄范围19~54岁［平均(29±11.4)岁］。痰Mtb涂片检查阳性者29例,余经痰Mtb培养阳性、支气管镜、穿刺活检或临床治疗随访证实。所有患者均在抗结核治疗前后行多次CT检查,双盲法动态观察CT表现特点及其征象转归。 结果 该类型的肺结核好发于两肺上野（30/43）,多为节段性分布,呈小片状或大片融合状,多数肺间质病变与正常肺组织界限清楚。CT上肺间质改变主要表现为小叶内细网织线影、微结节、树芽征、磨玻璃样密度影、小叶间隔增厚和气道壁增厚等,检出率分别为100.0%（43/43）、100.0%（43/43）、76.7%（33/43）、62.8%（27/43）、53.5%（23/43）和55.8%（24/43）。经抗结核治疗后以上肺间质性改变均有不同程度吸收,在巩固期末（6个月）后4种征象吸收率均达93%以上。 结论 以间质改变为主的肺结核是一种特殊类型的继发性肺结核,CT检查能够清晰客观显示该类型肺结核间质改变的特点,有助于该病的提示性诊断并可以观察和评价治疗的预后。     

Nonspecific interstitial pneumonia associated with polymyositis and dermatomyositis: serial high-resolution CT findings and functional correlation

STUDY OBJECTIVES: We described the features seen on serial high-resolution CT scans of nonspecific interstitial pneumonia (NSIP) that was associated with polymyositis (PM) and dermatomyositis (DM), and we correlated the changes in the CT scan findings with those of pulmonary function test results. Design, setting and patients: Serial CT scans of 14 patients with histologically proven NSIP and PM/DM from two university hospitals were evaluated retrospectively (follow-up period, 3 to 61 months; mean follow-up period, 27.6 months). Using initial and follow-up CT scan findings, the extent of each type of opacity and the total area of increased opacity were calculated and correlated with the results of pulmonary function tests. MEASUREMENTS AND RESULTS: The predominant findings on the initial CT scans were of reticular and/or ground-glass opacities with or without consolidation. Reticular and ground-glass opacities predominated in the lower zone of each lung, and consolidation predominated at the lung periphery. Thirteen patients showed significant improvement of the total area of increased opacity (p < 0.05), and this decrease in extent inversely correlated with changes in FVC (r = -0.650; p = 0.031). Ground-glass and reticular opacities also were improved significantly in 11 and 13 patients, respectively. The decrease in the extent of ground-glass opacity correlated inversely with the changes in FVC (r = -0.758; p = 0.0119) and diffusion capacity for carbon monoxide (r = -0.669; p = 0.0448). In one patient, ground-glass opacity progressed, and death occurred after 3 months. Traction bronchiectasis was seen in 12 patients, and it improved in four patients after treatment. Honeycomb lung was not noted in any patient during follow-up. CONCLUSIONS: With treatment, serial CT scans of PM/DM patients with NSIP showed significant improvement in the abnormal opacities, and radiographic progression of lung fibrosis was limited. The CT scan features and clinical course of NSIP in PM/DM patients were relatively uniform, and this constitutes a subset of NSIP.