结节病胸部影像学特征及其治疗后的变化

目的 探讨结节病胸部CT特征及其治疗后的变化.方法 回顾分析上海市肺科医院2000年1月至2006年3月收治的、经病理证实的90例结节病患者的临床资料及胸部CT表现.90例中男32例,女58例,年龄31～71岁,其中43例复查CT 2～8次,间隔时间最短5 d,最长1个月.随访时间最短3个月,最长4年.结果 CT影像表现为结节69例(77%),主要沿支气管血管束分布37例(41%),团块31例(34%),磨玻璃影39例(43%),支气管血管束增粗30例(33%),小叶间隔线58例(64%),纤维化17例(19%,包括支气管变形8例,条索影5例,蜂窝影4例),空气潴留3例(3%),支气管狭窄8例(9%),胸膜改变42例(47%),肺门纵隔淋巴结增大76例(84%),肺部病变并存83例(92%).结节、团块、磨玻璃影、支气管血管束增粗的患者治疗后随访复查5 d至4年,好转例数分别为25例(25/30)、9例(9/15)、11例(11/16)及10例(10/12);小叶间隔线、支气管变形、条索影、蜂窝影吸收好转例数分别为10例(10/22)、0例(0/4)、1例(1/3)及0例(0/2).结论 结节病胸部CT表现形式多样,具有一定特征,治疗中CT追踪检查可提高确诊率,且有利于观察治疗效果;结节、团块、磨玻璃影、支气管血管束增粗的患者治疗后吸收明显,表现为线状影、支气管变形、弥漫条索影、蜂窝影的患者治疗后吸收不佳.

Pulmonary sarcoidosis:CT features and the changes after glucocorticoid therapy

OBJECTIVE: To investigate the CT features of pulmonary sarcoidosis and to follow the changes after glucocorticoid therapy. METHODS: CT scans and clinical data of 90 patients with histologically confirmed pulmonary sarcoidosis were retrospectively reviewed. CT follow-up was carried out 5-30 d following therapy in 43 cases. The follow-up lasted 3-48 months. RESULTS: The main CT finding of pulmonary sarcoidosis was nodules which were present in 69 cases (77%), mostly distributed around bronchovascular bundles (n = 37, 41%). Other abnormalities included consolidation (n = 31, 34%), ground-grass ( n = 39, 43%), thickening of bronchovascular bundles (n = 30, 33%) interlobular septal lines (n = 58, 64%), fibrosis (n = 17, 19%), air-trapping (n = 3, 3%) bronchial narrowing (n = 8, 9%), pleural thickening (n = 42, 47%), hilar and mediastinal adenopathy (n =76, 84%). Two or more radiological patterns were present in 83 cases. Twenty-five cases of nodules (25/30), 9 cases of consolidation (9/15), 11 cases of ground-grass (11/16), 10 cases of thickening of bronchovascular bundles (10/12) were improved after therapy. Ten cases of interlobular septa (10/22), 1 case of diffuse linear changes (1/3), but no bronchial distortion (0/4) and honeycombing (0/2), were improved. CONCLUSIONS: The CT manifestations of pulmonary sarcoidosis are varied, with some specific radiographic features. The radiological diagnosis and the effect of glucocorticoidtherapy can be evaluated by repeated CT scanning. Nodules, consolidation, ground-grass, and thickening of bronchovascular bundles can be improved markedly after glucocorticoid therapy, but bronchial distortion, linear changes and honeycombing can not.