胸部高分辨CT检查技术的临床应用

笔者对５０例肺部疾病胸部常规ＣＴ和高分辨率ＣＴ（ＨＲＣＴ）图像进行了对照分析。其中特发性肺间质纤维化（ＩＦＰ）８例，肺转移癌５例，支气管扩张１５例，周围型肺癌７例。结果表明：ＨＲＣＴ在ＩＦＰ、支气管扩张和肺气肿的显示明显优于常规ＣＴ（Ｐ〈０．００１），在对肺部发或转移性肿瘤的显示能提供更多的诊断信息。笔者还讨论了ＨＲＣＴ的检查技术和图像后处理，分析了影响ＨＲＣＴ的若干因素，指出通过缩小视野（ＦＯＶ     

高分辨率CT对弥漫性肺疾病诊断的评价

笔者对１６个正常成人新鲜肺叶标本进行了ＣＴ－高分辨率ＣＴ（ＨＲＣＴ）－标本对照研究，分析了５０例正常成人胸部ＣＴ和ＨＲＣＴ图像。结果表明：ＨＲＣＴ在显示肺部细小结构方面明显优于常规ＣＴ。笔者还分析了３０例弥漫性肺疾病的ＨＲＣＴ征象：（１）小叶间隔增厚；（２）蜂窝肺；（３）磨玻璃样表现；（４）胸膜下线；（５）小结节。小叶间隔不规则增厚伴小叶结构变形常见于肺间质纤维化。肺淋巴管转移癌小叶间隔亦增厚，但无小叶结构变形。“小叶间隔串珠”征高度提示肺淋巴管转移癌。     

支气管扩张症的X线平片、CT和HRCT对照分析

目的：对支气管扩张的Ｘ线平片、ＣＴ和ＨＲＣＴ表现做一对比分析。方法：取病理证实支扩２０例，分别摄有胸正侧位片，常规ＣＴ扫描和ＨＲＣＴ扫描。ＨＲＣＴ选薄层，大矩阵和高分辨率算法。结果：显示Ｘ光平片漏诊率高（８／２０），特异性低（３／２０）。ＣＴ较平片显示肺“盲区”效果好，有粘液嵌塞者，常规ＣＴ像上有时不易与血管性病变鉴别，ＨＲＣＴ可显示部分含气的支气管腔存在。结论：ＨＲＣＴ扫描诊断支扩特异性高，可与支气管造影相媲美，它不仅显示支扩范围、程度和部位，还能显示小叶中央性改变。常规ＣＴ较平片显示率高。     

肺气肿的诊断：CT和肺功能检查的比较

作者比较了１１７例的ＣＴ扫描（其中５０例同时加作了ＨＲＣＴ扫描）和肺功能检查在检出肺气肿上的能力。结果显示ＣＴ和肺功能检查对肺气肿的检出率分别为７８．２６％和４７．８２％，两者有极显著的差异。６６．６７％（１６／２４）肺功能检查无肺气肿的病例，ＣＴ都发现了肺气肿征象，说明ＣＴ在检出轻度、早期肺气肿上较肺功能检查敏感。在５０例常规ＣＴ和ＨＲＣＴ的比较中发现３５．８％常规ＣＴ正常的病例，在ＨＲＣＴ上都     

煤工尘肺HRCT的形态学表现及诊断价值研究

目的：探索煤工尘肺的ＨＲＣＴ特征。方法：１２４例煤工尘肺作肺部常规ＣＴ,然后在主动脉弓顶、隆突水平、气管分叉下３ｃｍ右膈上２ｃｍ及重点兴趣区加作ＨＲＣＴ,对其图像表现进行研究。结果：本组１２４例煤工尘肺ＨＲＣＴ清晰地显示了肺小叶间隔增厚、小叶核心改变及小叶间质增厚、尘肺结节、各型肺气肿和大阴影等病变的特征。结论：ＨＲＣＴ对显示煤工尘肺微细病变的多种形态学表现极有帮助,在鉴别诊断中亦具有重要价值     

磨玻璃样改变的HRCT检查及其对弥漫性肺疾病的诊断价值

评价肺部磨玻璃样改变的高分辨率ＣＴ（ＨＲＣＴ）检查、病理基础以及它在弥漫性肺疾病（ＤＰＤ）中的诊断价值。材料和方法：一组连续的经病理学检查或临床综合其它各种检查而明确诊断的弥漫性肺疾病，经普通Ｘ线、ＣＴ和ＨＲＣＴ检查，ＨＲＣＴ采用层厚为１－１．５ｍｍ，间隔为１０ｍｍ，高空间频率重建算法。有病理学结果者则与之对照。结果：本组ＤＰＤ包括７３例，ＨＲＣＴ显示磨玻璃样改变征象１６例，分别为过敏性肺炎５例、淋巴瘤ｌ例、皮肌炎２例、特发性肺纤维化３例、类风湿性肺炎２例、放射性肺炎１例和肺水肿２例。普通Ｘ线仅显示９例（Ｐ＜０．０１）。病理学上磨玻璃样改变由肺泡腔内渗出、肺泡间隔增厚所致。结论：ＨＲＣＴ是显示肺部早期异常表现——磨玻璃样改变十分有效的方法，但对弥漫性肺疾病的鉴别诊断缺乏特异性。     

^99mTc—MIBI门控平面心肌显像评价心肌梗塞区存活心肌—与^99mTc…

为评价＾９９ｍＴｃ－甲氧基异丁基异腈（ＭＩＢＩ）平面门控心肌显像（ＥＧＰ）在心肌梗塞患者存活心肌判断中的生，对２１例心肌梗塞患者进行了静息ＥＧＰ、静息帮动物＾９９ｍＴｃ－ＭＩＢＩ心肌单光子发现计算机断层（ＳＰＥＣＴ）显像及饥饿时静息＾１８Ｆ－脱氧葡萄糖（ＦＤＧ）正电子发射计算机断层（ＰＥＴ）正像。在２１例患者共１０５个心肌节段中，有１５个节段运动ＳＰＥＣＴ半定量分析局部＾９９ｍＴｃ－ＭＩＢＩ放射性     

正常肺高分辨CT表现的解剖基础研究

笔者搜集８例尸体的正常肺标本，共１４侧肺。采用标本高分辨ＣＴ（ＨＲＣＴ）图像、软Ｘ线照片及组织学切片对照的研究方法。结果表明：（１）ＨＲＣＴ图像能清楚显示ＨＲＣＴ图像的基本影像单位─—次级肺小叶。小叶间隔分布趋势为：胸膜下比中央部丰富，且上、中（舌）叶比下叶丰富；中央部以肺尖和下叶各基底段支气管血管束内侧丰富；纵隔面、膈面比肋面丰富。（２）我们将肺的横断层面分为周边部与中央部，周边部范围为胸膜下１．５ｃｍ。（３）全肺五个代表层面分别为：主动脉弓、右上叶前段支气管、右中叶支气管、下肺静脉干和肺底隔上层面。这五个代表层面反映了肺的概貌。     

肺良性结节HRCT－病理对照研究

目的：本文对３３例肺良性结节进行高分辨力ＣＴ（ＨＲＣＴ）－病理对照研究。目的是探讨肺良性结节的ＨＲＣＴ周围特征、病理基础以及诊断价值。材料与方法：前瞻性分析病理确诊的３３例肺良性结节的ＨＲＣＴ周围特征，并作相应的病理对照研究。随机选择１０例肺原发性小肺癌作对照。通过两位有经验的放射科医师，双盲法观察肺结节周围４种ＨＲＣＴ征象：（１）ＣＴ晕征；（２）ＣＴ血管造影征；（３）周围性肺气肿；（４）灶周线状影。采用相关分析法，确定４种ＨＲＣＴ征象与肺内良性结节的相关性。结果：３３例肺良性结节ＨＲＣＴ－病理对照研究表明：ＣＴ晕征多见于肺部炎性病灶和肺结核瘤（敏感性７９％，特异性８９％）；ＣＴ血管造影征根据结节的部位良恶性各有差异；周围性肺气肿在病理上是由于炎症过程溶蛋白酶活性和瘢痕病变所致；灶周长线状影在良恶性结节无显著差异，短线状影有显著性差异。结论：ＣＴ晕征、ＣＴ血管造影征和周围性肺气肿对于≤３ｃｍ的肺内良性结节的ＨＲＣＴ诊断有重要价值     

先天性支气管闭锁的MDCT诊断

目的：回顾性分析先天性支气管闭锁的多层CT（MDCT）影像特征，提高对该病的诊断准确性。方法：回顾性分析9例经临床随访或纤维支气管镜证实的先天性支气管闭锁的MDCT资料，全部病例采取各向同性（层厚≤1mm）CT容积采集，并同时重建5～10mm的常规图像，5例完成增强检查。结果：7例呈典型表现，MDCT表现为受累支气管近端与中心气道不相通，远端扩张，呈粗大而弯曲的分支，其内含气含液6例，单纯含液1例，受累肺组织肺气肿；5例增强扫描显示肺血管变细变少；2例呈不典型表现，直接显示支气管中断伴远侧肺结构紊乱1例，显示受累支气管闭塞伴扩张和含气、含液但无肺气肿1例。三维重建显示病变特征优于常规横断面。结论：先天性支气管闭锁多呈典型表现，包括闭锁的支气管扩张伴黏液栓和肺气肿，现代MDCT各向同性成像三维重建可充分显示其特征从而获得正确诊断；不典型表现需要结合纤维支气管镜检查进行诊断。     

支气管侵袭性肺曲菌病HRCT诊断

目的 回顾性分析支气管侵袭性肺曲菌病的高分辨率CT(HRCT)表现,探讨HRCT在该病诊断中的价值.方法 收集30例经纤维支气管镜活检、CT导引下穿刺活检或痰培养证实的支气管侵袭性肺曲菌病的临床资料及影像学资料,所有HRCT图像均经2位经验丰富的胸部影像学主任医师阅片并分析总结其征象.结果 30例患者,19例具有多种CT征象,其中树芽征8例,支气管狭窄6例,支气管扩张8例,磨玻璃样密度灶(GGO)8例,腺泡结节10例,结节灶12例,腺泡结节灶伴有晕征4例,结节灶伴有晕征9例,空洞10例.11例具有单一CT征象,树芽征2例,支气管扩张2例,GGO 1例,腺泡结节2例,结节灶伴有晕征2例,空洞2例.30例病例中各征象出现率为:树芽征33.3%,支气管狭窄20%,支气管扩张33.3%,磨玻璃影30%,腺泡结节40%,结节灶46.6%,晕征53.3%,空洞40%.结论 支气管侵袭性肺曲菌病HRCT的主要征象是树芽征、支气管管腔狭窄或扩张,肺内见磨玻璃影、腺泡结节、结节灶,空洞,结节及空洞周围有晕征.支气管扩张合并树芽征、腺泡结节及晕征对诊断本病具有较高的特异性.     

High-resolution CT in chronic pulmonary changes after mustard gas exposure

PURPOSE: To identify the findings of high-resolution CT (HRCT) of the lung in patients with previous sulfur mustard gas exposure, and to correlate these findings with clinical and chest X-ray (CXR) results. MATERIAL AND METHODS: 50 consecutive patients were studied prospectively. The clinical data were recorded. Standard p.a. CXR and HRCT of the lung and spirometry were performed. The findings of CXR, HRCT and clinical and spirometry results were scored between 0 and 3 according to the severity of the findings. RESULTS: HRCT abnormality was detected in all 50 patients (100%), while CXR was abnormal in 40 patients (80%). The most common HRCT findings was airway abnormalities (bronchial wall thickening in 100% of cases). Other important findings were suggestive of interstitial lung disease (ILD) (80%), bronchiectasis (26%), and emphysema (24%). A statistically significant correlation was found between the severity of clinical presentation and that of the HCTR scores in patients with bronchiectasis, bronchitis and ILD (p< 0.05), but not with severity scores of HRCT in patients with emphysema. No significant correlation was found between severity scores of CXR findings. HRCT evidence of bronchial wall thickening and with a lower frequency ILD were present despite normal CXR in 20% of the patients. CONCLUSION: The results of this study suggest that bronchial wall thickening, ILD and emphysema are common chronic pulmonary sequelae of sulfur mustard injury. HRCT of the chest should be considered as the imaging modality of choice in chemical war injury.     

气管支气管内膜结核的CT诊断

目的：分析气管支气管内膜结核的CT表现，探讨其影像学特征及其病理基础。方法：收集痰菌、病理及临床证实的气管与支气管结核52例，分析其CT与HRCT表现。结果：CT表现有以下特点：①96．1％CT显示长段不规则气管或支气管壁增厚，其增厚的支气管壁范围较长为特征之一；②25％CT显示远处肺或对侧肺结核支气管播散病灶；③支气管狭窄、阻塞不伴有肺门肿块；④11．5％可见增厚的气管或支气管壁出现钙化。此征象具有特征性；⑤支气管阻塞性肺部病变中，若出现阻塞性肺气肿伴气肿区分支条状或指套样高密度灶、支气管阻塞远端实变、肺内或不张肺内出现大量无壁空洞、“蜂窝样”改变或伴有不规则或“串珠状”支气管扩张表现者也具有一定特征性诊断价值，其中后者考虑为继发于支气管壁破坏或实变与不张肺内病灶纤维化继发的牵拉性支气管扩张所致。结论：气管支气管内膜结核的CT表现，尤其是HRCT表现，有一定特征性，是诊断及鉴别诊断的有效于段。     

Scoring CT/HRCT findings among asbestos-exposed workers: effects of patient’s age,body mass index and common laboratory test results

We studied the effects of age, body mass index (BMI) and some common laboratory test results on several pulmonary CT/HRCT signs. Five hundred twenty-eight construction workers (age 38–80, mean 63 years) were imaged with spiral and high resolution CT. Images were scored by three radiologists for solitary pulmonary nodules, signs indicative of fibrosis and emphysema, ground glass opacities, bronchial wall thickness and bronchiectasis. Multivariate statistical analyses were adjusted for smoking and asbestos exposure. Increasing age, blood haemoglobin value and erythrocyte sedimentation rate correlated positively with several HRCT signs. Increasing BMI was associated with a decrease in several signs, especially parenchymal bands, honeycombing, all kinds of emphysema and bronchiectasis. The latter finding might be due to the suboptimal image quality in obese individuals, which may cause suspicious findings to be overlooked. Background data, including patients age and body constitution, should be considered when CT/HRCT images are interpreted.     

High-resolution computed tomographic findings of small peripherally located squamous cell carcinoma

With the spread of high-resolution computed tomography (HRCT) screening for lung cancer, we are increasingly faced with the need to determine whether certain small lesions are benign or malignant. The features of small adenocarcinomas have been clarified but not those of squamous cell carcinoma. The objective of our study was therefore to clarify the HRCT findings of peripherally located squamous cell carcinomas less than 2 cm in maximum dimension. Subjects consisted of 27 consecutive pathologically proven cases of peripherally located squamous cell carcinoma that were less than 2 cm in maximum dimension. HRCT findings of all 27 cases were analyzed retrospectively and independently by three radiologists who were unaware of the pathological diagnosis, and decisions were reached by consensus with special attention to 10 review points. Internal characteristic features included calcification, cavity formation, and air bronchogram. Tumor margin features included spiculation, notching, irregularity, and ground-glass opacity. Surrounding structural features consisted of pleural indentation, pulmonary emphysema, and satellite lesions. The presence of irregularity (70.4%), surrounding pulmonary emphysema (70.4%), and pleural indentation (51.9%) was observed frequently. No mass was accompanied by calcification. HRCT images of peripherally located squamous cell carcinoma suggested that the demonstration of irregularity, surrounding pulmonary emphysema, pleural indentation, and absence of calcification may contribute to the accurate CT diagnosis of small peripheral squamous cell carcinoma.     

气管支气管破裂的CT诊断

目的:探讨CT对气管支气管破裂的诊断价值水平。方法:回顾性分析22例气管支气管破裂患者的临床、胸片及CT影像资料,其中外伤性12例,自发性10例。结果:X线片诊断颈肩部皮下及纵隔气肿3例,可疑纵隔气肿8例,气胸4例,胸腔积液2例,肋骨骨折2例,均未能提示气管支气管破裂。CT诊断颈肩部皮下及纵隔气肿18例,气胸6例,胸腔积血4例,肋骨骨折2例,肺挫伤4例,肺气囊1例;CT发现气管或支气管破裂22例(23处);支气管破裂口宽1～3mm,气管破裂口宽1～12mm,涉及管腔周径均<50%,其中2例气管裂口纵径分别为28和40mm。破裂部位位于气管5例,其中外伤性2例,自发性3例;位于右主支气管8例(9处),位于右上叶后段支气管4例,位于左主支气管5例。10例外伤性支气管破裂均发生在右侧,自发性支气管破裂5例发生在左侧,2例发生在右侧;主支气管破裂均在隆突附近1.0～2.5cm范围内。结论:胸部CT对气管支气管破裂的定位明显优于胸片,对明确诊断有重要价值。     

High-definition computed tomography in the study of the pulmonary parenchyma. The author's own experience]

High-resolution CT (HRCT) scans were performed on 156 patients, using a bone-reconstruction algorithm, 1.5 collimation at 4 cm intervals from apex to base of the lungs and a 512 x 512 matrix. The patients appeared to have a pathologic condition on chest film, or else they presented positive clinical symptoms--i.e., cough, dyspnea, fever--and questionable/negative chest films. Since HRCT is capable of showing the secondary lobule, we employed it to study both its anatomy and the alterations that can modify its normal morphology--i.e., thickening of interlobular septa, reticular pattern, nodular pattern, high-density areas, sub-pleural lines, honeycomb pattern. HRCT findings in secondary lobules, airways, and pleura were examined. They were: lymphangitic spread of carcinoma, pulmonary fibrosis, sarcoidosis, pneumoconiosis, interstitial edema, phlogosis, bronchiectasis, emphysema, and bullae. Even though some limitations still exist due to the aspecificity of HRCT findings, the latter is the best method currently available to recognize and locate interstitial conditions and, sometimes, to make a diagnosis--e.g., of lymphangitic spread of carcinoma, interstitial edema, fibrosis, emphysema, bronchiectasis. Moreover, HRCT can accurately locate pathologic areas for lung biopsy and can be used instead of chest radiographs in the follow-up.     

Cystic Lung Disease: a Comparison of Cystic Size, as Seen on Expiratory and Inspiratory HRCT Scans

Objective

To determine the effects of respiration on the size of lung cysts by comparing inspiratory and expiratory high-resolution CT (HRCT) scans.

Materials and Methods

The authors evaluated the size of cystic lesions, as seen on paired inspiratory and expiratory HRCT scans, in 54 patients with Langerhans cell histiocytosis (n = 3), pulmonary lymphangiomyomatosis (n = 4), confluent centrilobular emphysema (n = 9), paraseptal emphysema and bullae (n = 16), cystic bronchiectasis (n = 13), and honeycombing (n = 9). Using paired inspiratory and expiratory HRCT scans obtained at the corresponding anatomic level, a total of 270 cystic lesions were selected simultaneously on the basis of five lesions per lung disease. Changes in lung cyst size observed during respiration were assessed by two radiologists. In a limited number of cases (n = 11), pathologic specimens were obtained by open lung biopsy or lobectomy.

Results

All cystic lesions in patients with Langerhans cell histiocytosis, lymphangiomyomatosis, cystic bronchiectasis, honeycombing, and confluent centrilobular emphysema became smaller on expiration, but in two cases of paraseptal emphysema and bullae there was no change.

Conclusion

In cases in which expiratory CT scans indicate that cysts have become smaller, cystic lesions may communicate with the airways. To determine whether, for cysts and cystic lesions, this connection does in fact exist, paired inspiratory and expiratory HRCT scans are necessary.