Tanaka Nobuyuki, Kim Jeung Sook, Newell John D, Brown Kevin K, Cool Carlyne D, Meehan Richard, Emoto Takuya, Matsumoto Tsuneo, Lynch David A
Department of Radiology, University of Colorado Health Sciences Center, Denver, CO, USA.
Radiology. 2004 Jul;232(1):81-91. doi: 10.1148/radiol.2321030174. Epub 2004 May 27.
To evaluate computed tomographic (CT) findings of rheumatoid arthritis-related lung disease and categorize findings according to pathologic features.
CT scans obtained in 63 patients (27 men, 36 women; mean age, 61.7 years +/- 11.2 [SD]; range, 28-81 years) with rheumatoid arthritis were assessed. Mean duration of disease was 7.6 years +/- 9.2. Lung parenchymal abnormalities that included airspace consolidation, ground-glass opacity (GGO), reticulation, honeycombing, nodules, bronchiectasis, and air trapping were assessed retrospectively by two chest radiologists. Final decision was reached with consensus of these radiologists and a third radiologist. Patients were classified according to the predominant CT pattern. One of the chest radiologists and a pulmonary pathologist compared CT findings with pathologic findings in 17 patients. Interobserver agreement between the first two radiologists was assessed. Correlation between CT finding extent score and pulmonary function test results was estimated with Spearman rank correlation coefficient.
GGO (57 [90%] patients) and reticulation (62 [98%] patients) were the most common CT features. Four major CT patterns were identified: usual interstitial pneumonia (n = 26), nonspecific interstitial pneumonia (n = 19), bronchiolitis (n = 11), and organizing pneumonia (n = 5). Usual interstitial pneumonia and nonspecific interstitial pneumonia CT patterns overlapped; GGO was more extensive in patients with nonspecific interstitial pneumonia CT pattern (P =.028). In 17 patients who underwent biopsy, CT findings reflected pathologic findings. Exceptions were two patients classified with usual interstitial pneumonia at CT but with nonspecific interstitial pneumonia at pathologic analysis; one patient, with nonspecific interstitial pneumonia at CT but desquamative interstitial pneumonia at pathologic analysis; and one patient, with lymphoid interstitial pneumonia at CT but nonspecific interstitial pneumonia at pathologic analysis.
Rheumatoid arthritis is associated with four CT patterns: usual interstitial pneumonia, nonspecific interstitial pneumonia, bronchiolitis, and organizing pneumonia. The most common CT features of rheumatoid arthritis-related lung disease were GGO and reticulation.
评估类风湿关节炎相关肺部疾病的计算机断层扫描（CT）表现，并根据病理特征对这些表现进行分类。
对63例类风湿关节炎患者（27例男性，36例女性；平均年龄61.7岁±11.2[标准差]；范围28 - 81岁）的CT扫描结果进行评估。疾病平均持续时间为7.6年±9.2年。两位胸部放射科医生回顾性评估了肺实质异常情况，包括气腔实变、磨玻璃影（GGO）、网状影、蜂窝状改变、结节、支气管扩张和空气潴留。这两位放射科医生与第三位放射科医生达成共识后做出最终诊断。根据主要的CT表现模式对患者进行分类。一位胸部放射科医生和一位肺病理科医生将17例患者的CT表现与病理结果进行了比较。评估了前两位放射科医生之间的观察者间一致性。用Spearman等级相关系数估计CT表现范围评分与肺功能测试结果之间的相关性。
磨玻璃影（57例[90%]患者）和网状影（62例[98%]患者）是最常见的CT特征。确定了四种主要的CT表现模式：寻常型间质性肺炎（n = 26）、非特异性间质性肺炎（n = 19）、细支气管炎（n = 11）和机化性肺炎（n = 5）。寻常型间质性肺炎和非特异性间质性肺炎的CT表现模式有重叠；非特异性间质性肺炎CT表现模式的患者磨玻璃影更广泛（P = 0.028）。在17例接受活检的患者中，CT表现反映了病理结果。例外情况是两名患者CT分类为寻常型间质性肺炎，但病理分析为非特异性间质性肺炎；一名患者CT为非特异性间质性肺炎，但病理分析为脱屑性间质性肺炎；一名患者CT为淋巴样间质性肺炎，但病理分析为非特异性间质性肺炎。
类风湿关节炎与四种CT表现模式相关：寻常型间质性肺炎、非特异性间质性肺炎、细支气管炎和机化性肺炎。类风湿关节炎相关肺部疾病最常见的CT特征是磨玻璃影和网状影。
