Arakawa Hiroaki, Honma Koichi, Saito Yoshiaki, Shida Hisao, Morikubo Hiroshi, Suganuma Narufumi, Fujioka Mutsuhisa
Department of Radiology and Pathology, Dokkyo University School of Medicine, Mibu, Tochigi 321-0293, Japan.
Radiology. 2005 Aug;236(2):685-93. doi: 10.1148/radiol.2362041363.
To retrospectively evaluate pleural disease on images from patients with autopsy-proved silicosis.
The study had institutional review board approval, and informed consent from relatives of diseased subjects was waived. Lung specimens were obtained at autopsy in 110 men (mean age, 72 years) who had been followed up radiologically for a mean of 14.8 years. Computed tomographic (CT) scans obtained within 2 years before death were examined for presence of pleural thickening; shape, composition, size, and subpleural location of progressive massive fibrosis (PMF); and pleural invagination (bandlike structure between lesion and pleura). Lung specimens were reviewed and compared with CT findings. Serial chest radiographs and CT scans were reviewed for presence of pleural effusion. Association between radiographic findings and pleural invagination was analyzed with chi2 and Student t tests. Multiple logistic regression analysis was used to find predictive variables for pleural invagination.
Pleural effusion was found in 12 (11%) patients at chest radiography and CT, and thickening was found in 64 (58%) patients at CT; the latter finding was significantly more frequent with complicated silicosis (P < .001). At CT, 128 PMF lesions were seen, 39 (30%) of which showed pleural invagination; CT scans showed pleural thickening in 36 (92%) of these 39 lesions. In 17 (44%) PMF lesions, CT scans depicted a bandlike structure that was pathologically confirmed to represent invaginated pleura in all cases. Pathologic presence of invagination was significantly associated with pleural thickening (P < .001), ipsilateral pleural effusion (P < .01), interstitial fibrosis (P < .05), and the nearness of PMF to the pleura (P < .005). Multiple logistic regression analysis showed that pleural thickening (odds ratio, 62.51; 95% confidence interval [CI]: 5.564, 70.2) and pleural effusion (odds ratio, 25.865; 95% CI: 1.992, 335.8) were significant CT variables associated with presence of pathologic pleural invagination (P = .001 and .013, respectively). Five PMF lesions had radiographic features of rounded atelectasis.
Various pleural abnormalities can occur in silicosis, especially in advanced disease.
回顾性评估经尸检证实患有矽肺患者的影像资料中的胸膜疾病。
本研究获机构审查委员会批准，且免除了患病受试者亲属的知情同意。对110名男性（平均年龄72岁）进行尸检获取肺标本，这些患者接受了平均14.8年的放射学随访。检查死亡前2年内获得的计算机断层扫描（CT）图像，以确定是否存在胸膜增厚；进行性大块纤维化（PMF）的形态、成分、大小及胸膜下位置；以及胸膜凹陷（病变与胸膜之间的带状结构）。对肺标本进行复查并与CT结果进行比较。复查系列胸部X线片和CT扫描以确定是否存在胸腔积液。采用卡方检验和学生t检验分析影像学表现与胸膜凹陷之间的关联。使用多因素逻辑回归分析寻找胸膜凹陷的预测变量。
胸部X线片和CT检查发现12例（11%）患者有胸腔积液，CT检查发现64例（58%）患者有胸膜增厚；后一发现在复杂矽肺患者中明显更常见（P <.001）。CT检查发现128个PMF病变，其中39个（30%）显示胸膜凹陷；CT扫描显示这39个病变中有36个（92%）存在胸膜增厚。在17个（44%）PMF病变中，CT扫描显示出带状结构，所有病例经病理证实代表内陷的胸膜。胸膜凹陷的病理存在与胸膜增厚（P <.001）、同侧胸腔积液（P <.01）、间质纤维化（P <.05）以及PMF与胸膜的接近程度（P <.005）显著相关。多因素逻辑回归分析显示，胸膜增厚（比值比，62.51；95%置信区间[CI]：5.564，70.2）和胸腔积液（比值比，25.865；95% CI：1.992，335.8）是与病理胸膜凹陷存在相关的显著CT变量（分别为P =.001和.013）。5个PMF病变具有圆形肺不张的影像学特征。
矽肺可出现多种胸膜异常，尤其是在晚期疾病中。
