Department of Radiology, Kanagawa Cardiovascular and Respiratory Center, 6-16-1 Tomioka-higashi, Kanazawa-ku, Yokohama, 236-8651, Japan.
Department of Pathology, Japanese Red Cross Medical Center, Tokyo, Japan.
Jpn J Radiol. 2018 Mar;36(3):165-180. doi: 10.1007/s11604-017-0713-0. Epub 2017 Dec 15.
Smoking-related lung abnormalities are now an increasing public health concern. According to the findings of large-cohort studies, approximately 8% of smokers have interstitial lung abnormalities, which are associated with a relatively high risk of all-cause mortality. We reviewed the radiological and pathological findings of smoking-related interstitial lung diseases, such as respiratory bronchiolitis-interstitial lung disease, desquamative interstitial pneumonia, and airspace enlargement with fibrosis. We have also discussed the histological basis of unclassifiable interstitial pneumonia in smokers, which exhibits airway-centered cystic lesions with fibrosis. A variety of radiological findings coexist in the lungs of a smoker. This overlapping of multiple pathological conditions might cause the radiological patterns of diseases to become unclassifiable. Therefore, diagnosis should be performed not on the basis of a single radiological finding, but in a comprehensive manner, by including clinical symptoms and disease behavior. Among interstitial abnormalities in smokers, the usual interstitial pneumonia (UIP) pattern is correlated with a worse prognosis than others. Basal-predominant subpleural reticulation is a clue for accurate diagnosis of UIP, which can be achieved by computer-aided quantitative analysis.
吸烟相关的肺部异常现在是一个日益严重的公共卫生问题。根据大规模队列研究的结果，约 8%的吸烟者存在间质性肺异常，这与全因死亡率的相对高风险相关。我们回顾了吸烟相关间质性肺疾病的影像学和病理学表现，例如呼吸性细支气管炎-间质性肺疾病、脱屑性间质性肺炎和伴有纤维化的气腔扩大。我们还讨论了吸烟者无法分类的间质性肺炎的组织学基础，其表现为伴有纤维化的气道中心性囊状病变。吸烟者的肺部存在多种影像学表现。这些多种病理情况的重叠可能导致疾病的影像学模式无法分类。因此，诊断不应基于单一的影像学发现，而是应综合考虑临床症状和疾病行为。在吸烟者的间质性异常中，通常的间质性肺炎（UIP）模式与预后较差相关。基底部为主的胸膜下网状影是准确诊断 UIP 的线索，可通过计算机辅助定量分析来实现。
