Tokura Sayoko, Okuma Tomohisa, Akira Masanori, Arai Toru, Inoue Yoshikazu, Kitaichi Masanori
Department of Radiology, National Hospital Organization Kinki-Chuo Chest Medical Center, Sakai City, Japan.
Department of Radiology, National Hospital Organization Kinki-Chuo Chest Medical Center, Sakai City, Japan Department of Radiology, Osaka City University Graduate School of Medicine, Osaka City, Japan
Acta Radiol. 2014 Nov;55(9):1050-5. doi: 10.1177/0284185113512300. Epub 2013 Nov 19.
Collagen vascular disease-associated interstitial lung disease (CVD-ILD) must be differentiated from idiopathic pulmonary fibrosis (IPF) since prognosis and treatment strategies differ between these two conditions. However, differentiating between CVD-ILD and IPF is often difficult.
To examine the utility of expiratory high-resolution computed tomography (HRCT) for differentiating between CVD-ILD and IPF.
Seventy patients were examined with expiratory and inspiratory HRCT with CVD-ILD (n = 36) or IPF (n = 34). Associated diagnoses in patients with CVD-ILD were rheumatoid arthritis (n = 22), Sjögren syndrome (n = 3), scleroderma (n = 2), polymyositis/dermatomyositis (n = 1), and unspecified connective tissue disease (n = 8). Parenchymal abnormalities on inspiratory HRCT and visual extent of air trapping on expiratory HRCT were evaluated, statistical differences in HRCT findings between the two conditions were determined, and air trapping CT scores were correlated with the results of pulmonary function testing.
Air trapping was found in 27 (75%) of 36 cases of CVD-ILD and four (12%) of 34 cases of IPF. Seventeen of the 27 cases for which air trapping was exhibited with CVD-ILD were diagnosed with rheumatoid arthritis. A significant difference in frequency of air trapping was seen between CVD-ILD and IPF (P < 0.0001). Frequency of centrilobular nodules was significantly higher in CVD-ILD than in IPF (P = 0.021). In contrast, frequencies of interlobular interstitial thickening and traction bronchiectasis were significantly higher in IPF than in CVD-ILD (P = 0.005, P = 0.007, respectively). Correlations were seen between visual extent of air trapping and pulmonary function test results such as air trapping index (P = 0.004, r = 0.34), closing volume/vital capacity (P = 0.0002, r = -0.47), and closing capacity/total lung capacity (P < 0.0001, r = -0.51).
The presence of air trapping on expiratory HRCT suggests CVD-ILD rather than IPF.
由于这两种疾病的预后和治疗策略不同，胶原血管病相关间质性肺病（CVD-ILD）必须与特发性肺纤维化（IPF）相鉴别。然而，区分CVD-ILD和IPF往往很困难。
探讨呼气期高分辨率计算机断层扫描（HRCT）在鉴别CVD-ILD和IPF中的应用价值。
对70例患者进行了呼气期和吸气期HRCT检查，其中CVD-ILD患者36例，IPF患者34例。CVD-ILD患者的相关诊断包括类风湿关节炎（22例）、干燥综合征（3例）、硬皮病（2例）、多发性肌炎/皮肌炎（1例）和未明确的结缔组织病（8例）。评估吸气期HRCT上的实质异常和呼气期HRCT上的空气潴留视觉范围，确定两种疾病HRCT表现的统计学差异，并将空气潴留CT评分与肺功能测试结果进行相关性分析。
36例CVD-ILD患者中有27例（75%）存在空气潴留，34例IPF患者中有4例（12%）存在空气潴留。CVD-ILD患者中表现出空气潴留的27例中有17例诊断为类风湿关节炎。CVD-ILD和IPF在空气潴留频率上存在显著差异（P<0.0001）。CVD-ILD患者的小叶中心结节频率显著高于IPF患者（P=0.021）。相比之下，IPF患者的小叶间质增厚和牵拉性支气管扩张频率显著高于CVD-ILD患者（分别为P=0.005，P=0.007）。空气潴留视觉范围与肺功能测试结果如空气潴留指数（P=0.004，r=0.34）、闭合容积/肺活量（P=0.0002，r=-0.47）和闭合容量/肺总量（P<0.0001，r=-0.51）之间存在相关性。
呼气期HRCT上存在空气潴留提示为CVD-ILD而非IPF。
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