Lee K S, Kim T S, Han J, Hwang J H, Yoon J H, Kim Y, Yoo S Y
Department of Radiology, Samsung Medical Center, College of Medicine, Sungkyunkwan University, Seoul, Korea.
J Comput Assist Tomogr. 1999 Jan-Feb;23(1):99-106. doi: 10.1097/00004728-199901000-00022.
The purpose of our study was to compare the findings seen on HRCT with those from pathologic examination in patients with diffuse micronodular lung disease (DMLD).
Forty consecutive patients with biopsy-proven DMLD (each nodule being <5 mm in diameter and occupying more than two-thirds of lung volume on chest radiograph) were included. High resolution CT (HRCT) scans were analyzed with particular attention to the location of nodules in and around the secondary pulmonary lobule (centrilobular, perilymphatic, and random) and the zonal distribution. The findings were compared to pathology.
CT scans showed centrilobular nodules in the patients with diffuse panbronchiolitis (n = 4), infectious bronchiolitis [n = 4; Hemophilus influenzae (n = 3) and Mycoplasma pneumoniae (n = 1)], hypersensitivity pneumonia (n = 3), bronchogenic disseminated tuberculosis (n = 3), pneumoconiosis (n = 1), primary lymphoma of the lung (n = 1), and foreign body-induced necrotizing vasculitis (n = 1). They demonstrated perilymphatic nodules in the patients with pneumoconiosis (n = 5), sarcoidosis (n = 2), and amyloidosis (n = 2). They demonstrated micronodules of random distribution in the patients with miliary tuberculosis (n = 9) and pulmonary metastasis (n = 5). Upper and middle zonal predominance was seen in two of two patients with sarcoidosis and in two of six patients with pneumoconiosis. The CT location of nodules in the secondary pulmonary lobule represented the location and nature of the lesion on pathologic examination.
By showing the distribution of micronodules in and around the secondary pulmonary lobule, HRCT enables the narrowing of the differential diagnosis of DMLD. CT findings reflect gross morphologic features of pathologic examination.
我们研究的目的是比较弥漫性微小结节性肺疾病（DMLD）患者高分辨率CT（HRCT）表现与病理检查结果。
纳入40例经活检证实的DMLD患者（每个结节直径<5mm，胸部X线片显示结节占据肺体积的三分之二以上）。对高分辨率CT（HRCT）扫描进行分析，特别关注次级肺小叶内及周围结节的位置（小叶中心性、淋巴管周围性和随机分布）以及分区分布。将结果与病理进行比较。
CT扫描显示弥漫性泛细支气管炎患者（n = 4）、感染性细支气管炎[ n = 4；流感嗜血杆菌（n = 3）和肺炎支原体（n = 1）]、过敏性肺炎（n = 3）、支气管播散性结核（n = 3）、尘肺（n = 1）、原发性肺淋巴瘤（n = 1）和异物性坏死性血管炎（n = 1）出现小叶中心性结节。它们显示尘肺患者（n = 5）、结节病（n = 2）和淀粉样变性（n = 2）出现淋巴管周围性结节。它们显示粟粒性结核患者（n = 9）和肺转移患者（n = 5）出现随机分布的微小结节。2例结节病患者和6例尘肺患者中的2例出现上、中区优势。次级肺小叶内结节的CT位置代表病理检查中病变的位置和性质。
通过显示次级肺小叶内及周围微小结节的分布，HRCT有助于缩小DMLD的鉴别诊断范围。CT表现反映了病理检查的大体形态特征。
