Hruban R H, Ren H, Kuhlman J E, Fishman E K, Wheeler P S, Baumgartner W A, Reitz B A, Hutchins G M
Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, MD 21205.
J Comput Assist Tomogr. 1990 May-Jun;14(3):329-35.
Pulmonary infections and lung rejection are the two major complications of lung transplantation. Although the therapies for these two processes differ greatly, they often cannot be differentiated using standard radiography. We applied high resolution CT (HRCT) to seven lung specimens that were obtained from patients who had received a heart-lung transplant. The lungs were fixed by a method that allows for direct one-to-one pathologic-radiologic correlation. We found: (a) that in contrast to the extensive changes present microscopically, acute lung allograft rejection was characterized by only minor changes on HRCT; (b) that bronchiolitis obliterans, the hallmark of chronic lung allograft rejection, was not reliably identifiable on HRCT; (c) that bronchiectasis with associated peribronchial inflammation and fibrosis, a common finding in lung allograft rejection, was identifiable on HRCT, but that the HRCT appearance of this lesion was not specific for rejection; and (d) that pulmonary infections were often identifiable as a mixed airway-interstitial process on HRCT.
肺部感染和肺排斥反应是肺移植的两大主要并发症。尽管针对这两个过程的治疗方法差异很大，但使用标准放射学检查往往无法区分它们。我们对7个取自心肺移植患者的肺标本进行了高分辨率CT（HRCT）检查。这些肺采用了一种能实现病理与放射学直接一一对应的方法进行固定。我们发现：（a）与显微镜下呈现的广泛变化不同，急性肺移植排斥反应在HRCT上仅表现为轻微变化；（b）细支气管闭塞，即慢性肺移植排斥反应的标志，在HRCT上无法可靠识别；（c）支气管扩张伴相关支气管周围炎症和纤维化，这是肺移植排斥反应中的常见表现，在HRCT上可以识别，但该病变的HRCT表现并非排斥反应所特有；（d）肺部感染在HRCT上常表现为气道-间质混合性病变。
