胸椎骨质增生引起邻近肺组织局灶性纤维化的CT诊断

CT Findings of Focal Pulmonary Interstitial Fibrosis Adjacent to Thoracic Spine Osteoproliferation

目的探讨胸椎骨质增生是否能引起邻近肺组织的局灶性纤维化。方法回顾性分析常规胸部CT检查显示胸椎骨质增生患者401例，观察骨质增生的厚度、方向以及骨赘邻近胸膜下肺组织有无局灶性改变。将肺间质改变的形态分为3型：I型磨玻璃密度影、Ⅱ型网格状影、Ⅲ型线状影，各型与胸椎骨质增生厚度的关系、局灶性肺间质改变的发生率行卡方检验。对以往曾行胸部CT检查者记录局灶性肺间质病变的形态变化情况，9例患者同时行仰、俯卧位CT检查。结果401例胸椎骨质增生者中，350例（87．3％）突向右或右前方；142例（35．4％）（165个病灶）伴邻近胸膜下局灶性肺间质改变。局灶性肺间质改变的发生率随骨质增生厚度的增加而增高（增生厚度〈5mm为7．4％，5～10mm为38．6％，〉10mm为70．9％），三者的差异有显著统计学意义（X2=134．981，P〈0．001）。同时行俯卧位CT检查的9例局灶性肺间质改变均未消失。有CT随访资料者27例，其中随访有变化者8例（3～29个月），无变化者19例（1周-41个月）。结论胸椎骨质增生的机械压迫能导致邻近肺组织局灶性纤维化，增生厚度越大局灶性肺纤维化的发生率越高，骨质增生引起的局灶性肺纤维化无需治疗或进一步检查。

Objective To investigate whether osteoproliferation of the thoracic vertebrae can cause focal pulmonary in- terstitial fibrosis in the subpleural region. Methods Four hundred and one patients with thoracic spine osteoproliferation in routine chest CT scan were retrospectively analysed. The thickness and directions of osteophytes and whether osteoprolif- eration of the thoracic vertebrae accompanied with focal pulmonary fibrosis were observed. The morphology of focal intersti- tial opacities were classified into three patterns ： ground glass, reticular and linear. The relationship among focal interstitial opacity, presence and thickness of the osteophyte was assessed by using a chi-square test. Morphological changes between previous and present chest CT were recorded. Nine patients were simuhaneously examined in supine and prone position CT scans. Results Among 401 patients with thoracic spine osteoproliferation, osteophytes in 350 cases （87.3%） were pres- ent in the right or right anterior portions. Focal interstitial opacities in the subpIeural region adjacent to the osteophytes were shown in 142 cases. The incidence of focal pulmonary fibrosis increased with the increasing thickness of osteophytes （ 〈 5 mm was 7.4%, 5 - l0 mm 38.6%, 〉 10 mm 70.9% ）. A significant difference was found between the thickness of the osteophyte and the incidence of focal interstitial opacity（ X2 = 134.981 ,P 〈0. 001 ）. Nine cases were simultaneously exam- ined in supine and prone position CT scans and all focal interstitial opacities did not disappear. Morphological changes were shown in 8 cases. Conclusion The mechanical compression by the osteophyte may causes focal fibrosis in the adjacent pulmonary tissue. The incidence of focal pulmonary fibrosis increased with the increasing thickness of osteophytes. The fo- cal pulmonary fibrosis adjacent to thoracic spine osteoproliferation neednt treatment or further check.