Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
AJR Am J Roentgenol. 2012 Sep;199(3):581-7. doi: 10.2214/AJR.11.7165.
We retrospectively analyzed the CT features of late-onset noninfectious pulmonary complications in patients with pathologically proven graft-versus-host disease (GVHD) after allogeneic stem cell transplant (SCT).
We analyzed the CT features of late-onset noninfectious pulmonary complications in 14 patients with pathologic diagnoses of GVHD who survived disease free for more than 3 months after SCT. Late-onset noninfectious pulmonary complications were diagnosed by excluding pulmonary infection in these patients with respiratory symptoms and signs. The presence, extent, and distribution of CT features were evaluated in terms of geographic hypoattenuation, expiratory airtrapping, ground-glass attenuation (GGA), reticulation, crazy paving pattern, bronchiectasis, nodules, and honeycombing. Further disease classification was made on the basis of clinical, radiologic, and pulmonary function test results and histologic findings. The longitudinal changes of late-onset noninfectious pulmonary complications were followed with CT.
The 14 patients with late-onset noninfectious pulmonary complications were classified into subgroups with bronchiolitis obliterans (BO) (n = 7), nonclassifiable interstitial pneumonia (n = 5), and combined BO and nonclassifiable interstitial pneumonia (n = 2). The CT features of nonclassifiable interstitial pneumonia were GGA (5/7, 71%), reticulation (4/7, 57%), and crazy paving pattern (4/7, 57%) with a peribronchovascular distribution (6/7, 86%). All patients with nonclassifiable interstitial pneumonia had progression of disease with an increased extent of traction bronchiectasis, reticulation, and honeycombing on follow-up CT scans (median follow-up period, 22 months).
Although not commonly encountered, nonclassifiable interstitial pneumonia as a pattern of chronic GVHD should be included in the differential diagnosis of unexplained peribronchial GGA or progressive traction bronchiectasis after SCT.
我们回顾性分析了经病理证实的异基因造血干细胞移植（SCT）后发生移植物抗宿主病（GVHD）患者的迟发性非感染性肺部并发症的 CT 特征。
我们分析了 14 例病理诊断为 GVHD 且 SCT 后无疾病存活超过 3 个月的患者的迟发性非感染性肺部并发症的 CT 特征。这些有呼吸道症状和体征的患者在排除肺部感染后被诊断为迟发性非感染性肺部并发症。根据 CT 特征的存在、范围和分布情况，评估了区域性低衰减、呼气空气潴留、磨玻璃影（GGA）、网状影、铺路石征、支气管扩张、结节和蜂窝肺。根据临床、影像学和肺功能测试结果以及组织学发现进行进一步的疾病分类。对迟发性非感染性肺部并发症进行 CT 随访，观察其纵向变化。
14 例迟发性非感染性肺部并发症患者分为细支气管炎性闭塞症（BO）亚组（n = 7）、非定型间质性肺炎亚组（n = 5）和 BO 与非定型间质性肺炎混合亚组（n = 2）。非定型间质性肺炎的 CT 特征为 GGA（71%，5/7）、网状影（57%，4/7）和铺路石征（57%，4/7），且具有支气管血管周围分布（86%，6/7）。所有非定型间质性肺炎患者均有疾病进展，在随访 CT 扫描中，牵引性支气管扩张、网状影和蜂窝肺的范围增加（中位随访时间 22 个月）。
虽然不常见，但非定型间质性肺炎作为慢性 GVHD 的一种模式，应包括在 SCT 后不明原因的支气管血管周围 GGA 或进行性牵引性支气管扩张的鉴别诊断中。
