涂阳活动性肺结核患者HRCT评分与细菌学及免疫学相关性分析

目的探讨HRCT评分标准在诊断活动性肺结核中的应用价值。方法对42例痰涂阳性肺结核患者,进行HRCT检查和评分,每侧肺组织划分为为三个区域,分别对各类型CT征象所累及范围进行评分;分析评分结果与痰细菌学检查结果和外周血结核菌特异性IFN—y水平之间的相关性。结果根据结核菌涂片结果分为4组,其中,AFB（＋）12例、AFB（＋＋）11例、AFB（＋＋＋）10例、AFB（＋＋＋＋）9例,相关性分析显示（1）HRCT总评分与痰阳性分级有正相关性（r=0．9661 P〈0．0001）：（2）HRCT总评分与结核菌抗原ESAT6、P4-6、P8．10特异性IFN—y释放水平均呈正相关（r=0．4805,P=0．0017,r=0．4451,P=0．0083,r=0．4211,P=0．0131）。结论以活动性肺结核患者复杂的CT征象的范围为基础的HRCT评分标准与细菌学及免疫学均呈正相关,表明该HRCT评分标准对临床诊断治疗和疗效判定具有一定指导意义。     

高原性肺内结节的HRCT分析

目的：探讨高原地区肺内结节性病灶的CT表现,利用HRCT薄层扫的特点,提高CT对肺内结节性病灶的定性诊断。方法：分析HRCT薄层扫描对病灶的筛选,经CT导引下穿刺活检和手术病理证实。结果：肺内结节灶86例,良性结节10例,恶性结节76例。结论：HRCT是检查筛肺内结节性病灶的最理想和最有效的检查方法。     

Rheumatoid arthritis patients with interstitial lung disease: Clinical,radiological and laboratory characteristics

BackgroundRheumatoid arthritis associated interstitial lung disease (RA-ILD) has a significant burden of morbidity and mortality.Aim of the workTo analyze clinical, radiological and laboratory characteristics of RA-ILD in an Egyptian cohort.Patients and methodsThe study included 160 RA patients. Detailed medical history, disease activity score (DAS28) and joint damage (Sharp score) were carefully recorded. Chest x-ray, high-resolution computed tomography (HRCT) and pulmonary function tests (PFTs) were done and patients were sub-grouped as RA-ILD (HRCT or PFTs abnormalities) and RA without ILD.ResultsPatients were 136 (85%) females and 24 (15%) males with a mean age of 37.8 ± 11.3 years and disease duration of 4.98 ± 5.53 years. 50% of patients had chest manifestations suggestive of ILD. 60% demonstrated abnormalities in PFT and 63.75% in HRCT. The most common HRCT findings were reticulation (66.6%) and ground glass appearance (64.7%), followed by bronchiectasis (50.9%) and honey combing (46%). usual interstitial pneumonia (UIP) was the most common HRCT subtype (49%). RA-ILD patients were significantly older (p < 0.001), had longer disease duration (p < 0.001), more frequent arthritis (p = 0.002), higher DAS28 (p < 0.001) and Sharp score (p < 0.001), significantly positive rheumatoid factor (RF) (p = 0.007) and anti-citrullinated protein antibody (ACPA) (p < 0.001).ConclusionA high frequency of ILD among Egyptian patients is recorded due to careful evaluation of respiratory symptoms and valuable assessment by PFTs and HRCT chest. UIP is the most common radiologic pattern of RA-ILD. RA patients with ILD are significantly older with longer disease duration, delayed age at onset, high disease activity with arthritis and positive RF and ACPA.     

螺旋高分辨率CT 对肺内结节定性诊断价值

目的：评价螺旋－高分辨率ＣＴ扫描（ＨＲＣＴ０对肺内孤立结节性病灶（ＳＰＮ）定性诊断的价值。方法 收集３５例肺内结节病变（２．５ｃｍ）,术前做了常规螺旋ＣＴ扫描与病灶局部ＨＲＣＴ扫描,有手术、病理结果,重点对病灶位置、病变形态、大小、边缘、内部结构等征象的显示率进行统计、比较、分析。结果 与常规螺旋ＣＴ扫描比较,ＨＲＣＴ扫描在显示病变特异性征像（病变轮廓、病灶内部结构等）方面敏感性为９０％以上。结论 ＨＲＣＴ扫描检查对肺内结节病灶的定性诊断有很高价值。     

Correlation between clinical features,high-resolution computed tomography findings,and a visual scoring system in patients with pneumonia due to Mycoplasma pneumoniae

Background

Mycoplasma pneumoniae (MP) is the primary cause of community-acquired pneumonia. We aimed to evaluate the correlation between clinical features, with special reference to hypoxemia and the total affected area obtained using high-resolution computed tomography (HRCT).

Lung-volume controlled computerised tomography in real-life acute severe asthma

Objective: It is not known how airway structure is altered during real-life acute asthma exacerbations. The aim of this study was to examine changes in airway structure during acute asthma exacerbations and at convalescence by using lung-volume controlled high resolution computerised tomography (HRCT). Methods: Eight subjects with acute asthma exacerbation admitted to hospital were recruited. HRCT was performed within 72?h of admission (n?=?8) and repeated after 8 weeks of convalescence (n?=?7). Individual airways were carefully matched on acute and convalescent CT data sets for comparisons of airway parameters. A novel methodology was employed for standardisation of lung volumes to permit valid comparisons of lung imaging. Measurements of bronchial cross sectional airway area (Aa) and bronchial luminal area (Ai)?for each matched airway were obtained using a validated program. Results: The airway wall thickness was analysed as wall area (WA) calculated as a percentage: WA%?=?WA/Aa?×?100. Wilcoxon signed-rank testing was used to compare acute and convalescent asthma and Spearman’s correlation to examine associations. Airway lumen (Ai) areas were similar in both acute and stable asthma phases (6.6?±?3.1?mm² versus 7.2?±?3.8?mm² p?=?0.8). However, the airway wall was significantly thickened during acute asthma exacerbations compared to convalescence (62?±?4% versus 55?±?7%; p?=?0.01). There was no correlation between airway structure dimensions and lung function measurements. Conclusions: This is the first study to demonstrate an increase in airway wall thickness during real-life acute asthma exacerbation. However, narrowing of the airway lumen area was variable and will require larger studies able to detect small differences. These results suggest that airway wall thickening linked to mucosal inflammation is likely to characterise acute asthma in vivo but that changes in the airway lumen accompanying bronchoconstriction may be more heterogeneous.     

放射性肺改变相关因素高分辨CT表现与预后的关系

目的 分析引起放射性肺损伤的相关因素，高分辨CT(HRCT)表现与预后的关系。方法 对580例胸部肿瘤中放射性肺损伤的86例行HRCT检查，观察其征象与预后的关系。结果 总结7种引起放射性肺损伤的相关因素。将HRCT表现分为4种类型：片状渗出型(8例)，补丁实变型(18例)，含气不全型(27例)和浓密纤维化型(33例)，其HRCT表现不可逆，治疗只能缓解症状。结论 阐述引起放射性肺损伤的相关因素及HRCT表现与各型放射件肺炎预后的关系。正确使用肺组织的放射剂量，定期HRCT检查对早期诊断和治疗有指导意义。     

HRCT对急性百草枯中毒肺损伤的影像与临床评价

目的:探讨胸部HRCT对百草枯中毒肺损伤的影像特征及临床意义。方法:回顾性分析13例百草枯中毒患者的胸部影像学资料,结合临床,总结胸部HRCT在百草枯中毒肺损伤中的影像特征及诊断价值。结果:13例中8例存活3周以上的患者,中毒早期(≤2 d)5例表现为过度通气、磨玻璃影。1例两下肺小片状实变。1例仅见双侧少量胸腔积液,2例无明显异常。中期(3d～21d)显示弥漫磨玻璃密度影分布7例,渗出病变6例,实变5例。肺气肿5例。纵隔积气1例。晚期(>3周)8例表现不同程度肺间质纤维化和肺小蜂窝改变,2例伴牵引性支气管扩张。5例死亡病例中早期即表现为渗出性病变和肺实变为主。结论:胸部HRCT检查对百草枯中毒肺损伤的影像特征和进展分析有明显优势,在指导临床治疗和预后评价方面有重要意义。     

界面影像分布特征在周围型肺癌定性诊断中的作用

目的　探讨周围型肺癌瘤周高分辨率CT(HRCT)的的影像分布特征及诊断价值。方法　分析病理确诊的 37例周围型肺癌的瘤周HRCT的影像分布特征 ,并随机选择 2 3例肺良性结节作对照。双盲法观察肺结节瘤 -肺交界区向心侧 (近端 )和离心侧 (远端 )HRCT的表现 :①模糊或 /和毛糙 ;②毛刺影 ;③光整。寻找其分布特征 ,确定 3种HRCT表现、分布特征及肺段水平支气管改变与良、恶性肺内结节的关系。结果　瘤 -肺交界区HRCT表现为远端模糊或 /和毛糙、毛刺影 ,周围型肺癌 79% ,肺良性结节 2 2 % (Ρ <0 .0 5) ;光整 ,周围型肺癌 1 4 % ,良性结节 74% (Ρ <0 .0 5) ,部分病例可同时具有两种或两种以上HRCT征象。周围型肺癌肺段水平支气管阻塞、狭窄发生率明显高于良性病灶 (Ρ <0 .0 5)。结论　瘤 -肺交界区HRCT的模糊或 /和毛糙、毛刺影等影像改变的不对称性远端优势分布 ,对≤ 3 .5cm的周围型肺癌的定性诊断有重要价值。其发生原因与病灶阻塞支气管的通气性有关