Reiff D B, Wells A U, Carr D H, Cole P J, Hansell D M
Department of Radiology, Royal Brompton National Heart and Lung Hospital, London, UK.
AJR Am J Roentgenol. 1995 Aug;165(2):261-7. doi: 10.2214/ajr.165.2.7618537.
The purpose of this study was to determine whether the pattern and distribution of bronchiectasis shown on CT scans can be used to discriminate between idiopathic cases and those with an identifiable cause.
The CT scans of 168 patients with chronic purulent sputum production and who were suspected of having bronchiectasis were analyzed (117 patients with idiopathic bronchiectasis, 15 with allergic bronchopulmonary aspergillosis, 15 with hypogammaglobulinemia, 15 with impaired mucociliary clearance, and seven with cystic fibrosis diagnosed in adult life). The scans were analyzed in random order by two observers. The extent, site, type, and lobar distribution of bronchiectasis and the severity of bronchial dilatation and bronchial wall thickening were scored. The frequency of these features in the known-cause groups was compared with that in the idiopathic group to identify any significant differences.
Compared with idiopathic bronchiectasis, no significant lobar predominance was seen in any of the known-cause groups, apart from a higher frequency of lower lobe involvement in the patients with syndromes of impaired mucociliary clearance (p < .02). The bronchiectasis of allergic bronchopulmonary aspergillosis and adult cystic fibrosis was more often widespread (five or six lobes involved (p < .001 and p < .01, respectively) than idiopathic bronchiectasis. Central bronchiectasis was more common in allergic bronchopulmonary aspergillosis (p < .005), although the sensitivity when this was used as a diagnostic feature was only 37%. In all groups, cylindrical bronchiectasis was the most common type, with varicose and cystic bronchiectasis occurring more frequently in allergic bronchopulmonary aspergillosis (p < .01). On multiple regression analysis, allergic bronchopulmonary aspergillosis and adult cystic fibrosis showed more extensive disease than idiopathic bronchiectasis (p < .0005 and p < .001, respectively), independent of other CT features. In hypogammaglobulinemia, dilatation of the bronchial lumen was less than in idiopathic bronchiectasis (p < .02) independent of disease extent and bronchial wall thickness.
Although differences in distribution and morphology of bronchiectasis may be seen on CT scans in groups of patients with bronchiectasis of different causes, CT findings applied to individual patients are of limited value in discriminating between idiopathic bronchiectasis and bronchiectasis of various known causes.
本研究旨在确定CT扫描显示的支气管扩张模式和分布是否可用于区分特发性病例和有明确病因的病例。
分析了168例有慢性脓性痰且疑似患有支气管扩张的患者的CT扫描结果（117例特发性支气管扩张患者，15例变应性支气管肺曲霉病患者，15例低丙种球蛋白血症患者，15例黏液纤毛清除功能受损患者，以及7例成年期诊断为囊性纤维化的患者）。两名观察者按随机顺序分析扫描结果。对支气管扩张的范围、部位、类型和叶分布以及支气管扩张和支气管壁增厚的严重程度进行评分。将已知病因组中这些特征的频率与特发性组进行比较，以确定是否存在任何显著差异。
与特发性支气管扩张相比，除黏液纤毛清除功能受损综合征患者下叶受累频率较高外（p < 0.02），其他已知病因组均未见明显的叶优势。变应性支气管肺曲霉病和成年期囊性纤维化的支气管扩张比特发性支气管扩张更常累及多个肺叶（分别累及五个或六个肺叶，p < 0.001和p < 0.01）。中心型支气管扩张在变应性支气管肺曲霉病中更为常见（p < 0.005），尽管将其作为诊断特征时的敏感性仅为37%。在所有组中，柱状支气管扩张是最常见的类型，静脉曲张型和囊状支气管扩张在变应性支气管肺曲霉病中更常见（p < 0.01）。多元回归分析显示，变应性支气管肺曲霉病和成年期囊性纤维化的病变范围比特发性支气管扩张更广泛（分别为p < 0.0005和p < 0.001），与其他CT特征无关。在低丙种球蛋白血症中，支气管腔扩张程度比特发性支气管扩张小（p < 0.02），与疾病范围和支气管壁厚度无关。
尽管不同病因的支气管扩张患者组在CT扫描上可能可见支气管扩张分布和形态的差异，但将CT表现应用于个体患者在区分特发性支气管扩张和各种已知病因的支气管扩张方面价值有限。
