非特异性间质性肺炎患者的高分辨率CT表现及其病理学特点

目的探讨非特异性间质性肺炎（NSIP）的高分辨率CT（HRCT）影像学特点及其病理学改变。方法对9例经开胸肺活组织检查（简称肺活检）证实为NSIP患者的HRCT与病理表现进行回顾性分析。结果9例NSIP患者HRCT主要表现为两侧斑片状磨玻璃影、实变影、伴或不伴不规则线影和牵拉性支气管和细支气管扩张，分布在中、下肺的外周，但未见蜂窝影。HRCT表现为磨玻璃影伴或不伴不规则线影和牵拉性支气管和细支气管扩张的区域，其相应的病理改变为不同程度的炎性细胞浸润和纤维化引起的肺间质增厚，病变时相基本一致；在HRCT表现为实变影的区域，其病理改变表现为间质纤维化病变程度重于间质炎症；也可表现为闭塞性细支气管炎伴机化性肺炎样改变，肺泡腔内泡沫状细胞聚集，镜下可见蜂窝肺内有黏液潴留等病理改变。结论NSIP患者的HRCT表现有一定的特征性；根据病理特点并结合临床资料及HRCT表现可初步诊断为NSIP。

A high-resolution CT and pathological study of nonspecific interstitial pneumonia

OBJECTIVE: To describe the characteristics of high-resolution CT(HRCT) findings of nonspecific interstitial pneumonia (NSIP) and the correlation with pathological changes. METHODS: The HRCT features of 9 cases (3 men and 6 women) of histopathologically confirmed NSIP were retrospectively analyzed and correlated with the pathological findings. RESULTS: The predominant HRCT features, found in all the cases, were bilaterally patchy areas of ground-glass opacity with or without areas of consolidation. Irregular linear opacities, traction bronchiectasis, and thickening of bronchovascular bundles were also frequently seen. The abnormalities were distributed over the peripheral zones of the middle and lower lungs in most cases. Honeycombing was not a feature in all the cases. Areas of ground-glass opacity with or without irregular linear opacity or traction bronchiectasis corresponded pathologically to areas of interstitial thickening caused by varying degrees of interstitial inflammation and fibrosis showing temporal uniformity. Areas of consolidation were associated with extensive collagen-type interstitial fibrosis and mild interstitial inflammation at the biopsy sites, and occasionally represented the areas of bronchiolitis obliterans organizing pneumonia, foamy cell collections in alveolar spaces, or microscopic honeycombing with mucin stasis. CONCLUSION: The HRCT manifestations of NSIP are characteristic though not specific. In patients with consistent clinical features, the diagnosis of NSIP can be suspected by typical HRCT findings.