ANCA阳性小血管炎的胸部高分辨率CT表现  

Pulmonary high-resolution CT findings in ANCA-associated small vessel vasculitis

作　　者：林志谦[1] 许建荣[1] 程杰军[1] 刘晓晟[1] 张科蓓[1] 华小兰[1] 

机构地区：[1]上海交通大学医学院附属仁济医院放射科,上海200001

出　　处：《医学影像学杂志》2010年第6期816-819,共4页Journal of Medical Imaging

基　　金：上海市重点学科建设项目(S30203);上海交通大学医学院重点学科建设项目

摘　　要：目的:探讨ANCA阳性小血管炎(ANCA-associated small vessel vasculitis,AASV)的肺部高分辨率CT(HRCT)的影像学表现。方法:搜集26例经临床证实的ANCA阳性小血管炎的胸部HRCT资料,对其HRCT表现进行回顾性分析。结果:AASV的主要表现包括:①间质性改变:主要为网状改变,不规则网状改变17例(65.4%)、结节状网状改变3例(11.5%),在不规则网状改变中,树冠征阳性较具特点,共7例;其它有小叶间隔增厚22例(84.6%)、磨玻璃影22例(84.6%)、支气管扩张9例(34.6%)、胸膜下线7例(26.9%)。囊状改变:葡萄串样2例(7.7%)、串珠样13例(50%)、蜂窝样9例(34.6%),囊内小叶核心征阳性较具特点,共13例(50%);②肺泡改变:其中弥漫渗出较具特点,共8例(30.8%),局部渗出1例(3.8%)、空气捕捉征3例(11.5%)、树芽征1例(3.8%)、实变灶3例(11.5%);③结节改变:均为散发,共10例(38.5%);④其它影像学改变:包括条索影22例(84.6%),斑片影12例(46.1%)、钙化灶(近胸膜下)3例(11.5%)、胸膜增厚17例(65.4%),结节状叶间胸膜增厚较具特点,共5例(19.2%),肺不张4例(15.4%)、纵隔、腋下淋巴结显示25例(96.2%);肿大4例(15.4%)、胸腔积液7例(26.9%)、心包积液4例(15.4%)、肺动脉高压3例(11.5%);⑤10位患者随访结果:无变化3例、加重5例,减轻2例。结论:HRCT可提供ANCA阳性小血管炎胸部病变的众多信息,对ANCA阳性小血管炎诊疗有重要参考价值。Objective：To investigate the pulmonary high-resolution CT（HRCT） imaging findings of ANCA-associated small vessel vasculitis（AASV）.Methods：Two chest radiologists retrospectively evaluated chest CT scans from 26 patients with AASV.Results：In this group,AASV features were as fouows.① interstitial changes included reticulate changes in 20 cases（76.9%）,irregular reticulate in 17 cases and nodular reticulate in 3 cases.Irregular reticulate was like a tree crown in 7 cases.Cystic change included grape bunch-like in 2 cases（7.7%）,bead-like in 13 cases（50%）,and cellular-like in 9 cases（34.6%）;② pulmonary changes included diffuse effusion in 8 cases（30.8%）,local effusion in 1 case（3.8%）,and air trap sign in three cases（11.5%）;③ nodular changes included scattered distributing in all 10 cases（38.5%）;④ Other image changes included bronchiectasis in 9 cases（34.6%）,pleural thickening in 17 cases（65.4%）,nodular pleural thickening was more characteristic in 5 cases（19.2%）,atelectasis in 4 cases（15.4%）,mediastinal and axillary lymph node in 25 cases（96.2%）;enlarged in 4 cases（15.4%）,pleural effusion in 7 cases（26.9%）,pericardial effusion in 4 cases（15.4%）,pulmonary hypertension in 3 cases（11.5%）;⑤ 10 patients with follow-up results showed that no change in 3 cases,increased in 5 cases and reduced in 2 cases.Conclusion：HRCT can provide a lot of manifestations of chest involvements in AASV,which play an important role in reference for the diagnosis and treatment in AASV.

关 键 词：ANCA阳性小血管炎 间质性肺疾病 体层摄影术 X线计算机 

分 类 号：R563[医药卫生—呼吸系统] R814.42[医药卫生—内科学]