Wells A U, Rubens M B, du Bois R M, Hansell D M
Department of Radiology, Royal Brompton National Heart & Lung Hospital, London, England.
AJR Am J Roentgenol. 1993 Dec;161(6):1159-65. doi: 10.2214/ajr.161.6.8249719.
In patients with fibrosing alveolitis, a reticular pattern on CT scans of the lungs correlates with histologic findings of fibrosis, whereas a ground-glass pattern has been reported to correlate with reversible inflammatory disease. The majority of patients with fibrosing alveolitis have a ground-glass component visible on CT scans, but response to therapy is infrequent. The aim of this study was to evaluate the prognostic significance of the relative extents of ground-glass and reticular patterns by analyzing serial changes in these CT appearances.
Serial CT scans were analyzed in 56 patients (21 with idiopathic pulmonary fibrosis and 35 with fibrosing alveolitis associated with systemic sclerosis). The relative extents of ground-glass and reticular patterns were assessed on the initial CT scan. Overall extent of abnormal lung and distribution of disease on initial CT scans were also categorized. Changes in extent and appearance of disease were evaluated in paired anatomically comparable CT sections and assessed independently by two observers; the median interval between scans was 16 months. Serial changes on CT were examined in relation to the initial pattern, extent, and distribution of disease seen on CT scans and in relation to trends in results of concurrent pulmonary function tests.
Changes in the extent of disease were due to regression of a ground-glass pattern in 18 patients, an increase in a reticular pattern in nine patients, and an increase in a ground-glass pattern in five patients. A reticular pattern did not regress in any patient. In treated patients, diminution in extent of disease, shown as regression of a ground-glass pattern, was seen most frequently when a ground-glass pattern was the most extensive abnormality at initial scanning (p < .002), independent of extent or distribution of disease seen on CT scans and the type of fibrosing alveolitis. When a ground-glass pattern was associated with an equally extensive reticular pattern, the extent of disease diminished with therapy in a minority of patients (5/13). Improvement in results of pulmonary function tests was associated with regression of a ground-glass pattern in the majority of patients (8/11).
These findings indicate that the prognostic significance of a ground-glass pattern depends on the extent of an associated reticular pattern and is independent of the extent and distribution of disease.
在纤维化肺泡炎患者中，肺部CT扫描上的网状影与纤维化的组织学表现相关，而磨玻璃影据报道与可逆性炎症性疾病相关。大多数纤维化肺泡炎患者在CT扫描上可见磨玻璃成分，但对治疗的反应并不常见。本研究的目的是通过分析这些CT表现的系列变化来评估磨玻璃影和网状影相对范围的预后意义。
对56例患者（21例特发性肺纤维化和35例与系统性硬化症相关的纤维化肺泡炎）的系列CT扫描进行分析。在初始CT扫描上评估磨玻璃影和网状影的相对范围。还对初始CT扫描上异常肺的总体范围和疾病分布进行分类。在配对的解剖学可比CT层面上评估疾病范围和表现的变化，并由两名观察者独立评估；扫描之间的中位间隔时间为16个月。根据CT扫描上所见疾病的初始模式、范围和分布以及同时进行的肺功能测试结果的趋势，检查CT上的系列变化。
疾病范围的变化是由于18例患者磨玻璃影消退、9例患者网状影增加以及5例患者磨玻璃影增加。没有患者的网状影消退。在接受治疗的患者中，当磨玻璃影在初始扫描时是最广泛的异常时，疾病范围缩小（表现为磨玻璃影消退）最为常见（p < 0.002），与CT扫描上所见疾病的范围或分布以及纤维化肺泡炎类型无关。当磨玻璃影与同样广泛的网状影相关时，少数患者（5/13）的疾病范围在治疗后缩小。大多数患者（8/11）肺功能测试结果的改善与磨玻璃影的消退相关。
这些发现表明，磨玻璃影的预后意义取决于相关网状影的范围，且与疾病的范围和分布无关。
