隐源性机化性肺炎的CT影像分析

Analysis of CT features of patients with cryptogenic organizing pneumonia

目的通过分析隐源性机化性肺炎(COP)的高分辨CT(HRCT)特征,提高对该疾病影像学的诊断水平。方法回顾性分析30例病理学确诊的COP患者的HRCT影像学特征。结果典型COP影像学表现有胸膜下多发性实变影(12例)或斑片影(6例),部分患者含空气支气管征或反晕征,病灶在几周内位置可以改变。典型表现还有支气管中央型(3例),病灶沿着较大的支气管血管束分布,常见反晕征。磨玻璃影(8例)也很常见,但不具特异性,多与实变、结节影并存,随机分布;少见的影像学表现包括孤立性团块影(1例)、结节影(4例)、多发团块影(2例)、带状影(4例)、小叶间隔增厚型(2例)。结论 COP的影像学表现多样化,但以胸膜下多发实变影和支气管中央型最为典型,病灶游走性是重要的特征,需要与细菌性肺炎、肺淋巴瘤、肺结节病鉴别。病理学检查是必要的。

Objective To analyze the chest high - resolution computed tomography （HRCT） features of cryptogenic organizing pneumonia（COP） and to improve the diagnostic level. Methods The HRCT features of 30 patients with biopsy - proven COP were retrospectively studied. Results The classic imaging patterns of COP were multifocal consolidation（n = 12） or patchy（n =6）, usually peripheral, some of them contained air bronchograms or reversed halo, changing in location over a matter of weeks. And bronchocentric pattern （ n = 3） around larger bronchovascular bundles, reversed halo was common. Ground glass opacity（ n = 8 ） was also common, but nonspeeific, usually co - existed with consolidation or nodules, randomly distributed. The unusual imaging patterns included solitary focal mass（n = 1 ）, nodular patterns（n =4）, multiple masses （n =2）, band - like pattern（ n =4） and interlobular septa thickening pattern （n = 2）. Conelusion The HRCT signs arevariety in COP. The most classic imaging patterns are multifocal peripheral consolidation and bronchocentric pattern. Migration over time is an important pointer of COP. It has necessary that differentiating COP with infective disease, lymphoma and sarcoidosis. Biopsy was necessary.