Gevenois P A, de Maertelaer V, Madani A, Winant C, Sergent G, De Vuyst P
Dept of Radiology, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium.
Eur Respir J. 1998 May;11(5):1021-7. doi: 10.1183/09031936.98.11051021.
The aim of this study was to investigate by computed tomography (CT) whether asbestosis, diffuse pleural thickening and/or pleural plaques are statistically associated. We also tried to find criteria to differentiate between diffuse and circumscribed pleural thickening. From 231 exposed workers, only those subjects whose radiograph showed neither bilateral calcified pleural plaques nor small pulmonary opacities higher than 1/1 grade according to the 1980 International Labour Office (ILO) Classification were considered. Scans were assessed for the presence of subpleural curvilinear lines, septal and intralobular lines, parenchymal bands, honeycombing, rounded atelectasis, pleural plaques and diffuse pleural thickening. CT scans revealed pleural and/or lung abnormalities in 99 workers. Pleural plaques were unilateral in one-third of cases with plaques. Diffuse pleural thickening, parenchymal bands and rounded atelectasis were unilateral in, respectively, 62 and 69 and 75% of cases with the abnormality. Septal and intralobular lines, and honeycombing were always bilateral. CT signs could be grouped into three patterns: 1) septal and intralobular lines, and honeycombing corresponding to pulmonary fibrosis; 2) pleural plaques corresponding to parietal pleural fibrosis; and 3) diffuse pleural thickening, rounded atelectasis and parenchymal bands corresponding to visceral pleural fibrosis. In these workers with a normal or near-normal radiograph, three groups of subjects with different responses were distinguished. Crow's feet and rounded atelectasis help to differentiate plaques from diffuse thickening.
本研究的目的是通过计算机断层扫描（CT）调查石棉肺、弥漫性胸膜增厚和/或胸膜斑之间是否存在统计学关联。我们还试图找到区分弥漫性和局限性胸膜增厚的标准。从231名接触石棉的工人中，仅考虑那些根据1980年国际劳工组织（ILO）分类，胸部X光片既未显示双侧钙化胸膜斑，也未显示高于1/1级的小肺实质阴影的受试者。对扫描结果进行评估，以确定是否存在胸膜下曲线、小叶间隔和小叶内线、实质带、蜂窝状改变、圆形肺不张、胸膜斑和弥漫性胸膜增厚。CT扫描显示99名工人存在胸膜和/或肺部异常。胸膜斑在三分之一有胸膜斑的病例中为单侧。弥漫性胸膜增厚、实质带和圆形肺不张在分别有该异常的病例中，单侧出现的比例分别为62%、69%和75%。小叶间隔和小叶内线以及蜂窝状改变总是双侧的。CT征象可分为三种类型：1）对应于肺纤维化的小叶间隔和小叶内线以及蜂窝状改变；2）对应于壁层胸膜纤维化的胸膜斑；3）对应于脏层胸膜纤维化的弥漫性胸膜增厚、圆形肺不张和实质带。在这些胸部X光片正常或接近正常的工人中，区分出了三组反应不同的受试者。“鱼尾征”和圆形肺不张有助于区分胸膜斑和弥漫性增厚。
