Souza Carolina Althoff, Müller Nestor L, Lee Kyung Soo, Johkoh Takeshi, Mitsuhiro Hiromitsu, Chong Semin
Department of Radiology, Vancouver General Hospital, University of British Columbia, 899 W 12th Ave., Vancouver, BC, Canada V5Z 1M9.
AJR Am J Roentgenol. 2006 Apr;186(4):995-9. doi: 10.2214/AJR.04.1663.
The purposes of our study were to determine the prevalence of mediastinal lymphadenopathy in idiopathic interstitial pneumonias, correlate their presence with high-resolution CT (HRCT) findings, and assess the potential value of mediastinal lymphadenopathy in the differential diagnosis of idiopathic interstitial pneumonias.
The study included 206 consecutive patients from three medical centers with pathologically proven idiopathic pulmonary fibrosis (n = 136), non-specific interstitial pneumonia (NSIP) (n = 47), cryptogenic organizing pneumonia (COP) (n = 16), respiratory bronchiolitis-interstitial lung disease (RB-ILD) (n = 5), and desquamative interstitial pneumonia (DIP) (n = 2). HRCT scans were retrospectively reviewed for the presence of mediastinal lymphadenopathy (short-axis diameter, >or= 10 mm), predominant parenchymal pattern, and extent of disease.
Mediastinal lymphadenopathy was seen in 139 (67%) of 206 patients, including 90 (66%) of 136 with idiopathic pulmonary fibrosis, 38 (81%) of 47 with NSIP, six (38%) of 16 with COP, and five (71%) of seven with RB-ILD or DIP. The presence of enlarged nodes was less common in COP than in the other idiopathic interstitial pneumonias (p = 0.04). No significant difference was found in the prevalence of lymphadenopathy in patients with predominant ground-glass opacity (53%) or predominant reticulation (40%). The extent of parenchymal abnormalities was 25-50% in 74 patients (53%), 50-75% in 30 (22%), < 25% in 22 (16%), and > 75% in 13 (9%). A positive correlation between the extent of disease and presence of lymphadenopathy was seen in patients with NSIP (p = 0.01).
Mediastinal lymphadenopathy is a common feature in idiopathic interstitial pneumonias, being slightly less common in COP than in the other idiopathic interstitial pneumonias. The presence of lymphadenopathy therefore has limited value in the differential diagnosis. In patients with idiopathic pulmonary fibrosis, the presence of lymph node enlargement did not correlate to any specific HRCT pattern or to the extent of disease.
我们研究的目的是确定特发性间质性肺炎中纵隔淋巴结肿大的患病率，将其存在情况与高分辨率CT（HRCT）表现相关联，并评估纵隔淋巴结肿大在特发性间质性肺炎鉴别诊断中的潜在价值。
该研究纳入了来自三个医疗中心的206例连续患者，这些患者经病理证实患有特发性肺纤维化（n = 136）、非特异性间质性肺炎（NSIP）（n = 47）、隐源性机化性肺炎（COP）（n = 16）、呼吸性细支气管炎伴间质性肺疾病（RB - ILD）（n = 5）和脱屑性间质性肺炎（DIP）（n = 2）。对HRCT扫描进行回顾性分析，以确定是否存在纵隔淋巴结肿大（短轴直径≥10 mm）、主要的实质病变模式以及疾病范围。
206例患者中有139例（67%）出现纵隔淋巴结肿大，其中136例特发性肺纤维化患者中有90例（66%）、47例NSIP患者中有38例（81%）、16例COP患者中有6例（38%）以及7例RB - ILD或DIP患者中有5例（71%）出现。COP患者中肿大淋巴结的出现比其他特发性间质性肺炎患者少见（p = 0.04）。在以磨玻璃影为主（53%）或网状影为主（40%）的患者中，淋巴结肿大的患病率无显著差异。74例患者（53%）的实质异常范围为25% - 50%，30例（22%）为50% - 75%，22例（16%）<25%，13例（9%）>75%。NSIP患者中疾病范围与淋巴结肿大的存在呈正相关（p = 0.01）。
纵隔淋巴结肿大是特发性间质性肺炎的常见特征，COP患者中比其他特发性间质性肺炎患者稍少见。因此，淋巴结肿大的存在在鉴别诊断中的价值有限。在特发性肺纤维化患者中，淋巴结肿大的出现与任何特定的HRCT模式或疾病范围均无相关性。
