High-resolution computed tomography in young patients with cystic fibrosis: distribution of abnormalities and correlation with pulmonary function tests

Objective

To assess pulmonary abnormalities detected by high-resolution computed tomography (HRCT) in young children with cystic fibrosis (CF) and mild to moderate lung disease.

Study design

High-resolution computed tomography was performed in 60 children, 6 to 10 years old, with mild to moderate lung disease (forced expiratory volume in 1 minute [FEV₁], 52-137; mean, 102; SD, 15% predicted). HRCTs were scored by using a system that evaluates each lobe for severity and extent of CF lung disease. Findings of CF lung disease were tabulated in all subjects and in a subgroup with normal pulmonary function tests. HRCT scores were correlated with FEV₁, forced vital capacity (FVC), and forced expiratory flow between 25% and 75% of expired vital capacity (FEF_25-75) in 57 patients.

Results

Bronchiectasis was present in 35% of subjects, mucous plugging in 15%, and air trapping in 63%. No abnormality was detected in 25%. In 37 subjects with FEV₁, FVC, and FEF_25-75 >85% predicted, bronchiectasis was present in 30%. In 17% of these subjects, bronchiectasis was seen in ≥4 lobes. Correlations between HRCT scores and FEV₁ were significant and showed fair to moderate correlation (r = 0.36-0.46).

Conclusions

High-resolution computed tomography demonstrated a broad range of pulmonary abnormalities in young patients with CF with mild to moderate lung disease. In this study, abnormalities, including bronchiectasis, were common in young children with CF and normal pulmonary function tests.     

Correlation between HRCT findings,pulmonary function tests and bronchoalveolar lavage cytology in interstitial lung disease associated with rheumatoid arthritis

A prospective study correlating high-resolution computed tomography (HRCT), lung function tests (PFT) and bronchoalveolar lavage (BAL) cytology in patients with interstitial lung disease (ILD) associated with rheumatoid arthritis (RA). Fifty-three RA patients with suspected ILD (19 men, 34 women) underwent 71 HRCT (14 of 53 with sequential HRCT, mean follow-up 24.3 months). The HRCT evaluation by two observers on consensus included a semi-quantitative characterisation of lesion pattern and profusion on representative anatomical levels. Fifty-two HRCT were followed by PFT and BAL. Agreement or discordance of HRCT-, PFT- and BAL findings were analysed with Pearsons correlation, score and McNemars test. Tobacco-fume exposure was estimated in pack years. Smoking/non-smoking groups were compared with Students t test. In 49 of 53 patients, HRCT was suggestive of ILD associated with RA (66 of 71 HRCT). Reticular lesions were found in 40 of 53 patients, in 15 of 40 presenting as mixed pattern with ground-glass opacities (GGO). Pure reticular patterns predominated in patients with long duration of ILD (p>0.01). Pure GGO were not observed. Lesion profusion was highly variable and correlated moderately negative with diffusion capacity (mean 88.2% (SD±20.9%); r=–0.54; p<0.001) and very weak with vital capacity and FEV1 (mean values 92.2% (SD±18.3%); r=–0.27; p<0.05 and 89.8% (SD±17.5%); r=–0.31; p<0.01). In patients with GGO, BAL differentials tended towards neutrophilia (=0.39; p=0.04; McNemar test p>0.2), but not towards lymphocytosis (=0.10; p=0.23; McNemar test p>0.2). Differences in smoking history were not significant (p>0.1). The HRCT appears most appropriate for the detection and follow-up of ILD associated with RA. The PFT and BAL correlate only partially with lesion profusion or grading on HRCT, but they contribute valuable information about dynamic lung function and differential diagnoses (pneumonia, medication side effects).     

Desquamative interstitial pneumonia, respiratory bronchiolitis and their relationship to smoking

AIMS: Respiratory bronchiolitis (RB) and desquamative interstitial pneumonia (DIP) are closely associated histological patterns of interstitial pneumonia, although there are no studies on the extent of individual histological parameters. Furthermore, the term smoking related-interstitial lung disease (SR-ILD) has been proposed as a term to encompass patients with both these histological patterns who give a history of smoking, though it is not well defined how this term relates to historical cases of DIP. The aim of this study was to compare histological parameters in cases of DIP and RB and then to review in detail clinical, imaging and histological data for DIP in relation to a history of smoking. METHODS AND RESULTS: Forty-nine cases were reviewed, 24 with RB and 25 with DIP; five cases of DIP were re-classified as RB on review due to bronchocentricity of the infiltrate. There was a significantly greater extent of interstitial fibrosis (P = 0.02), lymphoid follicles (P < 0.001) and eosinophilic infiltration (P < 0.0001) in patients with DIP compared with RB. In addition, the extents of these three parameters were significantly interrelated. Patients with DIP had a lower incidence of smoking (60%) when compared with patients with RB-ILD (93%) (P < 0.005). Further analysis of smokers versus never-smokers with DIP showed no difference in histological parameters, extent of haemosiderin deposition or the number of CD1a+ macrophages between the two groups, nor were there any differences in clinical data to suggest other aetiologies. Follow-up high-resolution computed tomography data from patients with DIP suggested that a pattern of fibrotic non-specific interstitial pneumonia (NSIP) may develop in the long term in both smokers and never-smokers. CONCLUSION: There are significant differences in the extent of interstitial fibrosis, lymphoid follicles and eosinophilic infiltration between DIP and RB, as well as a much lower incidence of smoking in patients with DIP. Whether the lower reported incidence of smoking in DIP reflects referral bias or conservatism in giving a history of smoking remains uncertain, as neither histological parameters nor clinical data indicate a difference between smokers and never-smokers with DIP. Nevertheless, some cases of DIP are likely to remain idiopathic and unrelated to RB, though still have a good prognosis. Furthermore, they may evolve into a pattern resembling fibrotic NSIP. Therefore, whilst SR-ILD is appropriate in the correct clinical setting, the distinction between the histological patterns of RB and DIP remains appropriate.     

早期周围型肺癌行HRCT诊断的临床价值

【摘要】目的探讨早期周围型肺癌HRCT诊断的临床应用价值。方法本次医学观察选择我院收治的25例早期周围型肺癌患者为观察对象,所有观察对象均同时接受常规螺旋CT和HRCT检查,对比分析患者临床检查结果。结果增强扫描前CT值在26～46HU之间,病灶增强扫描后不同时点CT值为：60s56～90HU,120s34～75HU,240s30—50HU。早期周围型肺癌患者HRCT检查与常规螺旋cT检查结果对比,具有明显的统计学差异（P〈0．05）,且HRCT对于液化、钙化、空泡、支气管气相等密度特征,胸膜凹陷征、血管集束征、细毛刺、光滑等边缘特征,以及不规则形、分叶和类圆形、圆形等性状特征检查准确率均高于常规螺旋CT检查。结论HRCT是一种较为有效的早期周围型肺癌临床检查和诊断技术,具有较高的临床应用价值。     

风湿性疾病肺间质变测定方法的评价

目的 探讨高分辨率ＣＴ（ＨＲＣＴ）、肺功能、胸片等风湿性疾病肺间质病变的诊断价值。方法 对２０例不同类型的风湿性疾病患者进行胸片、肺功能、ＨＲＣＴ检测,并将结果进行比较。结果 胸片、肺功能、ＨＲＣＴ对风湿性疾病肺间质病变检出率分别为２０％、５５％、８５％。肺功能和ＨＲＣＴ检出肺间质异常的俩组间比较,差异显著（Ｐ〈０．０５）。结论 ＨＲＣＴ对风湿性疾病早期,轻度肺间质病变的诊断有高度敏感性,可检出肺功能正常的肺部病变。肺功能尤其弥散功能亦可做为早期肺间质性病变的诊断方法,特别是对那些无明显临床症状、无胸片改变者。当出现弥散功能减低,ＨＲＣＴ出现磨玻璃影、胸膜下线、小叶间隔增厚等异常等,行积极有效治疗,可延缓终末肺发生,改善预后。     

煤工尘肺130例CT征象分析及诊断价值

目的探讨煤工尘肺的CT表现及其与X射线胸片比较在煤工尘肺检查应用中的价值。方法分析130例煤工尘肺患者的CT或HRCT的表现及X线胸片表现并进行比较。结果煤工尘肺Ⅰ期70例,Ⅱ期38例,Ⅲ期22例。130例胸部CT表现为两肺弥漫性小阴影(直径<10 mm),胸部X线发现117例小阴影。大阴影(直径>10mm)CT显示22例,X线胸片显示19例。并发症CT显示130例,其中肺气肿79例,气胸6例,肺炎37例,肺结核10例,肺癌5例;X线胸片显示73例,其中肺气肿37例,气胸6例,肺炎28例,肺结核6例,肺癌2例。结论 CT检出粟粒状高密度小阴影的范围与程度、肺纤维化、胸膜改变及弥漫性或局限性肺气肿明显优于X线胸片,CT较易发现与煤工尘肺合并的炎症、结核及肿瘤,因此CT诊断可作为X线胸片的必要补充。     

Hypersensitivity pneumonitis in a cluster of sawmill workers: a 10-year follow-up of exposure,symptoms, and lung function

Background:

The long-term prognosis of repeated acute episodes of hypersensitivity pneumonitis (HP) is not well described. We report on a 10-year follow-up of a 10-person cluster from a Norwegian sawmill who had all experienced relapsing episodes of HP.

Objectives:

To evaluate the health symptoms, work-related sick-leave, and lung function of 10 workers exposed to mold in a Norwegian sawmill.

Methods:

Participants were evaluated at baseline and 10 years later at follow-up. A structured interview, measurement of serum IgG antibodies to Rhizopus microsporus (R. microsporus) antigens, lung function tests, high resolution computed tomography (HRCT) of the chest, and personal measurements of exposure to mold spores and dust were completed for each participant.

Results:

At baseline, nearly all workers reported acute episodes of HP more than twice a month. At follow-up, both the frequency and intensity of symptoms had declined. Sick-leave was reduced and gas diffusing capacity improved – paralleling the gradually reduced air levels of mold spores.

Conclusions:

In spite of an initially high occurrence of symptoms, long-term clinical and physiological outcome was good. With reduced exposure to mold spores, symptoms declined and lung function was restored.     

肺炎性假瘤误诊为肺癌的HRCT表现及分析

目的：探讨肺炎性假瘤的HRCT征象,分析其误诊为肺癌的原因,提高诊断水平。方法：回顾性分析31例经手术或穿刺活检后病理证实的,之前被误诊为肺癌的肺炎性假瘤的HRCT征象,其中18例行增强扫描。结果：误诊病例中位于胸膜下17例,晕征26例,毛刺征23例分叶征19例,胸膜增厚21例,血管集束征7例,空泡征4例,均匀强化13例,非均匀强化7例等等。结论：HRCT对肺内炎性假瘤的诊断有重要价值,但全面综合分析CT表现并结合临床病史有助于正确诊断。     

肺内多发小结节病变的HRCT诊断分析

目的:评价HRCT在检出和显示肺内多发小结节微细表现的价值。方法:对16例直径≤3cm的孤立性结节行常规CT扫描后,于结节处行HRCT扫描,对不同病变结节的边缘形态和内在特征进行分析。结果:HRCT能充分显示孤立性肺结节内的细微结构,16例肺内多发性小结节HRCT扫描显示的征象为:分叶6例,毛刺6例,钙化1倒,小泡1例,胸膜凹陷2例。结论:HRCT在显示肺内多发小结节内部结构、形态等方面优于常规CT,是区分良恶性肺内多发小结节的有效方法。