煤工尘肺小叶内线影HRCT与病理的对照研究

A comparative study of HRCT findings and pathological basis of intralobular lines in coal workers' pneumoconiosis

目的:评估煤工尘肺患者离体肺标本在高分辨率CT(High-resolution Computed Tomography,HRCT)上的影像表现及其病理基础。方法:52例煤工尘肺标本尸检新鲜离体肺标本通过改良Heitzman法进行固定。充气状态肺标本进行HRCT冠状位及橫轴位扫描。2位有经验的胸部影像医师独立读片。评估参数包括小叶内线影、微小结节、磨玻璃密度影、小叶间隔增厚、铺路石征、支气管扩张及蜂窝影。根据HRCT上感兴趣区,做组织学切片,进行影像与病理的对照研究。结果:52例肺标本,31例纳入研究范围。在橫轴位CT上,仅有16.1%的病例分布在支气管血管周围,38.7%的病例分布在胸膜下。在冠状位CT上,上肺区分布的仅有16.1%。小叶内线影的伴随征象中微小结节和增厚的小叶间隔(100%)是最常见的,其次是磨玻璃密度影(83.9%)和肺气肿(80.6%)。HRCT上小叶内线影与增厚的肺泡间隔一致,组织病理学上肺泡间隔内可见煤斑、炎症细胞、肿瘤细胞或渗出液等。结论:煤工尘肺小叶内线影可以由多种病理基础造成,小叶间隔增厚是小叶内线影最常见的伴随征象。

Objective： To evaluate the imaging features of high-resolution CT （HRCT） and pathological basis in patients with coal workers＇ pneumoconiosis （CWP）. Methods： Fifty-two fresh lungs from patients with CWP were fixed and inflated by the Heitzman method. The inflated specimens underwent HRCT coronal and transverse planes scanning. Two experienced chest radiologists independently made the diagnosis results. The evaluation parameters included intralobular lines, micronodules, ground-glass opacity（GGO）, thickened intralobular septa, crazy-paving pattern, bronchiectasis, and honeycombing. A comparative study of image and pathology was performed on the tissue sections according to the HRCT region of interest. Results： Of the 52 specimens, 21 were excluded because of structure distortion, and 31 were enrolled in this study. In the transverse projec- tion, only 16.1% of the specimens exhibited peribronchovascular predominance, and 38.7% exhibited subpleural predominance. In the coronal view, the incidence of distribution in the upper-zone was only 16.1%. Among the accompanying signs of in- tralobular lines, micronodules and thickened interlobular septa were the most common observations （100%）, followed by GGO （83.9%） and emphysema（80.6%）. The intralobular lines on HRCT corresponded to thickened alveolar septa that were associated with coal macules, fibrosis, inflammation, tumors, and serous fluid based on pathology. Conclusion： The intralobular lines of CWP on HRCT correlate with a variety of pathological backgrounds. The thickened interlobular septa are the most frequent accompanying sign.