Hyperoxia-induced diffuse alveolar damage in pigs: correlation between thin-section CT and histopathologic findings

PURPOSE: To determine whether lung abnormalities at thin-section computed tomography (CT) in experimental hyperoxic lung injury correlate with the pathologic phases of diffuse alveolar damage (DAD). MATERIALS AND METHODS: Eighteen juvenile pigs were exposed to more than 80% oxygen-for 24, 48, 72, 96, or 120 hours-or room air in sealed cages. Their removed lungs were inflated with air infused through the trachea and examined with thin-section CT. Two independent observers, without knowledge of the exposure times, compared 63 areas selected on the CT scans with the corresponding pathologic and histologic findings, which were evaluated independently by two pathologists. RESULTS: CT findings correlated well with histologic findings (rho = 0.86, P <.001), which corresponded to the pathologic phases of DAD. All areas of normal CT attenuation, eight of nine spared regions within areas of opacity, and two of 15 areas of ground-glass opacity corresponded to the early exudative pathologic phase of DAD. All areas that showed traction bronchiolectasis at CT corresponded to the early proliferative pathologic phase. There was good observer agreement regarding the interpretation of CT findings (kappa statistic, >0.60) and histologic results (>/=0.70). CONCLUSION: Thin-section CT findings reflect the pathologic phases of DAD, although the early exudative phase cannot be specifically depicted by thin-section CT. Traction bronchiolectasis on a CT scan suggests progression to the proliferative phase.     

Exogenous lipoid pneumonia: high-resolution CT findings

The aim of this study was to assess high-resolution computed tomography (HRCT) findings of exogenous lipoid pneumonia. High-resolution computed tomography was obtained in 25 patients with proven exogenous lipoid pneumonia resulting from aspiration of squalene (derived from shark liver oil). Diagnosis was based on biopsy (n = 9), bronchoalveolar lavage (n = 8), or sputum cytology and clinical findings (n = 8). The clinical history of taking squalene was confirmed in all patients. The CT findings were classified into three patterns: diffuse ground-glass opacity, consolidation, and interstitial abnormalities. Distribution of the abnormalities, duration of taking squalene, predisposing factors for aspiration, and route of administration were analyzed. Ten patients showed diffuse ground-glass opacity pattern. Seven of 10 patients had predisposing conditions such as unconsciousness, pharyngeal dysmotility, or motor disturbances, and 6 patients had a recent history of taking large amount of squalene through nasal route. Seven patients who had consolidation pattern had a history of taking squalene for several months and did not have any predisposing factor. All of the 5 patients who had a pattern of interstitial abnormalities had a history of taking squalene longer than 1 year and showed segmental distribution of interstitial thickening with interposing ground-glass opacities. Three patients simultaneously had two different patterns at different lobes of the lung. The HRCT findings of lipoid pneumonia are ground-glass opacities, consolidation, and interstitial abnormalities. These HRCT findings with appropriate inquiries could be useful for diagnosis of exogeneous lipoid pneumonia. Received: 12 September 1997; Revision received: 13 February 1998; Accepted: 7 April 1998     

Acute interstitial pneumonia: thin-section CT findings in 36 patients.

PURPOSE: To characterize the computed tomographic (CT) findings of acute interstitial pneumonia and to correlate the pattern and the extent of abnormalities with the time between symptom onset and CT. MATERIALS AND METHODS: The study included 36 patients (20 men, 16 women; age range, 22-83 years; mean age, 61 years) with histopathologically proved acute interstitial pneumonia who were identified retrospectively. The time between symptom onset and CT was 2-90 days (mean, 22 days; median, 17 days). The presence, extent, and distribution of various CT findings were evaluated. Disease duration and extent of each finding were compared by using the Spearman rank correlation coefficient. RESULTS: Areas with ground-glass attenuation, traction bronchiectasis, and architectural distortion were present in all 36 patients. Airspace consolidation was present in 33 patients (92%). The extent of areas of ground-glass attenuation (r = 0.45, P < .01) and the extent of traction bronchiectasis (r = 0.35, P < .05) correlated with disease duration. No other significant correlation was found between the CT findings and disease duration. CONCLUSION: A combination of ground-glass attenuation, airspace consolidation, traction bronchiectasis, and architectural distortion is seen in the majority of patients with acute interstitial pneumonia. The extent of ground-glass attenuation and traction bronchiectasis increases with disease duration.     

Lymphocytic interstitial pneumonia: thin-section CT findings in 22 patients.

PURPOSE: To assess the thin-section computed tomographic (CT) findings of lymphocytic interstitial pneumonia. MATERIALS AND METHODS: The study included 22 patients (five men, 17 women; age range, 24-83 years; mean age, 50 years) with biopsy-proved lymphocytic interstitial pneumonia. The CT scans were obtained by using 1-3-mm collimation and reconstructed by using a high-spatial-frequency algorithm. RESULTS: The predominant abnormalities consisted of areas of ground-glass attenuation and poorly defined centrilobular nodules present in all 22 patients and subpleural small nodules seen in 19 patients. Other common findings included thickening of bronchovascular bundles (n - 19), interlobular septal thickening (n = 18), cystic airspaces (n = 15), and lymph node enlargement (n = 15). Less common findings included large nodules, emphysema, airspace consolidation, bronchiectasis, architectural distortion, honeycombing, and pleural thickening. CONCLUSION: Lymphocytic interstitial pneumonia is characterized by the presence of ground-glass attenuation, poorly defined centrilobular nodules, and thickening of the interstitium along the lymphatic vessels. Lymph node enlargement is more common than previously recognized; it was seen in 68% of patients.     

Nonspecific interstitial pneumonia: correlation between thin-section CT findings and pathologic subgroups in 55 patients

PURPOSE: To characterize thin-section computed tomographic (CT) findings of pathologic subgroups of nonspecific interstitial pneumonia (NIP) in a sizeable number of patients. MATERIALS AND METHODS: The study included 55 cases of pathologically proven NIP. The 55 cases were categorized histologically into four grades: grade 1, interstitial inflammation without fibrosis (n = 6); grade 2, interstitial inflammation predominating over fibrosis (n = 16); grade 3, fibrosis predominating over inflammation (n = 5); and grade 4, fibrosis only (n = 28). Two independent observers evaluated the presence, extent, and distribution of various CT findings. Thin-section CT findings and histologic grades were compared by using the Spearman rank correlation coefficient. Observer agreement was assessed. RESULTS: Areas with ground-glass attenuation and architectural distortion were present in all 55 patients. Traction bronchiectasis and intralobular reticular opacities were seen in 52 and 48 patients, respectively. The extent of traction bronchiectasis (r = 0.68; P <.001) and intralobular reticular opacities (r = 0.35; P <.05) correlated with the histologic grade. Honeycombing was seen in 12 (43%) of 28 patients with grade 4 NIP and in three (11%) of the remaining 27 patients (chi(2) test, P <.001). There was good agreement between the observers for the presence (kappa = 0.7-1.0) and extent (Spearman rank correlation; r = 0.87-0.98; P <.001) of various abnormalities. CONCLUSION: The extent of traction bronchiectasis and intralobular reticulation at thin-section CT correlates with increased fibrosis in NIP. Honeycombing is seen almost exclusively in patients with fibrotic NIP.     

Mucin-producing pancreatic tumor: CT findings and histopathologic correlation.

Twenty patients with mucin-producing pancreatic tumor and 60 with other pancreatic diseases underwent computed tomography (CT) to establish the CT characteristics of mucin-producing pancreatic tumor. Scans were obtained with thin sections by administering a large volume of contrast material (200 mL). Mucin-producing pancreatic tumors were divided into three subgroups, and the CT characteristics were as follows: Main duct type tumors consisted of a cystic mass in or communicating with the dilated main pancreatic duct (MPD). Excrescent nodules and/or septa were found in the cyst. The MPD was markedly dilated over its entire length. Branch duct type tumors consisted of clustered small cysts that were all approximately the same size in diameter (1-2 cm). Excrescent nodules or septa were not always seen. The MPD near the lesion was often slightly dilated. Peripheral type tumors consisted of a well-defined cystic mass with excrescent nodules and/or septa. Even if the cyst was multilocular, a large main cyst was in it. The MPD usually was not dilated. The CT findings corresponded to macroscopic findings. Mucin-producing pancreatic tumor can be differentiated from other pancreatic diseases with these criteria.     

Nontuberculous mycobacterial pulmonary infection in immunocompetent patients: comparison of thin-section CT and histopathologic findings

PURPOSE: To identify and describe the thin-section computed tomographic (CT) findings of nontuberculous mycobacterial (NTM) pulmonary infection in immunocompetent patients and to compare these findings with histopathologic findings. MATERIALS AND METHODS: Between April 2002 and March 2003, the thin-section chest CT findings in and histopathologic lung tissue specimens from 22 patients who fulfilled the American Thoracic Society diagnostic criteria for NTM pulmonary infection were retrospectively reviewed. The lung lesion patterns (ie, small nodules, branching centrilobular nodules [ie, tree-in-bud pattern], consolidation, cavities, bronchiectasis, and volume loss) seen at CT at the sites of transbronchial lung biopsy (n = 22) or lobectomy (n = 1) were compared with the histopathologic findings. RESULTS: Thirteen of the 22 patients were found to have Mycobacterium abscessus pulmonary infection; seven, to have Mycobacterium avium-intracellulare complex infection; and two, to have Mycobacterium fortuitum infection. Regardless of the specific infective mycobacterial species, bilateral small nodules (in 22 [100%] lung locations), cylindric bronchiectasis (in 20 [91%] locations), and branching centrilobular nodular lesions (in 17 [77%] locations) were the most common CT findings seen at the biopsy sites. All of the transbronchial lung biopsy specimens showed a thickened bronchiolar wall and bronchiolar and peribronchiolar inflammation at histopathologic analysis. Dilated bronchioles were identified in 19 (86%) patients, and epithelioid granulomas with or without caseation were seen in seven (32%). CONCLUSION: Regardless of the specific infective mycobacterial species, the most common thin-section CT findings of NTM pulmonary infection are bilateral small nodules, cylindric bronchiectasis, and branching centrilobular nodules. These findings correspond histopathologically to bronchiolectasis and bronchiolar and peribronchiolar inflammation with or without granuloma formation.     

Parotid gland oncocytosis: CT findings with histopathologic correlation

Oncocytic neoplasms result from metabolically altered cells that accumulate abundant mitochondria within their cytoplasm by oncocytic metaplasia. In this report, the CT findings are described and correlated with the histopathologic features of a case of oncocytoma involving the parotid gland that arose in a background of nodular oncocytic hyperplasia. When imaging demonstrates multiple small nodules in the parotid gland with a large, solid, or cystic mass, the diagnosis of oncocytic neoplasia should be considered.     

免疫抑制兔肺部真菌感染早期薄层CT表现与病理对照研究

目的 比较免疫抑制兔肺部感染白念珠菌、曲霉菌、隐球菌的薄层CT表现并与病理对照,以加深对肺部真菌感染早期表现的认识,提高临床诊断准确性.方法 建立免疫抑制兔肺部感染白念珠菌、曲霉菌及隐球菌动物模型后,各实验组及对照组行CT扫描观察CT表现,并与病理作对照研究;免疫抑制剂使用前后兔静脉血中性粒细胞值比较采用配对t检验,CT征象及病灶分布比较采用x2检验及Fisher's 精确检验,CT出现病变的时间比较采用独立样本t检验.结果 白念珠菌实验组17只中14只建模成功,隐球菌实验组19只中16只建模成功,曲霉菌实验组17只中15只建模成功;实验动物免疫抑制剂使用前后中性粒细胞值比较:白念珠菌组分别为(2.91±0.92)、(0.35±0.19)×109/L,差异有统计学意义(t=12.484,P＜0.05);曲霉菌组分别为(2.51 ± 0.82)、(0.76 ±0.71)×109/L,差异有统计学意义(t=5.792,P＜0.05);隐球菌组分别为(2.10±0.65)、(0.48±0.22)×109/L,差异有统计学意义(t=8.199,P＜0.05);3种真菌性肺炎胸部CT出现病变时间(白念珠菌组平均为接种后4.36 d,曲霉菌组5.86 d,隐球菌组3.69 d)比较差异无统计学意义(P值均＞0.05);14只白念珠菌肺炎兔中,磨玻璃影(GGO)10只,实变8只,结节1只,病灶累及双肺7只;15只熏烟色曲霉菌肺炎兔中,GGO 13只,实变4只,结节1只,双肺受累9只;16只新生隐球菌肺炎兔中GGO 10只,实变5只,结节1只,病灶累及双肺6只;病理上GGO主要为肺充血、出血、间质增生及炎细胞浸润,肺实变则提示较严重的充血、出血、间质增生、炎细胞浸润及组织坏死与血管栓塞出现.结论 免疫抑制兔肺部白念珠菌、曲霉菌及隐球菌肺部感染模型有较高的建模成功率,3种真菌病变早期在CT上以GGO、实变和结节表现为主,3种真菌性肺炎的早期表现相仿,没有明显差别;其薄层CT表现基本反映病理变化.     

Pulmonary involvement of malignant melanoma: thin-section CT findings with pathologic correlation

OBJECTIVES: The purpose of this study was to characterize the thin-section computed tomography (CT) findings of primary and secondary pulmonary malignant melanoma and to correlate them with the histopathologic features. MATERIALS AND METHODS: Patients were identified from a pathologic registration system database through a query for patients with diagnosed primary or secondary pulmonary melanoma who had undergone surgical resection. A total of 19 pulmonary malignant melanomas, including one primary and 18 secondary involvements, from 10 patients were enrolled into this study. The patients consisted of 3 men and 6 women, with a mean age of 55 years (range, 28 to 71 years). Thin-section CT findings evaluated by consensus between two radiologists were compared with the histopathologic specimens. RESULTS: Tumor size ranged from 4 to 62 mm (mean, 19 mm) on thin-section CT images. Four characteristic patterns including solitary or multiple solid nodule, endobronchial lesion, cavitary nodule, and nodule with ground-glass attenuation were disclosed by correlation between thin-section CT and pathologic findings. The most common thin-section CT finding was a solid nodule with a well-defined, smooth margin (n=14). Endobronchial lesions were seen in one primary and one secondary involvement (n=2). Less common CT findings were cavitary nodule (n=1) and nodule with ground-glass attenuation (n=1). CONCLUSION: Primary and secondary pulmonary malignant melanomas show various patterns of involvement on thin-section CT.     

Follicular bronchiolitis: thin-section CT and histologic findings.

PURPOSE: To evaluate the thin-section computed tomographic (CT) findings of follicular bronchiolitis and compare them with the histologic findings. MATERIALS AND METHODS: Thin-section CT scans obtained in 12 patients (age range, 24-77 years; mean age, 47 years) with follicular bronchiolitis proved at open lung biopsy were reviewed by two observers. Underlying conditions included rheumatoid arthritis (n = 8), mixed collagen vascular disorders (n = 2), autoimmune disorder (n = 1), and acquired immunodeficiency syndrome (n = 1). All patients had thin-section CT scans (1.0-1.5-mm collimation, 11 patients; 3.0-mm collimation, one patient; high-spatial-frequency reconstruction algorithm) obtained at 10-mm intervals through the chest. RESULTS: The main CT findings included bilateral centrilobular (n = 12) and peribronchial (n = 5) nodules. All 12 patients had nodules smaller than 3 mm in diameter; six patients also had nodules 3-12 mm in diameter. Areas of ground-glass opacity were present in nine (75%) patients. Histologically, all patients had lymphoid hyperplasia along the bronchioles; eight had peribronchiolar lymphocytic infiltration. CONCLUSION: The cardinal CT feature of follicular bronchiolitis consists of small centrilobular nodules variably associated with peribronchial nodules and areas of ground-glass opacity.     

Regenerative nodules in liver cirrhosis: findings at CT during arterial portography and CT hepatic arteriography with histopathologic correlation

PURPOSE: To determine the appearance of regenerative nodules in patients with liver cirrhosis at computed tomography (CT) during arterial portography (CTAP) and CT hepatic arteriography (CTHA). MATERIALS AND METHODS: CTAP and CTHA of the liver were performed in 28 consecutive patients with hepatocellular carcinoma (HCC) who were scheduled to undergo partial resection of the liver. Helical CTAP was performed after contrast material injection into the superior mesenteric artery followed by helical CTHA after contrast material injection into the hepatic artery. CT scans were analyzed for the presence of identifiable nodules and their size; results were correlated with gross and microscopic findings. RESULTS: Resected livers showed cirrhosis in 20 patients, chronic hepatitis in four, and normal liver in four. Among the 20 patients with cirrhosis, regenerative nodules were demonstrated as enhancing 3-10 mm nodules surrounded by lower attenuation fibrous septa 0.8-1.5 mm thick at CTAP in seven patients and nonenhancing nodules of the same size surrounded by enhancing fibrous septa at CTHA in 15 patients. The degree of fibrosis determined the conspicuity of nodules. CONCLUSION: Regenerative nodules in cirrhotic liver are visualized as enhancing nodules surrounded by lower attenuation thin septa at CTAP and nonenhancing nodules surrounded by enhancing fibrous septa at CTHA. CTHA is more sensitive than CTAP in depicting regenerative nodules (P < .005).     

Acute respiratory distress syndrome and acute interstitial pneumonia: comparison of thin-section CT findings

PURPOSE: The purpose of this work was to compare the thin-section CT findings of acute respiratory distress syndrome (ARDS) with those of acute interstitial pneumonia (AIP). METHOD: The thin-section CT scans from 25 patients with ARDS and 25 with AIP were independently assessed by two observers without knowledge of clinical and pathologic data. The presence, extent, and distribution of various CT findings were independently analyzed. RESULTS: Honeycombing was seen more frequently in lobes of patients with AIP (26%) than in lobes with ARDS (8%) (p < 0.001). Compared with patients with ARDS, a greater number of patients with AIP had a predominantly lower lung zone distribution (p < 0.05) and a symmetric distribution (p < 0.05) of the parenchymal abnormalities. CONCLUSION: Patients with AIP have a greater prevalence of honeycombing and are more likely to have a symmetric bilateral distribution and a lower lung zone predominance than patients with ARDS. However, significant overlap exists among the CT findings.     

Meticillin-resistant Staphylococcus aureus and meticillin-susceptible S. aureus pneumonia: comparison of clinical and thin-section CT findings

Objectives

The purpose of this study was to compare the clinical and thin-section CT findings in patients with meticillin-resistant Staphylococcus aureus (MRSA) and meticillin-susceptible S. aureus (MSSA).

Methods

We retrospectively identified 201 patients with acute MRSA pneumonia and 164 patients with acute MSSA pneumonia who had undergone chest thin-section CT examinations between January 2004 and March 2009. Patients with concurrent infectious disease were excluded from our study. Consequently, our study group comprised 68 patients with MRSA pneumonia (37 male, 31 female) and 83 patients with MSSA pneumonia (32 male, 51 female). Clinical findings in the patients were assessed. Parenchymal abnormalities, lymph node enlargement and pleural effusion were assessed.

Results

Underlying diseases such as cardiovascular were significantly more frequent in the patients with MRSA pneumonia than in those with MSSA pneumonia. CT findings of centrilobular nodules, centrilobular nodules with a tree-in-bud pattern, and bronchial wall thickening were significantly more frequent in the patients with MSSA pneumonia than those with MRSA pneumonia (p=0.038, p=0.007 and p=0.039, respectively). In the group with MRSA, parenchymal abnormalities were observed to be mainly peripherally distributed and the frequency was significantly higher than in the MSSA group (p=0.028). Pleural effusion was significantly more frequent in the patients with MRSA pneumonia than those with MSSA pneumonia (p=0.002).

Conclusions

Findings from the evaluation of thin-section CT manifestations of pneumonia may be useful to distinguish between patients with acute MRSA pneumonia and those with MSSA pneumonia.Staphylococcus aureus is one of the most common and important pathogens involved in nosocomial pneumonia, particularly because of the development of meticillin-resistant S. aureus (MRSA) [1]. Pneumonia caused by MRSA is a clinically important type of pneumonia because of its severity, the high incidence of complications, and the increased mortality it causes in nosocomial pulmonary infections [2-4].In recent years, MRSA has also emerged as an increasingly important cause of community-acquired bacterial infection, often affecting healthy children and adults who have no apparent risk factors for infection. community-acquired MRSA strains causing life-threatening infections, such as necrotising pneumonia and necrotising fasciitis, have been found to frequently carry Panton–Valentine leukocidin (PVL) genes [5-7].The mortality of pneumonia is usually associated with inadequate initial antibiotic therapy; therefore, early recognition of S. aureus pneumonia is important for reducing morbidity and mortality. Meanwhile bacteriological evaluation may take time and cause a delay in diagnosis. As such, thin-section CT may be helpful in expediting differential diagnosis of infections and in the selection of appropriate antibiotics. Recently, a small number of reports have emerged describing thin-section CT findings in patients with pathogens, including Klebsiella pneumoniae, Mycoplasma pneumoniae and Chlamydia pneumoniae [8-11]. As for S. aureus pneumonia, several studies have shown differences in clinical findings between MRSA pneumonia and meticillin-susceptible S. aureus (MSSA) pneumonia [12-13]. In a radiological study, González et al [14] reported that there were no differences on chest radiographs between 32 patients with MRSA and 54 patients with MSSA. Nguyen and colleagues [15] reported CT findings in nine patients with community-acquired MRSA, whose conditions were characterised by extensive bilateral consolidation and frequent cavitation, which is commonly associated with rapid progression and clinical deterioration. However, there are currently very few reports with radiological findings in patients with MRSA or MSSA pneumonia. Moreover, to the best of our knowledge, no studies describing the comparison of CT findings in patients with MRSA with those with MSSA have been published. As such, the current study sought to evaluate thin-section CT findings of acute MRSA pneumonia compared with those with acute MSSA pneumonia.     

Calcified plaque: measurement of area at thin-section flat-panel CT and 64-section multidetector CT and comparison with histopathologic findings

The purpose of this study was to assess the blooming artifacts in ex vivo coronary arteries at multidetector computed tomography (CT) and flat-panel-volume CT by comparing measured areas of calcified plaque with respect to the reference standard of histopathologic findings. Three ex vivo hearts were scanned with multidetector CT and flat-panel-volume CT after institutional review board approval. The area of calcified plaque was measured at histopathologic examination, multidetector CT, and flat-panel-volume CT. The plaque area was overestimated at multidetector CT by 400% (4.61/1.15) on average, and the predicted difference between the measurements was significant (3.46 mm(2), P = .018). The average overestimation of plaque area at flat-panel-volume CT was twofold (214% [2.18/1.02]), and the predicted difference was smaller (1.16 mm(2), P = .08). The extent of the blooming artifact in visualizing calcified coronary plaque is reduced by using flat-panel-volume CT.     

钙化斑块:薄层平板CT和64层螺旋CT的面积测量及与组织病理学的对比

目的本研究的目的是使用多层螺旋CT和平板容积CT对离体冠状动脉标本进行检查,以病理结果为标准,比较其钙化斑块的面积,评估两者的溢出伪影。方法本研究