Pinheiro Lucas Gabriel R, Treviso Carlos Augusto, Forte Gabriele Carra, Muller Enrico Mattana, Hochhegger Bruno, Andrade Rubens Gabriel Feijó
Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil.
University of Florida, Gainesville, FL, United States of America.
PLoS One. 2024 Dec 3;19(12):e0314572. doi: 10.1371/journal.pone.0314572. eCollection 2024.
Currently, high-resolution computed tomography (HRCT) is the imaging of choice for the differential diagnosis of various cystic lung lesions, including true cystic lung diseases (CLD) and lesions that may mimic them. However, the traditionally used inspiratory scan still presents a significant spectrum of overlapping radiological features. Recent studies have demonstrated variation in lesion size between inspiratory and expiratory phases, probably due to cyst-airway communication. In this study, we aimed to conduct a systematic review of paired inspiratory and expiratory HRCT in the assessment of cystic lesions as an additional tool to narrow the differential diagnosis.
A systematic search was performed in PubMed, Scopus, EMBASE, BVS, and Cochrane through August 2023. Full-text articles that performed paired inspiratory and expiratory CT scans in adult patients with cystic lung lesions were included, with the outcome measured as the reduction in lesion size according to the respiratory phase. Diagnoses were confirmed through histopathological or radiological features.
Out of the 96 records, three studies met the criteria for inclusion and were analyzed, comprising a total of 149 participants and 513 cystic lesions. Pulmonary Langerhans Cell Histiocytosis (PLCH), Lymphangioleiomyomatosis (LAM) honeycombing and cystic bronchiectasis became considerably smaller during expiratory CT scans, while the size of emphysema tended to remain constant during respiratory cycles.
This study has suggested that paired inspiratory and expiratory CT scans can be valuable for helping differentiate between emphysema and other diseases with a cystic pattern due to their ability to reveal dynamic properties of the lesions. However, the average reduction in cyst size as a single parameter is not sufficient for further refining diagnostics. Studies exploring advanced metrics to assess the reduction in lesion diameter emerge as potential opportunities to investigate the cyst-airway communication hypothesis and further enhance the diagnostic accuracy of paired methods.
目前，高分辨率计算机断层扫描（HRCT）是用于鉴别各种肺囊性病变的首选成像方法，这些病变包括真性肺囊性疾病（CLD）以及可能与之相似的病变。然而，传统使用的吸气扫描仍呈现出显著的一系列重叠的放射学特征。最近的研究表明，吸气期和呼气期之间病变大小存在差异，这可能是由于囊肿与气道相通所致。在本研究中，我们旨在对吸气期和呼气期配对的HRCT进行系统评价，以作为一种辅助工具来缩小囊性病变的鉴别诊断范围。
截至2023年8月，在PubMed、Scopus、EMBASE、BVS和Cochrane中进行了系统检索。纳入了对成年肺囊性病变患者进行吸气期和呼气期配对CT扫描的全文文章，结果以根据呼吸期病变大小的缩小情况来衡量。通过组织病理学或放射学特征确诊诊断。
在96条记录中，三项研究符合纳入标准并进行了分析，共包括149名参与者和513个囊性病变。肺朗格汉斯细胞组织细胞增多症（PLCH）、淋巴管平滑肌瘤病（LAM）蜂窝状改变和囊性支气管扩张在呼气期CT扫描时明显变小，而肺气肿的大小在呼吸周期中倾向于保持不变。
本研究表明，吸气期和呼气期配对的CT扫描有助于区分肺气肿和其他具有囊性表现的疾病，因为它们能够揭示病变的动态特性。然而，作为单一参数的囊肿大小平均缩小不足以进一步完善诊断。探索评估病变直径缩小的高级指标的研究成为研究囊肿-气道相通假说以及进一步提高配对方法诊断准确性的潜在机会。
