Staats Paul, Kligerman Seth, Todd Nevins, Tavora Fabio, Xu Lauren, Burke Allen
Departments of Pathology and Radiology, University of Maryland Medical Center, Baltimore, MD, United States.
Departments of Pathology and Radiology, University of Maryland Medical Center, Baltimore, MD, United States.
Pathol Res Pract. 2015 Jan;211(1):55-61. doi: 10.1016/j.prp.2014.08.013. Epub 2014 Oct 22.
There is little information comparing high-resolution computed tomography (HRCT) findings in UIP with different components that make up remodeling histologically.
We compared histologic features with HRCT scans from 69 explants with UIP. The extent of 7 histologic features were semi-quantitated: respiratory-lined cysts, bronchiolectasis, pulmonary interstitial emphysema (PIE), lobular remodeling, areas resembling non-specific interstitial pneumonia (NSIP), desquamative interstitial pneumonia (DIP)-like pattern, and mucus pooling within cysts extending into surrounding parenchyma. Subpleural cystic spaces and areas of lobular remodeling were measured morphometrically. Histologic features were compared to three findings on HRCT: diagnostic pattern (UIP, probable UIP, or inconsistent with UIP pattern), degree of honeycombing, and degree of ground-glass opacities.
Histologically, respiratory-lined cysts were observed in 78%, bronchiolectasis in 83%, interstitial emphysema in 22%, lobular remodeling in 96%, NSIP-like areas in 87%, DIP-like reaction in 10%, and mucin extravasation in 78%. Morphometrically, cysts of PIE measured 6.2±2.9 mm, respiratory-lined cysts 3.5±2.4 mm, and bronchiolectatic cysts 3.3±1.5 mm. Remodeled lobules measured 3.6±1.1 mm. UIP pattern on CT correlated strongly with histologic extent of bronchiolectasis (p=0.001). HRCT honeycombing showed a positive correlation with histologic bronchiolectasis (p=0.001) and respiratory-lined cysts (p=0.001). GGO was positively associated with NSIP-like areas (p=0.02) and extravasated mucus (p=0.05).
HRCT findings typical of UIP and HRCT honeycombing correlate best with bronchiolectasis histologically. NSIP pattern is common, and is associated with CT finding of GGO.
关于高分辨率计算机断层扫描（HRCT）在特发性肺纤维化（UIP）中的表现与组织学上构成重塑的不同成分之间的比较信息较少。
我们将69例UIP肺移植标本的组织学特征与HRCT扫描结果进行了比较。对7种组织学特征的范围进行了半定量分析：呼吸性衬里囊肿、细支气管扩张、肺间质肺气肿（PIE）、小叶重塑、非特异性间质性肺炎（NSIP）样区域、脱屑性间质性肺炎（DIP）样模式以及囊肿内黏液积聚并延伸至周围实质。对胸膜下囊性空间和小叶重塑区域进行了形态计量学测量。将组织学特征与HRCT上的三个表现进行了比较：诊断模式（UIP、可能的UIP或与UIP模式不一致）、蜂窝状改变程度和磨玻璃影程度。
组织学上，78%观察到呼吸性衬里囊肿，83%有细支气管扩张，22%有间质肺气肿，96%有小叶重塑，87%有NSIP样区域，10%有DIP样反应，78%有黏液外渗。形态计量学上，PIE囊肿大小为6.2±2.9毫米，呼吸性衬里囊肿为3.5±2.4毫米，细支气管扩张性囊肿为3.3±1.5毫米。重塑小叶大小为3.6±1.1毫米。CT上的UIP模式与细支气管扩张的组织学范围密切相关（p=0.001）。HRCT蜂窝状改变与组织学上的细支气管扩张（p=0.001）和呼吸性衬里囊肿（p=0.001）呈正相关。磨玻璃影与NSIP样区域（p=0.02）和外渗黏液（p=0.05）呈正相关。
UIP典型的HRCT表现和HRCT蜂窝状改变在组织学上与细支气管扩张的相关性最佳。NSIP模式常见，且与CT上磨玻璃影的表现相关。
