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1.
Sarcoidosis Vasc Diffuse Lung Dis ; 27(2): 103-10, 2010 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-21319592

RESUMO

BACKGROUND: Although acute exacerbation (AE) of idiopathic pulmonary fibrosis (IPF) is a well known clinical condition, predicting risk factors remain unknown. We evaluated the frequency, risk factors and impact on survival of AE-IPF. METHODS: We retrospectively studied patients diagnosed with IPF based on the criteria of the ATS/ERS consensus statement and followed them for periods of more than 3 years except in dead cases. Initial characteristics including the level of dyspnoea, which was assessed with the modified Medical Research Council (MRC) scale, and decline of forced vital capacity (FVC) defined by at least 10% decline at 6 months, were evaluated as possible risk factors for AE. RESULTS: Seventy-four patients with IPF were studied. One-year, two-year, and three-year incidence of AE were 8.6%, 12.6%, and 23.9%, respectively. Multivariate analysis revealed that higher body mass index (BMI) [hazard ratio (HR), 1.20; 95% confidence interval (CI), 1.03-1.40], higher modified MRC scale [HR, 2.93; 95% CI, 1.46-5.85], and a decline in FVC at 6 mounths [HR, 0.97-2.60 (per mo); 95% CI, 1.01-7.45] were independent risk factors for AE-IPF. The causes of death were assessed to be AE in 20 of 57 expired patients. A stepwise multivariate Cox regression model evaluating AE-IPF, adjusted for %FVC and decline in FVC, demonstrated a statistically significant impact on overall survival [HR, 2.79; 95% CI, 1.59-4.88; p < 0.001]. CONCLUSION: These data suggest that initial high modified MRC scale, high BMI, and decline in FVC at 6 months were significant independent risk factors for AE-IPF. AE was an independent prognostic factor in IPF.


Assuntos
Fibrose Pulmonar Idiopática/epidemiologia , Idoso , Índice de Massa Corporal , Lavagem Broncoalveolar , Progressão da Doença , Feminino , Humanos , Fibrose Pulmonar Idiopática/patologia , Fibrose Pulmonar Idiopática/fisiopatologia , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Prognóstico , Fatores de Risco , Capacidade Vital
2.
Br J Radiol ; 82(981): 742-7, 2009 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-19332515

RESUMO

The purpose of this study was to investigate the reproducibility of volumetric software evaluation and manual evaluation of tumour growth. Three observers manually evaluated whether tumour volume was increasing, if it was unchanged, or if it had decreased in size in 2 serial CT examinations of 45 solid lung cancers. The tumour volumes were calculated 3 times using volumetric software and were evaluated using the same classifications as for manual evaluation. Both data sets were divided into three groups: growth or reduction with consistency among all three evaluations (group A), growth or reduction with consistency between only two evaluations (group B), and others (group C). The volume variation and relative volume variation were calculated from the median volumes measured by volumetric software. Although all 45 tumours were categorised in group A by volumetric software, only 21 tumours were categorised in group A by manual assessment. The relative volume variation of the manual assessment was 88.5 +/- 76.5%, 20.8 +/- 28.3% and 12.9 +/- 12.8% in group A, B and C, respectively. Significant differences were found between groups A and B (p<0.01) and between groups A and C (p<0.001). Inconsistency is often seen in manual assessment; in contrast, evaluation using volumetric software has good reproducibility, even when the relative change in tumour volume is small.


Assuntos
Adenocarcinoma/diagnóstico por imagem , Carcinoma de Células Escamosas/diagnóstico por imagem , Neoplasias Pulmonares/diagnóstico por imagem , Carga Tumoral , Adenocarcinoma/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma de Células Escamosas/patologia , Feminino , Humanos , Imageamento Tridimensional , Neoplasias Pulmonares/patologia , Masculino , Pessoa de Meia-Idade , Interpretação de Imagem Radiográfica Assistida por Computador/métodos , Reprodutibilidade dos Testes , Estudos Retrospectivos , Software , Tomografia Computadorizada por Raios X/métodos
3.
Br J Radiol ; 82(979): 532-40, 2009 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-19124564

RESUMO

The purpose of our investigation was to compare the usefulness of the subjective visual assessment of ground-glass opacity (GGO) with a quantitative method that used a profile curve to determine prognosis. 96 adenocarcinomas were studied. Three diameters ([D1]-[D3]) were defined for estimating the diameter of tumours on the monitor: the distance between two points was measured using software that displays a CT density profile across the tumour. One experienced and one less experienced radiologist independently evaluated the following six parameters: the three diameters [D1]-[D3]; the solid portion of total tumour in the two different ratios ([D2]/[D1], [D3]/[D1]); and the area ratio of GGO for total opacity to subjective visual evaluation. Interobserver agreement between the two radiologists of the diameters (mean bias+/- 1.96 standard deviations) was as follows: [D1], -0.7 +/- 6 mm; [D2], 0.4 +/- 4.4 mm; and [D3], -0.1 +/- 4.2 mm (Bland and Altman's method). Interobserver agreement was fair in evaluating the area ratio of GGO (kappa test, kappa = 0.309). Univariate logistic regression analysis revealed that two ratios ([D2]/[D1], [D3]/[D1]) might be significantly useful in estimating lymph node metastasis (p < 0.026), lymph duct invasion (p < 0.001) and recurrence (p < 0.015). Observation of the area ratio of GGO by an experienced radiologist would be necessary for estimating lymph node metastasis (p = 0.04) and lymph duct invasion (p < 0.001). We concluded that the ratio of solid component to total tumour, which is obtainable in a more objective and simple way using profile curves obtained by software, is a more useful method of estimating prognosis than is visual assessment.


Assuntos
Adenocarcinoma/diagnóstico por imagem , Neoplasias Pulmonares/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/diagnóstico por imagem , Variações Dependentes do Observador , Prognóstico , Análise de Regressão , Estudos Retrospectivos , Software
4.
Monaldi Arch Chest Dis ; 63(1): 59-64, 2005 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-16035566

RESUMO

BACKGROUND AND AIM: To evaluate CT findings of pulmonary alveolar microlithiasis and correlate the CT with the pathologic findings. METHODS: The study included 10 patients with pathologically proven microlithiasis. Two independent observers evaluated the presence, extent and distribution of the CT findings. CT findings were compared with those at autopsy in two patients and with transbronchial biopsy in eight patients. RESULTS: All patients had a myriad of calcified nodules measuring approximately 1 mm in diameter. Close apposition of the nodules resulted in areas of ground-glass attenuation and consolidation, which were the predominant abnormality on CT in all 10 patients, involving 41% +/- 16.3 (mean +/- SD) and 30% +/- 4.8 of the lung parenchyma, respectively. Calcifications were also seen along interlobular septa, bronchovascular bundles and pleura. Other findings included interlobular septal thickening, thickening of bronchovascular bundles, nodules, and subpleural cysts. There was a solid agreement between the observers for the presence (kappa value; 0.77) and extent (Spearman rank correlation; r = 0.81 to 1.0 p < 0.01) of abnormalities. Autopsy specimens demonstrated microliths in alveolar airspaces and along interlobular septa, bronchovascular bundles and pleura. Subpleural small cysts were shown to represent dilated alveolar ducts. CONCLUSION: Pulmonary microlithiasis is characterised by the presence of numerous small, calcified nodules, calcifications along interlobular septa, bronchovascular bundles and pleura, ground-glass opacities, consolidation, and subpleural cysts. The cysts represent dilated alveolar ducts.


Assuntos
Calcinose/diagnóstico por imagem , Pneumopatias/diagnóstico por imagem , Alvéolos Pulmonares/diagnóstico por imagem , Adulto , Idoso , Calcinose/patologia , Diagnóstico Diferencial , Feminino , Humanos , Pneumopatias/patologia , Masculino , Pessoa de Meia-Idade , Alvéolos Pulmonares/patologia , Estatísticas não Paramétricas , Tomografia Computadorizada por Raios X
5.
AJR Am J Roentgenol ; 177(6): 1417-22, 2001 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-11717098

RESUMO

OBJECTIVE: The purpose of our study was to correlate the high-resolution CT findings of small peripheral adenocarcinoma of the lung with underlying histopathology and to evaluate the prognostic implications of the CT findings. MATERIALS AND METHODS: The high-resolution CT findings of small peripheral adenocarcinoma of the lung in 224 patients were analyzed by two independent observers for location, size, marginal characteristics, and extent of ground-glass opacity and necrosis. The pathologic specimens were reviewed by an experienced lung pathologist. RESULTS: One hundred and thirty-two patients had bronchioloalveolar carcinoma and 92 had adenocarcinoma. The extent of ground-glass opacity was greater in bronchioloalveolar carcinomas (mean +/- SD, 29% +/- 31.6%) than in other adenocarcinomas (8% +/- 13.3%) (p < 0.001). The extent of ground-glass opacity was significantly greater in patients without recurrence (p = 0.020) and those without nodal (p = 0.017) or distant (p = 0.007) metastases than in patients with nodal or distant metastases or in whom the carcinoma had recurred. CONCLUSION: The extent of ground-glass opacity in a nodule is greater in bronchioloalveolar carcinomas than in other adenocarcinomas. Greater extent of ground-glass opacity also correlates with improved prognosis.


Assuntos
Adenocarcinoma/diagnóstico por imagem , Adenocarcinoma/patologia , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/patologia , Tomografia Computadorizada por Raios X/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Vidro , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico
6.
J Thorac Imaging ; 16(4): 290-6, 2001 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-11685094

RESUMO

The purpose of this study was to describe the high-resolution computed tomography (HRCT) findings of pulmonary involvement in primary Sjögren's syndrome. The study included 60 patients who met the diagnostic criteria for primary Sjögren's syndrome. The authors retrospectively reviewed the presence, extent, and distribution of various HRCT findings. Results showed that the most common HRCT findings were areas with ground-glass attenuation (92%), followed by subpleural small nodules (78%), non-septal linear opacity (75%), interlobular septal thickening (55%), bronchiectasis (38%), and cysts (30%).


Assuntos
Pneumopatias/diagnóstico por imagem , Pneumopatias/etiologia , Síndrome de Sjogren/complicações , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X
7.
J Comput Assist Tomogr ; 25(3): 388-93, 2001.
Artigo em Inglês | MEDLINE | ID: mdl-11351188

RESUMO

PURPOSE: The purpose of this work was to evaluate the CT features of thymoma and to determine the most helpful findings in differentiating invasive from noninvasive thymoma. METHOD: The CT scans from 27 patients with invasive thymoma and 23 with noninvasive thymoma were independently assessed by two observers without knowledge of their invasiveness. The presence and distribution of various CT findings were independently analyzed. RESULTS: Invasive thymomas were more likely to have lobulated (16/27, 59%) or irregular (6/27, 22%) contours than noninvasive thymomas (8/23, 35% and 1.5/23, 6%, respectively) (p < 0.05). Invasive thymomas had a higher prevalence of low attenuation areas within the tumor (16/27, 60%) than noninvasive thymomas (5/23, 22%) (p < 0.001) as well as foci of calcification (14.5/27, 54% vs. 6/23, 26%; p < 0.01). CONCLUSION: The presence of lobulated or irregular contour, areas of low attenuation, and multifocal calcification is suggestive of invasive thymoma.


Assuntos
Timoma/diagnóstico por imagem , Neoplasias do Timo/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Adulto , Idoso , Calcinose , Distribuição de Qui-Quadrado , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Necrose , Invasividade Neoplásica , Estatísticas não Paramétricas , Timoma/patologia , Neoplasias do Timo/patologia
8.
Radiat Med ; 18(5): 277-81, 2000.
Artigo em Inglês | MEDLINE | ID: mdl-11128397

RESUMO

PURPOSE: To compare MR perfusion imaging with perfusion scintigraphy in the evaluation of patients with pulmonary emphysema being considered for lung volume reduction surgery. PATIENTS AND METHODS: Six patients with pulmonary emphysema and two normal individuals were evaluated by MR perfusion imaging, perfusion scintigraphy, and selective bilateral pulmonary angiography. MR images were obtained with an enhanced fast gradient recalled echo with three-dimensional Fourier transformation technique (efgre 3D) (6.3/1.3; flip angle, 30 degrees; field of view, 45-48 cm; matrix, 256 x 160). The presence or absence of perfusion defects in each segment was evaluated by two independent observers. RESULTS: Using angiography as the gold standard, the sensitivity, specificity, and accuracy of MR perfusion imaging in detecting focal perfusion abnormalities were 90%, 87%, and 89%, respectively, while those of perfusion scintigraphy were 71%, 76%, and 71%, respectively. The diagnostic accuracy of MR perfusion imaging was significantly higher than that of scintigraphy (p<0.001, McNemar test). There was good agreement between two observers for MR perfusion imaging (kappa statistic, 0.66) and only moderate agreement for perfusion scintigraphy (kappa statistic, 0.51). CONCLUSION: MR perfusion imaging is superior to perfusion scintigraphy in the evaluation of pulmonary parenchymal perfusion in patients with pulmonary emphysema.


Assuntos
Imageamento por Ressonância Magnética , Pneumonectomia , Enfisema Pulmonar/diagnóstico por imagem , Adulto , Idoso , Angiografia , Meios de Contraste , Feminino , Análise de Fourier , Gadolínio DTPA , Humanos , Processamento de Imagem Assistida por Computador , Imageamento Tridimensional , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Projetos Piloto , Cuidados Pré-Operatórios , Circulação Pulmonar/fisiologia , Enfisema Pulmonar/cirurgia , Cintilografia , Compostos Radiofarmacêuticos , Sensibilidade e Especificidade , Estatística como Assunto , Agregado de Albumina Marcado com Tecnécio Tc 99m
9.
Radiat Med ; 18(5): 299-304, 2000.
Artigo em Inglês | MEDLINE | ID: mdl-11128400

RESUMO

PURPOSE: In the early stages, clinical and chest radiographic findings of acute interstitial pneumonia (AIP) are often similar to those of bronchiolitis obliterans organizing pneumonia (BOOP). However, patients with AIP have a poor prognosis, while those with BOOP can achieve a complete recovery after corticosteroid therapy. The objective of this study was to identify differences in high-resolution CT (HRCT) findings between the two diseases. METHODS: The study included 27 patients with AIP and 14 with BOOP who were histologically diagnosed [open-lung biopsy (n=7), autopsy (n=17), transbronchial lung biopsy (n=17)]. The frequency and distribution of various HRCT findings for each disease were retrospectively evaluated. RESULTS: Traction bronchiectasis, interlobular septal thickening, and intralobular reticular opacities were significantly more prevalent in AIP (92.6%, 85.2%, and 59.3%, respectively) than in BOOP (42.9%, 35.7%, and 14.3%, respectively) (p<0.01). Parenchymal nodules and peripheral distribution were more prevalent in BOOP (28.6% and 57.1%, respectively) than in AIP (7.4% and 14.8%, respectively) (p<0.01). Areas with ground-glass attenuation, air-space consolidation, and architectural distortion were common in both AIP and BOOP. CONCLUSION: For a differential diagnosis of AIP and BOOP, special attention should be given to the following HRCT findings: traction bronchiectasis, interlobular septal thickening, intralobular reticular opacities, parenchymal nodules, pleural effusion, and peripheral zone predominance.


Assuntos
Pneumonia em Organização Criptogênica/diagnóstico por imagem , Doenças Pulmonares Intersticiais/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Doença Aguda , Adulto , Idoso , Idoso de 80 Anos ou mais , Biópsia , Bronquiectasia/diagnóstico por imagem , Distribuição de Qui-Quadrado , Diagnóstico Diferencial , Feminino , Humanos , Processamento de Imagem Assistida por Computador/métodos , Pulmão/patologia , Masculino , Pessoa de Meia-Idade , Derrame Pleural/diagnóstico por imagem , Prognóstico , Estudos Retrospectivos , Tomógrafos Computadorizados , Tomografia Computadorizada por Raios X/métodos
10.
Radiology ; 217(3): 907-10, 2000 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-11110962

RESUMO

A respiratory gating technique was developed to allow computed tomography-guided needle biopsy of small pulmonary nodules. Twenty-three pulmonary nodules less than 15 mm in diameter underwent biopsy with the use of this technique. There were 14 true-positive, eight true-negative, and one false-negative result (diagnostic accuracy, 96%). The diagnostic accuracy for small nodules without this technique in a historical control was 69% (P: <.05).


Assuntos
Biópsia por Agulha/métodos , Nódulo Pulmonar Solitário/patologia , Tomografia Computadorizada por Raios X , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Radiologia Intervencionista , Nódulo Pulmonar Solitário/diagnóstico por imagem
11.
Radiology ; 216(2): 531-8, 2000 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-10924582

RESUMO

PURPOSE: To determine whether lung abnormalities at thin-section computed tomography (CT) in experimental hyperoxic lung injury correlate with the pathologic phases of diffuse alveolar damage (DAD). MATERIALS AND METHODS: Eighteen juvenile pigs were exposed to more than 80% oxygen-for 24, 48, 72, 96, or 120 hours-or room air in sealed cages. Their removed lungs were inflated with air infused through the trachea and examined with thin-section CT. Two independent observers, without knowledge of the exposure times, compared 63 areas selected on the CT scans with the corresponding pathologic and histologic findings, which were evaluated independently by two pathologists. RESULTS: CT findings correlated well with histologic findings (rho = 0.86, P <.001), which corresponded to the pathologic phases of DAD. All areas of normal CT attenuation, eight of nine spared regions within areas of opacity, and two of 15 areas of ground-glass opacity corresponded to the early exudative pathologic phase of DAD. All areas that showed traction bronchiolectasis at CT corresponded to the early proliferative pathologic phase. There was good observer agreement regarding the interpretation of CT findings (kappa statistic, >0.60) and histologic results (>/=0.70). CONCLUSION: Thin-section CT findings reflect the pathologic phases of DAD, although the early exudative phase cannot be specifically depicted by thin-section CT. Traction bronchiolectasis on a CT scan suggests progression to the proliferative phase.


Assuntos
Hiperóxia/diagnóstico por imagem , Alvéolos Pulmonares/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Animais , Brônquios/patologia , Bronquiectasia/diagnóstico por imagem , Bronquiectasia/patologia , Broncografia , Capilares/patologia , Cricetinae , Progressão da Doença , Epitélio/patologia , Exsudatos e Transudatos , Hemorragia/patologia , Hialina , Hiperóxia/patologia , Processamento de Imagem Assistida por Computador/métodos , Variações Dependentes do Observador , Alvéolos Pulmonares/patologia , Edema Pulmonar/patologia , Suínos , Fatores de Tempo
12.
J Thorac Imaging ; 15(3): 162-7, 2000 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-10928607

RESUMO

The aim of the present study was to assess the evolution of various computed tomographic (CT) findings of lymphocytic interstitial pneumonia (LIP) with determination of potentially reversible or irreversible features. The study included 14 patients with biopsy-proved LIP who had serial thin-section CT examination 4 to 82 months (median 13 months) apart. Initial and follow-up CT scans were evaluated independently and then directly compared with each other by two observers. The main parenchymal abnormalities on the initial CT scan consisted of ground-glass attenuation (n = 14), thickening of interlobular septa (n = 13), centrilobular nodules (n = 12), cystic airspaces (n = 10), and airspace consolidation (n = 4). On follow-up CT, nine patients improved, one showed no change, and four showed increased extent of disease. With the exception of cysts, the parenchymal opacities were reversible. On follow-up CT, new cysts were seen in three patients; these developed mainly in areas with centrilobular nodules on initial CT. Honeycombing was seen on follow-up CT in four patients; in three patients it developed in areas of airspace consolidation and in one patient it developed in an area with ground-glass attenuation on initial CT. The majority of patients with LIP improved on follow-up. However, airspace consolidation may progress to honeycombing and centrilobular nodules may precede cystic formation.


Assuntos
Doenças Pulmonares Intersticiais/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Processamento de Imagem Assistida por Computador , Doenças Pulmonares Intersticiais/patologia , Masculino , Pessoa de Meia-Idade
13.
AJR Am J Roentgenol ; 174(2): 517-21, 2000 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-10658733

RESUMO

OBJECTIVE: We assessed the high-resolution CT findings of pulmonary leukemic infiltrates. CONCLUSION: High-resolution CT findings of pulmonary leukemic infiltrates reflect the predilection of leukemic cells to involve the perilymphatic pulmonary interstitium.


Assuntos
Infiltração Leucêmica/diagnóstico por imagem , Pulmão/diagnóstico por imagem , Pulmão/patologia , Tomografia Computadorizada por Raios X , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
14.
Radiat Med ; 18(4): 233-8, 2000.
Artigo em Inglês | MEDLINE | ID: mdl-11246998

RESUMO

PURPOSE: The purpose of this study was to survey the usefulness of high-resolution CT (HRCT) for the evaluation of activity in acute and subacute non-infectious diffuse infiltrative lung diseases before and after corticosteroid treatment. PATIENTS AND METHODS: Sequential HRCT images and chest radiographs obtained before and after treatment were retrospectively evaluated in 33 patients with acute or subacute noninfectious diffuse infiltrative lung diseases. All these patients were histologically confirmed to have pulmonary Inflammation and to have responded to treatment with corticosteroid. Radiographic and CT scores were correlated with the degree of dyspnea and the results of arterial blood gas analysis using Spearman's rank-correlation coefficient. RESULTS: On follow-up HRCT, the profusion score of areas with increased attenuation was significantly correlated with arterial oxygen tension (PaO2) (p=.003, r=-.53) and the alveolar-arterial oxygen tension difference (AaDO2) (p=.001, r=.57). No other correlation was found after treatment. Nodular and linear opacities were more commonly seen on follow-up chest radiographs and HRCT images than on initial ones. CONCLUSION: HRCT is useful for the evaluation of disease activity in acute and subacute noninfectious infiltrative lung diseases before and after treatment if paying special attention to the profusion of ground-glass attenuation. Even if pretreatment HRCT has not been performed, posttreatment HRCT should be examined.


Assuntos
Pneumopatias/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Doença Aguda , Corticosteroides/uso terapêutico , Feminino , Seguimentos , Humanos , Pneumopatias/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Tempo
15.
AJR Am J Roentgenol ; 173(6): 1617-22, 1999 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-10584810

RESUMO

OBJECTIVE: Our objective was to assess high-resolution CT findings of respiratory bronchiolitis, respiratory bronchiolitis-associated interstitial lung disease, and desquamative interstitial pneumonia and to determine whether these three entities could be reliably differentiated by radiologic criteria. MATERIALS AND METHODS: CT scans (1- to 3-mm collimation) were reviewed in 40 patients with pathologically proven respiratory bronchiolitis (n = 16), respiratory bronchiolitis-associated interstitial lung disease (n = 8), or desquamative interstitial pneumonia (n = 16). All patients with respiratory bronchiolitis and respiratory bronchiolitis-associated interstitial lung disease were cigarette smokers, and 85% of the patients with desquamative interstitial pneumonia had a history of smoking. CT scans were independently reviewed by two radiologists who assessed the pattern and distribution of abnormalities. RESULTS: The predominant abnormalities in respiratory bronchiolitis were centrilobular nodules (12 [75%] of 16 patients) and ground-glass attenuation (six [38%] of 16). No single abnormality predominated in the respiratory bronchiolitis-associated interstitial lung disease group; findings included ground-glass attenuation (four [50%] of eight), centrilobular nodules (three [38%] of eight), and mild fibrosis (two [25%] of eight). All patients with desquamative interstitial pneumonia showed ground-glass attenuation, and 10 (63%) of the 16 showed evidence of fibrosis. CONCLUSION: The significant overlap between the CT findings of respiratory bronchiolitis, respiratory bronchiolitis-associated interstitial lung disease, and desquamative interstitial pneumonia is consistent with the concept that they represent different degrees of severity of small airway and parenchymal reaction to cigarette smoke.


Assuntos
Bronquiolite/diagnóstico por imagem , Doenças Pulmonares Intersticiais/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Adulto , Idoso , Bronquiolite/etiologia , Bronquiolite/patologia , Feminino , Humanos , Pulmão/diagnóstico por imagem , Pulmão/patologia , Doenças Pulmonares Intersticiais/etiologia , Doenças Pulmonares Intersticiais/patologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fumar/efeitos adversos
16.
AJR Am J Roentgenol ; 173(6): 1623-9, 1999 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-10584811

RESUMO

OBJECTIVE: The purpose of this study was to analyze the high-resolution CT features of diffuse bronchioloalveolar carcinoma and determine the useful findings in differential diagnosis. MATERIALS AND METHODS: High-resolution CT scans of 38 patients with pathologically proven diffuse bronchioloalveolar carcinoma were reviewed. Sequential CT scans were obtained in 15 patients. The high-resolution CT findings were compared with those of eosinophilic pneumonia (n = 22), multiple pulmonary metastases (n = 12), and tuberculosis (bronchogenic: n = 22; miliary: n = 12). RESULTS: High-resolution CT findings of diffuse bronchioloalveolar carcinoma included ground-glass opacity (n = 29), consolidation (n = 29), nodules (n = 28), centrilobular nodules (n = 26), peripheral distribution (n = 19), and air bronchogram (n = 18). According to the major features, high-resolution CT findings of diffuse bronchioloalveolar carcinoma could be classified into three patterns: predominantly ground-glass (n = 4), consolidative (n = 22), and multinodular (n = 12). Most patients with diffuse bronchioloalveolar carcinoma had a mixture of these findings. The frequency of findings of diffuse bronchioloalveolar carcinoma on high-resolution CT was not different from that of tuberculosis, but the predominant distribution of the nodules and areas of ground-glass attenuation differed between the two. Difference in distribution between bronchioloalveolar carcinoma and bronchogenic tuberculosis included ground-glass opacity remote from the consolidation and a lower lung predominance. CONCLUSION: Although these high-resolution CT findings are not specific, the combination of consolidation and nodules and the coexistence of centrilobular nodules and remote areas of ground-glass attenuation are characteristic of diffuse bronchioloalveolar carcinoma.


Assuntos
Adenocarcinoma Bronquioloalveolar/diagnóstico por imagem , Neoplasias Pulmonares/diagnóstico por imagem , Intensificação de Imagem Radiográfica , Tomografia Computadorizada por Raios X , Adenocarcinoma Bronquioloalveolar/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Biópsia , Diagnóstico Diferencial , Feminino , Humanos , Pulmão/diagnóstico por imagem , Pulmão/patologia , Neoplasias Pulmonares/patologia , Neoplasias Pulmonares/secundário , Masculino , Pessoa de Meia-Idade , Eosinofilia Pulmonar/diagnóstico por imagem , Eosinofilia Pulmonar/patologia , Tuberculose/diagnóstico por imagem , Tuberculose/patologia
17.
Radiology ; 212(2): 567-72, 1999 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-10429719

RESUMO

PURPOSE: To assess the thin-section computed tomographic (CT) findings of lymphocytic interstitial pneumonia. MATERIALS AND METHODS: The study included 22 patients (five men, 17 women; age range, 24-83 years; mean age, 50 years) with biopsy-proved lymphocytic interstitial pneumonia. The CT scans were obtained by using 1-3-mm collimation and reconstructed by using a high-spatial-frequency algorithm. RESULTS: The predominant abnormalities consisted of areas of ground-glass attenuation and poorly defined centrilobular nodules present in all 22 patients and subpleural small nodules seen in 19 patients. Other common findings included thickening of bronchovascular bundles (n - 19), interlobular septal thickening (n = 18), cystic airspaces (n = 15), and lymph node enlargement (n = 15). Less common findings included large nodules, emphysema, airspace consolidation, bronchiectasis, architectural distortion, honeycombing, and pleural thickening. CONCLUSION: Lymphocytic interstitial pneumonia is characterized by the presence of ground-glass attenuation, poorly defined centrilobular nodules, and thickening of the interstitium along the lymphatic vessels. Lymph node enlargement is more common than previously recognized; it was seen in 68% of patients.


Assuntos
Doenças Pulmonares Intersticiais/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Biópsia , Feminino , Humanos , Processamento de Imagem Assistida por Computador , Pulmão/diagnóstico por imagem , Linfonodos/diagnóstico por imagem , Linfonodos/patologia , Sistema Linfático/patologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
18.
AJR Am J Roentgenol ; 173(1): 47-52, 1999 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-10397098

RESUMO

OBJECTIVE: The aim of the study was to determine whether various causes of bronchiectasis can be differentiated by the pattern and distribution of abnormalities seen on high-resolution CT. MATERIALS AND METHODS: The retrospective study included 82 consecutive patients who had a specific diagnosis of bronchiectasis proven by appropriate clinical and laboratory criteria. All patients underwent high-resolution CT scanning (1- to 1.5-mm collimation). The CT scans were assessed for the presence, extent, type, and anatomic distribution of bronchiectasis by two independent observers who were not aware of the clinical data. The observers recorded their most likely diagnosis and the degree of confidence in that diagnosis. RESULTS: The two independent observers made a correct diagnosis in 61% of cases (100/164 interpretations). On average, a correct diagnosis was made in 19 (68%) of 28 cases of cystic fibrosis, 16 (67%) of 24 cases of previous tuberculosis, six (43%) of 14 cases of previous childhood infection, five (56%) of nine cases of allergic bronchopulmonary aspergillosis, and four (57%) of seven cases of other causes of bronchiectasis. We found moderate agreement between the observers for the correct diagnosis (kappa = .53) and good agreement for the presence or absence of bronchiectasis in each lobe (kappa = .71). CONCLUSION: The pattern and distribution of abnormalities revealed by high-resolution CT in patients with bronchiectasis are influenced by the underlying cause. Bilateral, predominantly upper lobe, bronchiectasis is seen most commonly in patients with cystic fibrosis and allergic bronchopulmonary aspergillosis, unilateral upper lobe predominance in patients with tuberculosis, and lower lobe predominance in patients after childhood viral infection.


Assuntos
Bronquiectasia/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Aspergilose Broncopulmonar Alérgica/complicações , Bronquiectasia/etiologia , Fibrose Cística/complicações , Diagnóstico Diferencial , Feminino , Humanos , Pulmão/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Infecções Respiratórias/complicações , Estudos Retrospectivos , Tuberculose Pulmonar/complicações
19.
AJR Am J Roentgenol ; 173(1): 71-4, 1999 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-10397102

RESUMO

OBJECTIVE: Lymphoproliferative disorders span a spectrum from inflammatory lesions to malignant neoplasms. The purpose of this study was to compare high-resolution CT findings of lymphocytic interstitial pneumonia with those of malignant lymphoma of the chest. MATERIALS AND METHODS: The study included 17 patients with lymphocytic interstitial pneumonia and 44 patients with malignant lymphoma (35 with non-Hodgkin's lymphoma and nine with Hodgkin's disease). Without knowledge of the pathologic diagnosis, two chest radiologists evaluated the frequency and distribution of high-resolution CT findings in both groups of patients. RESULTS: Cysts were more common in patients with lymphocytic interstitial pneumonia (14/17, 82%) than in patients with malignant lymphoma (1/44, 2%) (p < .0001). Air-space consolidation was more commonly seen in patients with malignant lymphoma (29/44, 66%) than in patients with lymphocytic interstitial pneumonia (3/17, 18%) (p < .001). Large nodules (11-30 mm in diameter) were more common in patients with malignant lymphoma (41%) than in patients with lymphocytic interstitial pneumonia (6%). Pleural effusions (25%) were seen only in patients with malignant lymphoma. We found no statistically significant difference in the distribution of lung lesions between patients with lymphocytic interstitial pneumonia and patients with malignant lymphoma. CONCLUSION: On high-resolution CT, cysts are characteristic in patients with lymphocytic interstitial pneumonia, whereas consolidation, large nodules, and pleural effusions are characteristic in patients with malignant lymphoma. These findings on high-resolution CT help differentiate lymphocytic interstitial pneumonia from malignant lymphoma.


Assuntos
Doenças Pulmonares Intersticiais/diagnóstico por imagem , Neoplasias Pulmonares/diagnóstico por imagem , Linfoma/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Adulto , Idoso , Idoso de 80 Anos ou mais , Diagnóstico Diferencial , Feminino , Humanos , Pulmão/diagnóstico por imagem , Pulmão/patologia , Doenças Pulmonares Intersticiais/patologia , Linfócitos/patologia , Transtornos Linfoproliferativos/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade
20.
AJR Am J Roentgenol ; 173(1): 75-9, 1999 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-10397103

RESUMO

OBJECTIVE: The purpose of this study was to correlate thin-section CT findings with histologic findings for the three histopathologic subtypes of localized bronchioloalveolar carcinoma. CONCLUSION: Thin-section CT can be used to predict the histologic subtype of bronchioloalveolar carcinoma.


Assuntos
Adenocarcinoma Bronquioloalveolar/diagnóstico por imagem , Neoplasias Pulmonares/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Adenocarcinoma Bronquioloalveolar/classificação , Adenocarcinoma Bronquioloalveolar/patologia , Adulto , Idoso , Feminino , Humanos , Pulmão/diagnóstico por imagem , Pulmão/patologia , Neoplasias Pulmonares/classificação , Neoplasias Pulmonares/patologia , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos
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