CAJ | 학술논문

目的探讨HRCT上肺细网状影的形态学表现及病理基础.方法搜集本院2004年8月至2007年2月107例在HRCT上有细网状影患者临床病例资料进行细网状影形态学及动态变化分析研究.搜集24例病理证实充气标本进行影像与病理的对照研究.用X~2检验进行统计学分析.结果细网状影网间隙直径一般≤3 mm,为圆形或不规则形,网间隙内为肺实质密度.网壁光滑或粗糙,厚度约≤1 mm.107例临床患者细网状影的伴随征象有磨玻璃密度影(GGO)(68.2%,73例)、铺路石征(23.4%,25例)、小叶间隔增厚(84.1%,90例)、肺气肿(32.7%,35例)、界面征(58.9%,63例)、牵拉性支气管扩张(41.1%,44例)及蜂窝征(26.2%,28例).纤维化患者与肺炎患者在蜂窝、牵拉性支气管扩张、小叶间隔增厚、界面征及铺路石征方面差异有统计学意义(P均＜0.01).肺炎大片状GGO合并细网状影形成铺路石征;癌性淋巴管炎细网状影合并小叶间隔增厚,并见串珠样结节影;特发性肺纤维化(IPF)细网状影多镶嵌在蜂窝之间;结缔组织病(CTD)并肺间质纤维化早期以细网状影为主,蜂窝影少见,及时治疗后可完全或部分吸收;慢性支气管炎细网状影合并肺气肿.58例随访患者中26例网状影增加,22例网状影减少或消失,10例无变化.24例肺标本细网状影病理基础主要为小叶内间质纤维增生、炎性细胞及肿瘤细胞浸润、渗出液充填、煤尘沉积等.结论细网状影是由小叶内间质增厚形成,可由炎症、间质增生、肺纤维化和肿瘤引起,有助于提示这些疾病的存在,诊断价值需结合其他CT表现及动态变化.
목적 탐토HRCT상폐세망상영적형태학표현급병리기출.방법 수집본원2004년8월지2007년2월107례재HRCT상유세망상영환자림상병례자료진행세망상영형태학급동태변화분석연구.수집24례병리증실충기표본진행영상여병리적대조연구.용X~2검험진행통계학분석.결과 세망상영망간극직경일반≤3 mm,위원형혹불규칙형,망간극내위폐실질밀도.망벽광활혹조조,후도약≤1 mm.107례림상환자세망상영적반수정상유마파리밀도영(GGO)(68.2%,73례)、포로석정(23.4%,25례)、소협간격증후(84.1%,90례)、폐기종(32.7%,35례)、계면정(58.9%,63례)、견랍성지기관확장(41.1%,44례)급봉와정(26.2%,28례).섬유화환자여폐염환자재봉와、견랍성지기관확장、소협간격증후、계면정급포로석정방면차이유통계학의의(P균＜0.01).폐염대편상GGO합병세망상영형성포로석정;암성림파관염세망상영합병소협간격증후,병견천주양결절영;특발성폐섬유화(IPF)세망상영다양감재봉와지간;결체조직병(CTD)병폐간질섬유화조기이세망상영위주,봉와영소견,급시치료후가완전혹부분흡수;만성지기관염세망상영합병폐기종.58례수방환자중26례망상영증가,22례망상영감소혹소실,10례무변화.24례폐표본세망상영병리기출주요위소협내간질섬유증생、염성세포급종류세포침윤、삼출액충전、매진침적등.결론 세망상영시유소협내간질증후형성,가유염증、간질증생、폐섬유화화종류인기,유조우제시저사질병적존재,진단개치수결합기타CT표현급동태변화.
Objective To study the morphological appearance and pathological basis of the fine pulmonary reticulation at HRCT.Methods One hundred and seven patients were analyzed about the morphology findings and dynamic changes on pulmonary HRCT.Twenty-four coal worker's pneumoconiosis(CWP)specimens were examined to make comparison between CT and pathology.The data was analyzed by using the Chi-square test.Results The reticular gap was less than 3 mm in diameter.The morphology of reticulation was round or irregular.Pulmonary parenchyma was seen between the gaps.The reticular wall was smooth or coarse.The thickness was less than 1 mm.One hundred and seven patients had accompanying signs including ground-glass opacity(68.2%,73 patients),crazy paving(23.4%,25 patients),interlobular septal thickening(84.1%,90 patients),emphysema(32.7%,35 patients),interface sign(58.9%,63 patients),traction bronchiolectasis(41.1%,44 patients)and honeycombing(26.2%,28 patients).The differences of the honeycomb,traction bronchiolectosis,interbobular septal thickening,interface sign and paving were statistically significant between the fibrotic group and pneunonia(P＜0.01).Pneumonia showed extensive area of ground-glass opacity(GGO)with fine reticulation.Fine reticulation with both interlobular septal thickening and small nodules were observed more frequently in lmphangitic carcinomatosis.Idiopathic pulmonary fibrosis(IPF)showed fine reticulation among the honeycombing.Connective tissue disease (CTD)showed fine reticulation with rarely honeycombing and it could be partly absorbed.Fine reticulation with emphysema was seen in chronic bronchitis.In the 58 follow-up patients,the fine reticulation increased in 26 patients,decreased or disappeared in 22 patients and showed no change in 10 patients.The major pathological basis of the fine reticulation was intralobular interstitial thickening,including fibrosis hyperplasia,inflammatory cells and tumor cells infiltration,effusion filling,smut deposition and so on.Conclusions The fine reticulation was caused by intralobular interstitial thickening including inflammation,interstitial hyperplasia,pulmonary fibrosis and tumor.The fine reticulation is helpful to prompt the diagnosis of these diseases,but the diagnosis need its combination with the other CT findings and dynamic changes.