胸部CT磨玻璃影及其他影像学特征对部分间质性肺病诊断价值探讨

Diagnostic value of ground-glass opacity and other imaging features in thoracic CT in some interstitial lung diseases

目的探讨胸部CT磨玻璃影(GGO)及其他影像学特征对部分间质性肺病的诊断价值。方法回顾分析2014年5月-2016年5月于鼓楼医院呼吸内科住院的患者,包括间质性肺炎、肺泡蛋白沉积症(PAP)及百草枯中毒性肺炎,分析比较GGO及其他影像学特征的诊断价值。结果共698例间质性肺炎患者入选,其中胸部CT上表现有GGO者392例,占56.2%。共38例肺泡蛋白沉积症患者入选,胸部CT有GGO者比例高达100%。共14例百草枯中毒入选,其中6例胸部CT有GGO,比例为42.9%。GGO伴铺路石征在PAP组高达94.7%,而间质肺炎组中仅为0.5%,百草枯中毒肺炎组中则未有发现。GGO胸膜下带状分布在百草枯中毒肺炎胸部CT上具有GGO的患者中占83.3%,而在PAP及间质肺炎胸部CT上具有GGO的患者中分别为18.4%和5.6%,均显著低于百草枯中毒肺炎(P<0.05)。PAP组患者GGO呈胸膜下带状分布同时均可发现并存铺路石征,而在间质肺炎及百草枯中毒肺炎组中均未发现并存铺路石征。GGO伴蜂窝样改变及GGO伴胸膜下线在间质肺炎组中分别占22.7%和11.2%,而在PAP组及百草枯中毒肺炎组中均未见有并存蜂窝样改变和胸膜下线。结论胸部CT上GGO改变是间质性肺炎、PAP及百草枯中毒肺炎的常见影像学改变。结合包括其胸膜下带状分布、铺路石征及胸膜下线等其他影像学特征对间质性肺病具有一定的诊断和鉴别诊断意义。

Objective To explore the differential diagnosis role of ground-glass opacity and their radiological characteristics of thoracic CT in some interstitial lung diseases. Methods A retrospective study was taken on the hospital patients CT database from May 2014 to May 2016. The patients with interstitial pneumonia,pulmonary alveolar proteinosis（ PAP） and paraquat poisoning were enrolled and their radiological characteristics of thoracic CT were analyzed. Results There were 698 cases of interstitial pneumonia in this study,in which 392 of them presented with ground-glass opacity in thoracic CT. Otherwise,a total of 38 cases of PAP were enrolled,with GGO on chest CT,with a proportion of 100%. A total of 14 cases of paraquat poisoning were selected,including 6 patients with chest CT,GGO,the proportion of 42. 9%. In the group PAP,94. 7% of GGO patients had crazy paving pattern in thoracic CT,and 0. 5% in the interstitial pneumonia group and zero in the paraquat pneumonia group. In the group of paraquat poisoning,GGO pleural banding distribution accounted for 83. 3%,18. 4% in the PAP group,and 5. 6% in the interstitial pneumonia group,all significantly lower than in paraquat poisoning patients（ P〈0. 05）. In the interstitial pneumonia group,GGO had a honeycomb like change,accounting for 22. 7%. GGO with pleural line accounted for 11. 2%. In the PAP and paraquat poisoning group,no change of GGO with sub-pleural line or honeycomb like change was found. Conclusion GGO is commonly found in interstitial pneumonia,PAP and paraquat poisoning patients. Combined with crazy paving pattern,sub-pleural band-like distribution,sub-pleural line and honeycomb like change,GGO in thoracic CT may play a key role in the diagnosis of some selected interstitial lung diseases.