Murdoch J, Müller N L
Department of Radiology, University of British Columbia, Vancouver, Canada.
AJR Am J Roentgenol. 1992 Sep;159(3):473-7. doi: 10.2214/ajr.159.3.1503008.
To determine serial changes in the pattern, distribution, and extent of disease over time, and to determine if any specific findings could be used to predict prognosis in patients with pulmonary sarcoidosis, we reviewed the CT scans of 18 patients with pulmonary sarcoidosis.
The study included 18 patients with biopsy-proved sarcoidosis and pulmonary abnormalities who had two serial high-resolution CT examinations (1.5-mm collimation, high-spatial-frequency reconstruction algorithm) 4-49 months apart. Initial and follow-up CT scans were evaluated independently and then directly compared with each other by two observers. Scans were assessed for the presence, extent, and severity of ground-glass, nodular, and irregular linear opacities; interlobular septal thickening; cystic air spaces; and architectural distortion. If a finding was predominant, it was noted.
Reversible findings included ground-glass, nodular, and irregular linear opacities and septal thickening. Irreversible findings included cystic air spaces and architectural distortion. Follow-up CT showed overall improvement in 12 of 18 patients, progression in five, and no change in one. A predominant pattern of disease could be determined for each patient. Fourteen patients had predominant nodular opacities; of these, 11 had improved by follow-up. Four had predominant irregular linear opacities; of these, three showed progression of disease on follow-up. The presence of any other specific abnormalities, including ground-glass opacities, was not helpful in predicting improvement or worsening of disease on the follow-up examination.
In pulmonary sarcoidosis, ground-glass, nodular, and irregular linear opacities and interlobular septal thickening represent potentially reversible disease, while cystic air spaces and architectural distortion are irreversible findings. Follow-up CT usually shows improvement in patients with predominant nodular opacities, while disease tends to progress in patients with predominant irregular opacities.
为了确定疾病的模式、分布及范围随时间的系列变化，并确定是否有任何特定的发现可用于预测结节病患者的预后，我们回顾了18例结节病患者的CT扫描结果。
本研究纳入18例经活检证实为结节病且有肺部异常的患者，这些患者在4至49个月的时间间隔内接受了两次系列高分辨率CT检查（1.5毫米准直，高空间频率重建算法）。初始和随访CT扫描由两名观察者独立评估，然后直接相互比较。对扫描结果评估磨玻璃影、结节及不规则线状影的存在、范围及严重程度；小叶间隔增厚；囊状气腔；以及结构扭曲情况。如果某种表现为主，则予以记录。
可逆性表现包括磨玻璃影、结节及不规则线状影和间隔增厚。不可逆性表现包括囊状气腔和结构扭曲。随访CT显示，18例患者中12例总体改善，5例进展，1例无变化。可为每位患者确定主要的疾病模式。14例患者以结节影为主；其中11例在随访时有所改善。4例以不规则线状影为主；其中3例在随访时疾病进展。其他任何特定异常的存在，包括磨玻璃影，对预测随访检查时疾病的改善或恶化均无帮助。
在结节病中，磨玻璃影、结节及不规则线状影和小叶间隔增厚代表潜在可逆性疾病，而囊状气腔和结构扭曲是不可逆性表现。随访CT通常显示以结节影为主的患者病情改善，而以不规则影为主的患者病情往往进展。
