隐原性机化性肺炎的CT表现特点及激素治疗后改变

Serial CT findings of cryptogenic organizing pneumonia and changes after corticosteroid therapy

目的回顾性分析隐原性机化性肺炎（COP）的系列CT表现特点及CT半定量分析激素治疗后的变化情况。方法对经病理确诊的13例COP患者的临床、病理和影像学资料进行回顾性分析。CT病变评价采用半定量方法计算，并进行皮质激素治疗前后病变程度变化分析。结果CT上所有患者均表现为两肺野多个肺叶受累，下叶分布为主，沿支气管或胸膜下分布，CT最主要的表现是磨玻璃影（13例）及斑片状实变影（12例），病变范围占全肺的比例分别为13％、10％。所有患者确诊前抗炎治疗效果不明显或无效，确诊后均给予糖皮质激素治疗，2例完全吸收，8例好转，1例无明显改变，2例病变进展，病变以磨玻璃影（10例）及网格影（5例）为主，实变影4例，病变平均范围分别为19％、2％、1％。结论典型COP的CT表现具有特征性。经皮质激素治疗后复查CT大多数吸收或好转。病变半定量评价有助于临床医师更准确了解疾病的疗效。

Objective To review the serial CT findings of cryptogenic organizing pneumonia （COP） and semiquantitatively analyze the changes after corticosteroid therapy. Methods The clinical and radiological features of 13 patients with COP confirmed by pathology were retrospectively collected and analyzed. The lung lesions extent on CT scans was estimated using semi-quantitative method. Changes of overall disease extent were evaluated by comparing the initial CT images and the follow-up CT scans after corticosteroid therapy. Results CT images of all cases revealed diffuse and bilateral lesions, mainly located in lower zone, distributed as predominantly subpleural and （or） along the bronehovascular bundle. The two most common manifestations of lung abnormality on initial scans were ground-glass opacity （GGO） （13 cases） and consolidation （12 cases） ,the average areas of which were 13% and 10% respectively. The treatment with antibiotics was ineffective. After treatment with corticosteroid, the lesions resolved completely in 2 patients ; the disease was decreased in extent in 8 patients ; and the lesion showed no change in extent in one patient, while the disease progressed in extent in 2 patients on follow-up CT. The most common CT findings were GGO （ 10 cases ） and reticulation （ 5 cases ） , followed by consolidation （ 4 cases ） , the average areas of which were 19%, 2% and 1% respectively. Conclusion The CT features of the patients with COP are characteristic. The most lesions resolved or improved after corticosteroid therapy on follow-up CT scans. The estimation of disease extent with semi-quantitative method is helpful for the clinicians to evaluate the therapeutic effect.