高分辨率CT上肺细网状影的形态分析及病理基础  

Morphological analysis and pathological basis of the fine pulmonary reticulation at high-resolution CT

作　　者：关春爽[1] 马大庆[1] 关砚生[2] 陈步东[1] 张岩松[2] 

机构地区：[1]首都医科大学附属北京友谊医院放射科,100050 [2]国家安全生产监督管理总局职业安全卫生研究所

出　　处：《中华放射学杂志》2010年第4期374-378,共5页Chinese Journal of Radiology

摘　　要：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x2检验进行统计学分析。结果细网状影网间隙直径一般≤3mm，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≤1mm。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。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 c

关 键 词：尘肺 体层摄影术 X线计算机 病理学 

分 类 号：R816.4[医药卫生—放射医学]