隐源性机化性肺炎的CT表现及糖皮质激素治疗后改变

CT diagnosis of cryptogenic organizing pneumonia and the effect of glucocorticoids

目的探讨隐源性机化性肺炎(COP)的CT表现及糖皮质激素治疗后改变。方法回顾性分析我院COP患者29例,其中21例患者给予糖皮质激素治疗并随诊,随访时间1~38个月。结果23例(79.3%)为多发病灶,病灶位于双肺20例,单肺3例,其中14例为多发实变,3例为多发磨玻璃样变,6例为实变及磨玻璃样病灶并存;6例(20.7%)为单发病灶,其中4例为片状肺实变,1例为实性结节,1例为片状部分实性密度影;16例(55.2%)伴有条索样改变。9例(31.0%)COP患者可见“反晕征”表现。11例(37.9%)COP患者伴有轻度支气管扩张。糖皮质激素治疗21例,治疗后病灶大部分吸收14例,完全吸收2例;3例在治疗过程中出现游走性。结论COP最常见的表现是肺实变影和磨玻璃样变影,肺实变多表现为沿支气管血管束和胸膜下分布,磨玻璃样变分布不具有特异性。CT上出现“反晕征”对诊断COP有一定提示作用。糖皮质激素对部分COP患者有较好的疗效。

Objective To study the CT manifestation of cryptogenic organizing pneumonia after glucocorticoids treatment.Methods 29 cases with COP confirmed by biopsy and pathological examination during 2012 to 2017 were collected.CT was performed before and after glucocorticoids treatment.21 cases were follow-up for 1~38 months.Results 23 patients(79.3%)had multiple lesions.The lesions were located in 20 patients with bilateral lungs and 3 patients with single lung.Among them,14 patients had multiple consolidations,3 patients had multiple ground-glass opacifications,and 6 patients had consolidations and ground-glass opacifications lesions coexist;6 cases(20.7%)were single lesion,four of which were flaky lung consolidation,one was solid nodule,one was flaky partial solid density;16 cases(55.2%)accompanied by cable-like changes.9 patients(31.0%)with COP showed"anti-halo sign"performance.11 patients(37.9%)with COP were associated with mild bronchiectasis.21 patients were treated with glucocorticoids.After treatment,most of the lesions were absorbed in 19 cases,and 2 cases were completely absorbed.3 cases showed migratory during treatment.Conclusion The most common form of COP is solidation and ground-glass opacification.Lung consolidations are often distributed around the bronchial vascular bundle or(and)subpleural.The ground-glass opacifications distributions are not specific.The appearance of"anti-halo sign"is valuable in diagnosis of COP.Glucocorticoids have a good effect on most patients with COP.