Koba H
Department of Internal Medicine (Section 3), Sapporo Medical College.
Nihon Igaku Hoshasen Gakkai Zasshi. 1990 Dec 25;50(12):1532-46.
A direct CT-pathologic correlative study of interstitial pneumonia was performed using inflated and fixed lungs. The specimens, which were obtained from 26 patients at the time of autopsy or during surgery, had pathologic findings of interstitial pneumonia (UIP and/or DAD). The specimens were fixed in distension and air dried. They were then scanned with a GE CT/T9800. HRCT images of the specimens could be correlated with two different types of pathologic processes. One was the chronic fibrotic change which was seen in the subpleural area of the specimens both from the autopsied and surgical cases, and the other was the acute alveolar change which was seen in the diffuse area of the specimens only from autopsied cases. HRCT images of the chronic fibrotic change showed nodular opacities, ring like opacities, increased density (high density), and air-bronchiologram in the subpleural area. These findings were correlated with patchy fibrotic lesions, honeycombing, mucus stasis in cysts of the honeycomb, and dilatation of the airways. HRCT images of the acute alveolar change showed mainly diffuse increased densities (hazy appearance and high density) and diffuse nodular opacities. These findings were correlated with a diffuse thickening of the alveolar walls, hyaline membranes in the alveoli and alveolar ducts, and their organization. Understanding of the difference between HRCT images of these chronic and acute pathologic processes is helpful for the evaluation of disease processes of interstitial pneumonia by HRCT. The abnormal patterns of HRCT images of the specimens were influenced by several technical factors of CT scanning, such as reconstruction algorithm, thickness of the slice, window level, and window width. It is, therefore, necessary to know the influence to HRCT images by these technical factors for a better understanding of HRCT images in interstitial pneumonia.
采用充气并固定的肺组织对间质性肺炎进行了CT与病理的直接对照研究。这些标本取自26例尸检或手术患者，具有间质性肺炎（UIP和/或DAD）的病理表现。标本在膨胀状态下固定并风干。然后用GE CT/T9800进行扫描。标本的HRCT图像可与两种不同类型的病理过程相关联。一种是慢性纤维化改变，可见于尸检和手术病例标本的胸膜下区域；另一种是急性肺泡改变，仅见于尸检病例标本的弥漫区域。慢性纤维化改变的HRCT图像显示胸膜下区域有结节状阴影、环状阴影、密度增加（高密度）及空气支气管征。这些表现与斑片状纤维化病变、蜂窝状改变、蜂窝囊肿内的黏液潴留以及气道扩张相关。急性肺泡改变的HRCT图像主要显示弥漫性密度增加（模糊影和高密度）及弥漫性结节状阴影。这些表现与肺泡壁弥漫性增厚、肺泡及肺泡管内的透明膜及其机化相关。了解这些慢性和急性病理过程的HRCT图像差异，有助于通过HRCT评估间质性肺炎的疾病进程。标本HRCT图像的异常表现受CT扫描的多种技术因素影响，如重建算法、层厚、窗位和窗宽。因此，有必要了解这些技术因素对HRCT图像的影响，以便更好地理解间质性肺炎的HRCT图像。
