Zompatori M, Fasano L, Rimondi M R, Poletti V, Pacilli A M, Battaglia M, Canini R, Stambazzi C
Radiodiagnoistica Padiglione Pneumonefrologico, Policlinico S. Orsola-Malpighi, Bologna.
Radiol Med. 1996 Mar;91(3):238-46.
The authors report the results of the study performed with high resolution CT (HRCT) in a group of 29 patients affected with idiopathic pulmonary fibrosis (IPF). Each patient underwent HRCT at the beginning of the study and after one year. A complete clinico-functional assessment was available in 20 cases and functional CT correlation was made in these patients; 15/20 subjects underwent immunosuppressive therapy with corticosteroids and cyclophosphamide. Disease severity was assessed with chest radiography and HRCT. On the basis of CT findings the patients were classified into three groups, according to Wells classification: predominant ground-glass pattern, mixed pattern and predominant reticular disease with honeycombing. Furthermore, a visual score was assigned to total disease extent and a different score to ground-glass and reticular opacities. Our data confirm the poor accuracy of chest radiography in assessing disease type and overall severity, versus the outstanding diagnostic accuracy of HRCT. We also found a high incidence of mediastinal adenopathies (37.9% of the patients) and signs of pulmonary arterial hypertension (62%), together with low extent of pulmonary emphysema (65.5% of the patients; mean extent: 5.4%). Ground-glass attenuation is an early sign of IPF and might suggest alveolitis activity. In our series, however, the patients with grade I disease were rare (6.8%), but likely to benefit from therapy. Different from Wells, we found no significant difference in the evolution of the patients with grade II versus grade III disease. Wells grading was useful in early disease assessment, but the visual score of total disease extent and the score of ground-glass and reticular opacities were much more useful in the follow-up because they can assess disease progression. Furthermore, in the few patients with predominant alveolitis, who improve after therapy, the relative prevalence of the reticular pattern might allocate the patient in a higher Wells group with a "paradoxical" worsening, if the visual score of the extent of the primary lesion is not used.
作者报告了对一组29例特发性肺纤维化（IPF）患者进行高分辨率CT（HRCT）研究的结果。每位患者在研究开始时和一年后均接受了HRCT检查。20例患者有完整的临床功能评估，并对这些患者进行了功能CT相关性分析；20例中的15例接受了皮质类固醇和环磷酰胺的免疫抑制治疗。通过胸部X线摄影和HRCT评估疾病严重程度。根据CT表现，按照Wells分类法将患者分为三组：主要为磨玻璃样改变、混合性改变和主要为网状病变伴蜂窝状改变。此外，对疾病总范围给予视觉评分，对磨玻璃样和网状阴影给予不同评分。我们的数据证实，与HRCT出色的诊断准确性相比，胸部X线摄影在评估疾病类型和总体严重程度方面准确性较差。我们还发现纵隔淋巴结肿大的发生率较高（占患者的37.9%）和肺动脉高压的征象（62%），同时肺气肿程度较低（占患者的65.5%；平均程度：5.4%）。磨玻璃样衰减是IPF的早期征象，可能提示肺泡炎活动。然而，在我们的系列研究中，I级疾病患者很少（6.8%），但可能从治疗中获益。与Wells分类不同的是，我们发现II级和III级疾病患者的病情进展没有显著差异。Wells分级在疾病早期评估中有用，但疾病总范围的视觉评分以及磨玻璃样和网状阴影的评分在随访中更有用，因为它们可以评估疾病进展。此外，在少数主要为肺泡炎且治疗后病情改善的患者中，如果不使用原发性病变范围的视觉评分，网状模式的相对患病率可能会使患者被归入更高的Wells组，出现“矛盾性”恶化。
