AIM To determine the sensitivity and specificity of high resolution computed tomography(HRCT) in the diagnosis of otosclerosis.METHODS A systematic literature review was undertaken to include Level I-III studies(Oxfor...AIM To determine the sensitivity and specificity of high resolution computed tomography(HRCT) in the diagnosis of otosclerosis.METHODS A systematic literature review was undertaken to include Level I-III studies(Oxford Centre for Evidenced based Medicine) that utilised HRCT to detect histology confirmed otosclerosis.Quantitative synthesis was then performed.RESULTS Based on available level III literature,HRCT has a relatively low sensitivity of 58%(95%CI: 49.4-66.9),a high specificity,95%(95%CI: 89.9-98.0) and a positive predictive value of 92%(95%CI: 84.1-95.8).HRCT is better at diagnosing the more prevalent fenestral form of otosclerosis but remains vulnerable to inframillimetre,retrofenestral and dense sclerotic lesions,despite the advent of more advanced CT scanners with improved collimation.CONCLUSION Whilst the diagnosis of otosclerosis remains largely clinical,HRCT remains the gold standard imaging of choice for the middle ear and serves as a useful adjunct to the clinician,helping to delineate extent of disease and exclude other causes.展开更多
Mineral dissemination and pore space distribution in ore particles are important features that influence heap leaching performance. To quantify the mineral dissemination and pore space distribution of an ore particle,...Mineral dissemination and pore space distribution in ore particles are important features that influence heap leaching performance. To quantify the mineral dissemination and pore space distribution of an ore particle, a cylindrical copper oxide ore sample (I center dot 4.6 mm x 5.6 mm) was scanned using high-resolution X-ray computed tomography (HRXCT), a nondestructive imaging technology, at a spatial resolution of 4.85 mu m. Combined with three-dimensional (3D) image analysis techniques, the main mineral phases and pore space were segmented and the volume fraction of each phase was calculated. In addition, the mass fraction of each mineral phase was estimated and the result was validated with that obtained using traditional techniques. Furthermore, the pore phase features, including the pore size distribution, pore surface area, pore fractal dimension, pore centerline, and the pore connectivity, were investigated quantitatively. The pore space analysis results indicate that the pore size distribution closely fits a log-normal distribution and that the pore space morphology is complicated, with a large surface area and low connectivity. This study demonstrates that the combination of HRXCT and 3D image analysis is an effective tool for acquiring 3D mineralogical and pore structural data.展开更多
COVID-19 which is caused by its new type called SARS-CoV-2 is a viral disease predominantly involving the lungs. <b>Objective:</b> To investigate HRCT features of pulmonary disease in COVID-19 in Lahore, P...COVID-19 which is caused by its new type called SARS-CoV-2 is a viral disease predominantly involving the lungs. <b>Objective:</b> To investigate HRCT features of pulmonary disease in COVID-19 in Lahore, Pakistan. <b>Methods:</b> This is a prospective study that involved 127 COVID-19 positive patients (age 18 - 80 years, both genders) through non-probability sampling was conducted at the Radiology Department, Sir Ganga Ram Hospital, Lahore, in 2021. All patients with RT-PCR positive underwent HRCT chest. All findings in HRCT chest were assessed. Confirmed patients had positive HRCT. Excluded situations are low quality of images irrespective of its reason, HRCT indications other than COVID-19 pneumonia, and patients who do not want to participate in the study <b>Results:</b> Considering the exclusion and inclusion criteria, totally 127 COVID-19 confirmed patients ranging age from 18 to 80 years with a mean age of 52 ± 18 years, took part in this study. The most important and common HRCT finding was the multilobar ground-glass pattern which was present in 95% of patients. Other findings including, crazy paving pattern, consolidation, air bronchogram, and bronchiectasis were present in 8.7%, 82%, 63%, and 37% of patients respectively. Pleural effusion seen in 21% patients. 16% of patients had mediastinal lymphadenopathy. <b>Conclusion:</b> In our study, the ground-glass pattern was found to be the most common and important HRCT finding in patients confirmed with COVID-19 pneumonia. This important HRCT pattern is mostly found to be in posterobasal and peripheral subpleural locations. Other than ground-glass pattern, bronchiectasis, and consolidation having the air bronchogram were also reported commonly.展开更多
AIM: To investigate the chest radiographic and high resolution computed tomography (HRCT) chest manifestations in glucocorticoid-na?ve allergic bronchopulmonary aspergillosis (ABPA) patients. METHODS: This is a prospe...AIM: To investigate the chest radiographic and high resolution computed tomography (HRCT) chest manifestations in glucocorticoid-na?ve allergic bronchopulmonary aspergillosis (ABPA) patients. METHODS: This is a prospective observational study and includes 60 consecutive glucocorticoid-na?ve patients with ABPA who underwent chest radiography and HRCT of the chest (1.25 mm every 10 mm) in the routine diagnostic workup for ABPA. RESULTS: Chest radiographs were normal in 50% of cases. Of the remainder, most patients demonstrated permanent findings in the form of parallel line and ring shadows suggesting bronchiectasis. Consolidation was detected in 17 cases but in the majority, the corresponding HRCT chest scan showed mucus-filled bronchiectatic cavities. Chest HRCT was normal in 22 patients, while central bronchiectasis (CB) was demonstrated in the remaining 38 patients. Bronchiectasis extended to the periphery in 33%-43% depending on the criteria used for defining CB. The other findings observed on HRCT were mucoid impaction, centrilobular nodules and high-attenuation mucus in decreasing order of frequency. CONCLUSION: Patients with ABPA can present with normal HRCT chest scans. Central bronchiectasis cannot be considered a characteristic feature of ABPA as peripheral bronchiectasis is commonly observed. Consolidation is an uncommon finding in ABPA.展开更多
The main challenge in bone ultrasound imaging is the large acoustic impedance contrast and sound velocity differences between the bone and surrounding soft tissue. It is difficult for conventional pulse-echo modalitie...The main challenge in bone ultrasound imaging is the large acoustic impedance contrast and sound velocity differences between the bone and surrounding soft tissue. It is difficult for conventional pulse-echo modalities to give accurate ultrasound images for irregular bone boundaries and microstructures using uniform sound velocity assumption rather than getting a prior knowledge of sound speed. To overcome these limitations, this paper proposed a frequency-domain fullwaveform inversion(FDFWI) algorithm for bone quantitative imaging utilizing ultrasonic computed tomography(USCT).The forward model was calculated in the frequency domain by solving the full-wave equation. The inverse problem was solved iteratively from low to high discrete frequency components via minimizing a cost function between the modeled and measured data. A quasi-Newton method called the limited-memory Broyden–Fletcher–Goldfarb–Shanno algorithm(L-BFGS) was utilized in the optimization process. Then, bone images were obtained based on the estimation of the velocity and density. The performance of the proposed method was verified by numerical examples, from tubular bone phantom to single distal fibula model, and finally with a distal tibia-fibula pair model. Compared with the high-resolution peripheral quantitative computed tomography(HR-p QCT), the proposed FDFWI can also clearly and accurately presented the wavelength scaled pores and trabeculae in bone images. The results proved that the FDFWI is capable of reconstructing high-resolution ultrasound bone images with sub-millimeter resolution. The parametric bone images may have the potential for the diagnosis of bone disease.展开更多
Background:?High resolution chest computed tomography (HRCT) is an established imaging modality that accurately assesses disease processes that are non-specific on conventional chest radiography. Chest Computed Tomogr...Background:?High resolution chest computed tomography (HRCT) is an established imaging modality that accurately assesses disease processes that are non-specific on conventional chest radiography. Chest Computed Tomography (CT) has proven invaluable in the evaluation of various diseases of the chest providing precise diagnosis that have great impact on the course of management. In this study, our aim is to evaluate the spectrum of radiological findings in all patients that had chest CTs at a tertiary health Institution in a developing Country. Method: This is a 6-year retrospective study of all patients that had Chest CT from 2009 till 2015. All patient data were retrieved and their Chest CT images reviewed and radiological findings and diagnosis documented. Results: Age range of patients was 1 - 84 years with a mean of 52.36 ± 22.9 years. Ten patients were children (12%). There were more males 53 (63.1%) than females 31 (36.9%) in the study. Referral for imaging was predominantly from internal medicine 33 (47.1%) and Surgery 27 (38.6%) departments. Most of the patients, 53 (63.1%) did not have previous chest radiographs. Consolidative changes were the most common parenchymal finding (77.4%). Few mediastinal masses were found in the study population. CT angiography constituted only 10.7% of all chest CTs done in adults. Conclusion: Few chest CT evaluations are performed compared to CTs of other parts of the body done in the same period. Chest CT is generally under-utilized even in a tertiary institution. There is a need to educate chest physicians on the role and advantages of CT use for the management of their patients.展开更多
Modern computer techniques have been in use for several years to generate three-dimensional visualizations of human anatomy. Very good 3-D computer models of the human body are now available and used routinely in anat...Modern computer techniques have been in use for several years to generate three-dimensional visualizations of human anatomy. Very good 3-D computer models of the human body are now available and used routinely in anatomy instruction. These techniques are subsumed under the heading “virtual anatomy” to distinguish them from the conventional study of anatomy entailing cadavers and anatomy textbooks. Moreover, other imaging procedures (X-ray, angiography, CT and MR) are also used in virtual anatomy instruction. A recently introduced three-dimensional post-processing technique named Cinematic Rendering now makes it possible to use the output of routine CT and MR examinations as the basis for highly photo-realistic 3-D depictions of human anatomy. We have installed Cinematic Rendering (enabled for stereoscopy) in a high-definition 8K 3-D projection space that accommodates an audience of 150. The space’s projection surface measures 16 × 9 meters;images can be projected on both the front wall and the floor. A game controller can be used to operate Cinematic Rendering software so that it can generate interactive real-time depictions of human anatomy on the basis of CT and MR data sets. This prototype installation was implemented without technical problems;in day-to-day, real-world use over a period of 22 months, there were no impairments of service due to software crashes or other technical problems. We are already employing this installation routinely for educational offerings open to the public, courses for students in the health professions, and (continuing) professional education units for medical interns, residents and specialists—in, so to speak, the dissecting theater of the future.展开更多
Background The correct diagnosis of etiology of fungal infection after bone marrow transplantation is very important to the choice of antifungal drugs and a premise for improvement of therapeutic efficacy. This study ...Background The correct diagnosis of etiology of fungal infection after bone marrow transplantation is very important to the choice of antifungal drugs and a premise for improvement of therapeutic efficacy. This study aimed to compare high-resolution computed tomography （HRCT） findings of the pulmonary fungal infections to determine whether the etiology of various fungal infections could be diagnosed with HRCT. Methods Eighty-five cases were enrolled. According to the pathogens responsible for fungal infections, the patients were classified into three groups including invasive aspergillosis （n=52）, candidiasis （n=19） and cryptococcosis （n=14） groups. All the patients underwent HRCT scans. Two independent radiologists retrospectively analyzed the HRCT scans regarding CT patterns and distribution of lung abnormality. Results Most fungal infections in the three groups occurred in the neutropenic phase. There was no significant difference in the constituent ratio of fungal infections at different phases after bone marrow transplantation among the three groups. Agreement between the two observers for all the CT characteristics of fungal infections was excellent （k 〉0.75）. There was a significant difference in occurrence ratio of mass among the three groups （P=-0.02）. Occurrence ratio of mass （43.3%, 13/30） in the group with invasive aspergillosis was higher than in each of other two groups （20.0%, 2/10; 14.3%, 1/7）. There was no significant difference in other CT characteristics of nodules or masses; including number, margin, halo sign, cavitation and air-crescent sign. There was no significant difference in number, margin, air bronchogram and distribution of air-space consolidation. Conclusions The HRCT appearance of various pulmonary fungal infections has a great deal of overlap and is nonspecific. Mass is more common in invasive aspergillosis, which is helpful to the diagnosis of invasive aspergillosis after bone marrow transplantation.展开更多
目的探讨高分辨率CT评估免疫治疗相关性肺炎患者诊疗效果及预后。方法2021年5月至2023年5月于肇庆市第一人民医院进行免疫治疗的恶性肿瘤患者1205例,其中32例治疗后并发免疫相关性肺炎,将所有患者的临床资料进行回顾性分析,对所有患者...目的探讨高分辨率CT评估免疫治疗相关性肺炎患者诊疗效果及预后。方法2021年5月至2023年5月于肇庆市第一人民医院进行免疫治疗的恶性肿瘤患者1205例,其中32例治疗后并发免疫相关性肺炎,将所有患者的临床资料进行回顾性分析,对所有患者进行高分辨率计算机断层扫描(CT),分析患者免疫检查点抑制剂治疗情况,免疫相关性肺炎患者临床症状及影像学表现,免疫相关性肺炎出现的时间、诊疗效果及预后。结果14例非小细胞肺癌患者及6例肺部低分化肉瘤样癌均采用纳武力尤单抗注射液静脉滴注治疗,用药剂量为3 mg/kg,治疗频次为每半个月1次;12例非小细胞肺癌患者采用信迪利单抗静脉滴注治疗,剂量为200 mg/次,频次为每21 d 1次。32例免疫相关性肺炎患者的临床分级情况为:2级3例,3级20例,4级9例。12例为对称分布,而20例为非对称分布。患者分型情况如下:20例为磨玻璃型,6例为实变型,6例为网格型。其中有23例伴有胸膜变厚,23例纵隔淋巴结受累,12例伴有支气管扩张,9例伴有小叶间隔变厚,9例伴有多发小叶中心结节,3例伴有胸腔积液。出现免疫相关性肺炎后,32例患者均停止PD-1抑制剂治疗,而应用糖皮质激素连续治疗1~6周,13例出院。结论采用高分辨率CT可以对免疫性肺炎进行诊断,并且有助于对患者进行准确分级、分型,对于已经明确诊断的免疫相关性肺炎患者,应立即停止PD-1抑制剂治疗,之后采用糖皮质激素对患者进行治疗,必要时还可联合抗生素治疗。展开更多
文摘AIM To determine the sensitivity and specificity of high resolution computed tomography(HRCT) in the diagnosis of otosclerosis.METHODS A systematic literature review was undertaken to include Level I-III studies(Oxford Centre for Evidenced based Medicine) that utilised HRCT to detect histology confirmed otosclerosis.Quantitative synthesis was then performed.RESULTS Based on available level III literature,HRCT has a relatively low sensitivity of 58%(95%CI: 49.4-66.9),a high specificity,95%(95%CI: 89.9-98.0) and a positive predictive value of 92%(95%CI: 84.1-95.8).HRCT is better at diagnosing the more prevalent fenestral form of otosclerosis but remains vulnerable to inframillimetre,retrofenestral and dense sclerotic lesions,despite the advent of more advanced CT scanners with improved collimation.CONCLUSION Whilst the diagnosis of otosclerosis remains largely clinical,HRCT remains the gold standard imaging of choice for the middle ear and serves as a useful adjunct to the clinician,helping to delineate extent of disease and exclude other causes.
基金financially supported by the National Natural Science Foundation of China(No.51304076)the Natural Science Foundation of Hunan Province,China(No.14JJ4064)
文摘Mineral dissemination and pore space distribution in ore particles are important features that influence heap leaching performance. To quantify the mineral dissemination and pore space distribution of an ore particle, a cylindrical copper oxide ore sample (I center dot 4.6 mm x 5.6 mm) was scanned using high-resolution X-ray computed tomography (HRXCT), a nondestructive imaging technology, at a spatial resolution of 4.85 mu m. Combined with three-dimensional (3D) image analysis techniques, the main mineral phases and pore space were segmented and the volume fraction of each phase was calculated. In addition, the mass fraction of each mineral phase was estimated and the result was validated with that obtained using traditional techniques. Furthermore, the pore phase features, including the pore size distribution, pore surface area, pore fractal dimension, pore centerline, and the pore connectivity, were investigated quantitatively. The pore space analysis results indicate that the pore size distribution closely fits a log-normal distribution and that the pore space morphology is complicated, with a large surface area and low connectivity. This study demonstrates that the combination of HRXCT and 3D image analysis is an effective tool for acquiring 3D mineralogical and pore structural data.
文摘COVID-19 which is caused by its new type called SARS-CoV-2 is a viral disease predominantly involving the lungs. <b>Objective:</b> To investigate HRCT features of pulmonary disease in COVID-19 in Lahore, Pakistan. <b>Methods:</b> This is a prospective study that involved 127 COVID-19 positive patients (age 18 - 80 years, both genders) through non-probability sampling was conducted at the Radiology Department, Sir Ganga Ram Hospital, Lahore, in 2021. All patients with RT-PCR positive underwent HRCT chest. All findings in HRCT chest were assessed. Confirmed patients had positive HRCT. Excluded situations are low quality of images irrespective of its reason, HRCT indications other than COVID-19 pneumonia, and patients who do not want to participate in the study <b>Results:</b> Considering the exclusion and inclusion criteria, totally 127 COVID-19 confirmed patients ranging age from 18 to 80 years with a mean age of 52 ± 18 years, took part in this study. The most important and common HRCT finding was the multilobar ground-glass pattern which was present in 95% of patients. Other findings including, crazy paving pattern, consolidation, air bronchogram, and bronchiectasis were present in 8.7%, 82%, 63%, and 37% of patients respectively. Pleural effusion seen in 21% patients. 16% of patients had mediastinal lymphadenopathy. <b>Conclusion:</b> In our study, the ground-glass pattern was found to be the most common and important HRCT finding in patients confirmed with COVID-19 pneumonia. This important HRCT pattern is mostly found to be in posterobasal and peripheral subpleural locations. Other than ground-glass pattern, bronchiectasis, and consolidation having the air bronchogram were also reported commonly.
文摘AIM: To investigate the chest radiographic and high resolution computed tomography (HRCT) chest manifestations in glucocorticoid-na?ve allergic bronchopulmonary aspergillosis (ABPA) patients. METHODS: This is a prospective observational study and includes 60 consecutive glucocorticoid-na?ve patients with ABPA who underwent chest radiography and HRCT of the chest (1.25 mm every 10 mm) in the routine diagnostic workup for ABPA. RESULTS: Chest radiographs were normal in 50% of cases. Of the remainder, most patients demonstrated permanent findings in the form of parallel line and ring shadows suggesting bronchiectasis. Consolidation was detected in 17 cases but in the majority, the corresponding HRCT chest scan showed mucus-filled bronchiectatic cavities. Chest HRCT was normal in 22 patients, while central bronchiectasis (CB) was demonstrated in the remaining 38 patients. Bronchiectasis extended to the periphery in 33%-43% depending on the criteria used for defining CB. The other findings observed on HRCT were mucoid impaction, centrilobular nodules and high-attenuation mucus in decreasing order of frequency. CONCLUSION: Patients with ABPA can present with normal HRCT chest scans. Central bronchiectasis cannot be considered a characteristic feature of ABPA as peripheral bronchiectasis is commonly observed. Consolidation is an uncommon finding in ABPA.
基金Project supported by the National Natural Science Foundation of China(Grant Nos.11827808,11874289,and 11804056)the National Science Fund for Distinguished Young Scholars of China(Grant No.11525416)+3 种基金Shanghai Municipal Science and Technology Major Project,China(Grant No.2017SHZDZX01)Shanghai Talent Development Fund(Grant No.2018112)State Key Laboratory of ASIC and System Project(Grant No.2018MS004)China Postdoctoral Science Foundation(Grant No.2019M661334)。
文摘The main challenge in bone ultrasound imaging is the large acoustic impedance contrast and sound velocity differences between the bone and surrounding soft tissue. It is difficult for conventional pulse-echo modalities to give accurate ultrasound images for irregular bone boundaries and microstructures using uniform sound velocity assumption rather than getting a prior knowledge of sound speed. To overcome these limitations, this paper proposed a frequency-domain fullwaveform inversion(FDFWI) algorithm for bone quantitative imaging utilizing ultrasonic computed tomography(USCT).The forward model was calculated in the frequency domain by solving the full-wave equation. The inverse problem was solved iteratively from low to high discrete frequency components via minimizing a cost function between the modeled and measured data. A quasi-Newton method called the limited-memory Broyden–Fletcher–Goldfarb–Shanno algorithm(L-BFGS) was utilized in the optimization process. Then, bone images were obtained based on the estimation of the velocity and density. The performance of the proposed method was verified by numerical examples, from tubular bone phantom to single distal fibula model, and finally with a distal tibia-fibula pair model. Compared with the high-resolution peripheral quantitative computed tomography(HR-p QCT), the proposed FDFWI can also clearly and accurately presented the wavelength scaled pores and trabeculae in bone images. The results proved that the FDFWI is capable of reconstructing high-resolution ultrasound bone images with sub-millimeter resolution. The parametric bone images may have the potential for the diagnosis of bone disease.
文摘Background:?High resolution chest computed tomography (HRCT) is an established imaging modality that accurately assesses disease processes that are non-specific on conventional chest radiography. Chest Computed Tomography (CT) has proven invaluable in the evaluation of various diseases of the chest providing precise diagnosis that have great impact on the course of management. In this study, our aim is to evaluate the spectrum of radiological findings in all patients that had chest CTs at a tertiary health Institution in a developing Country. Method: This is a 6-year retrospective study of all patients that had Chest CT from 2009 till 2015. All patient data were retrieved and their Chest CT images reviewed and radiological findings and diagnosis documented. Results: Age range of patients was 1 - 84 years with a mean of 52.36 ± 22.9 years. Ten patients were children (12%). There were more males 53 (63.1%) than females 31 (36.9%) in the study. Referral for imaging was predominantly from internal medicine 33 (47.1%) and Surgery 27 (38.6%) departments. Most of the patients, 53 (63.1%) did not have previous chest radiographs. Consolidative changes were the most common parenchymal finding (77.4%). Few mediastinal masses were found in the study population. CT angiography constituted only 10.7% of all chest CTs done in adults. Conclusion: Few chest CT evaluations are performed compared to CTs of other parts of the body done in the same period. Chest CT is generally under-utilized even in a tertiary institution. There is a need to educate chest physicians on the role and advantages of CT use for the management of their patients.
文摘Modern computer techniques have been in use for several years to generate three-dimensional visualizations of human anatomy. Very good 3-D computer models of the human body are now available and used routinely in anatomy instruction. These techniques are subsumed under the heading “virtual anatomy” to distinguish them from the conventional study of anatomy entailing cadavers and anatomy textbooks. Moreover, other imaging procedures (X-ray, angiography, CT and MR) are also used in virtual anatomy instruction. A recently introduced three-dimensional post-processing technique named Cinematic Rendering now makes it possible to use the output of routine CT and MR examinations as the basis for highly photo-realistic 3-D depictions of human anatomy. We have installed Cinematic Rendering (enabled for stereoscopy) in a high-definition 8K 3-D projection space that accommodates an audience of 150. The space’s projection surface measures 16 × 9 meters;images can be projected on both the front wall and the floor. A game controller can be used to operate Cinematic Rendering software so that it can generate interactive real-time depictions of human anatomy on the basis of CT and MR data sets. This prototype installation was implemented without technical problems;in day-to-day, real-world use over a period of 22 months, there were no impairments of service due to software crashes or other technical problems. We are already employing this installation routinely for educational offerings open to the public, courses for students in the health professions, and (continuing) professional education units for medical interns, residents and specialists—in, so to speak, the dissecting theater of the future.
文摘Background The correct diagnosis of etiology of fungal infection after bone marrow transplantation is very important to the choice of antifungal drugs and a premise for improvement of therapeutic efficacy. This study aimed to compare high-resolution computed tomography （HRCT） findings of the pulmonary fungal infections to determine whether the etiology of various fungal infections could be diagnosed with HRCT. Methods Eighty-five cases were enrolled. According to the pathogens responsible for fungal infections, the patients were classified into three groups including invasive aspergillosis （n=52）, candidiasis （n=19） and cryptococcosis （n=14） groups. All the patients underwent HRCT scans. Two independent radiologists retrospectively analyzed the HRCT scans regarding CT patterns and distribution of lung abnormality. Results Most fungal infections in the three groups occurred in the neutropenic phase. There was no significant difference in the constituent ratio of fungal infections at different phases after bone marrow transplantation among the three groups. Agreement between the two observers for all the CT characteristics of fungal infections was excellent （k 〉0.75）. There was a significant difference in occurrence ratio of mass among the three groups （P=-0.02）. Occurrence ratio of mass （43.3%, 13/30） in the group with invasive aspergillosis was higher than in each of other two groups （20.0%, 2/10; 14.3%, 1/7）. There was no significant difference in other CT characteristics of nodules or masses; including number, margin, halo sign, cavitation and air-crescent sign. There was no significant difference in number, margin, air bronchogram and distribution of air-space consolidation. Conclusions The HRCT appearance of various pulmonary fungal infections has a great deal of overlap and is nonspecific. Mass is more common in invasive aspergillosis, which is helpful to the diagnosis of invasive aspergillosis after bone marrow transplantation.
文摘目的探讨高分辨率CT评估免疫治疗相关性肺炎患者诊疗效果及预后。方法2021年5月至2023年5月于肇庆市第一人民医院进行免疫治疗的恶性肿瘤患者1205例,其中32例治疗后并发免疫相关性肺炎,将所有患者的临床资料进行回顾性分析,对所有患者进行高分辨率计算机断层扫描(CT),分析患者免疫检查点抑制剂治疗情况,免疫相关性肺炎患者临床症状及影像学表现,免疫相关性肺炎出现的时间、诊疗效果及预后。结果14例非小细胞肺癌患者及6例肺部低分化肉瘤样癌均采用纳武力尤单抗注射液静脉滴注治疗,用药剂量为3 mg/kg,治疗频次为每半个月1次;12例非小细胞肺癌患者采用信迪利单抗静脉滴注治疗,剂量为200 mg/次,频次为每21 d 1次。32例免疫相关性肺炎患者的临床分级情况为:2级3例,3级20例,4级9例。12例为对称分布,而20例为非对称分布。患者分型情况如下:20例为磨玻璃型,6例为实变型,6例为网格型。其中有23例伴有胸膜变厚,23例纵隔淋巴结受累,12例伴有支气管扩张,9例伴有小叶间隔变厚,9例伴有多发小叶中心结节,3例伴有胸腔积液。出现免疫相关性肺炎后,32例患者均停止PD-1抑制剂治疗,而应用糖皮质激素连续治疗1~6周,13例出院。结论采用高分辨率CT可以对免疫性肺炎进行诊断,并且有助于对患者进行准确分级、分型,对于已经明确诊断的免疫相关性肺炎患者,应立即停止PD-1抑制剂治疗,之后采用糖皮质激素对患者进行治疗,必要时还可联合抗生素治疗。
