肺部弥漫性磨玻璃阴影的CT诊断与鉴别诊断

[](1971-),,,,。:。E-mail:[e-mail][],,,450003。E-mail:[e-mail][]2007-01-09　　[]2007-06-05CTdiagnosisanddifferentialdiagnosisofpulmonarydiffuseground-glassopacityLEIZhi-dan,GEYing-hui*,SHIDa-peng(DepartmentofRadiology,HenanProvincialPeople'sHospital,Zhengzhou450003,China)[Abstract]　Objective　TostudytheCTfeaturesofpulmonarydiseaseswithdiffuseground-glassopacity(DGGO),andtoimprovediagnosticanddifferentialdiagnosticaccuracyofthesesdiseases.Methods　Theclinical,CTandhigh-resolutionCT(HRCT)materialsof121cases'DGGOwhichwereprovedbypathologyorclinicalcomprehensivediagnosiswereretrospec-tivelyanalyzed,anditsCTfeaturesweresummarized.Thevaluablediagnosticanddifferentialdiagnosticsignswereinvesti-gated.Results　Inthese121cases,23caseswerethediseaseswithabnormityofinherentpulmonarystructures,including18cases'interstitialpneumoniaand5cases'connectivetissuedisease.TheDGGOhadperipherallydistributedwithinterstitialthickening,fibrosis,tractivebronchiectasisorhoneycombshadow.Twentycaseswerethediseaseswithabnormityofpul-monaryair-space'sfillingstate,including10cases'allergicpneumonia,5cases'pulmonaryhemorrhage,3cases'metastaicne-oplasmand2cases'alveolarcellcarcinoma.TheDGGOhadcentrallydistributedwithlobularcentralnode,acinosenodeormass.26caseswerethediseaseswithabnormityofextravascularfluidoverload,including21cases'pulmonaryedemaand5cases'contusionoflung.TheDGGOhaddistributedpulmonarypendulousregionorrelativependulousregion.15caseswerethediseaseswithabnormityofpulmonaryblood'snon-homogenousperfusion,including11cases'pulmonaryembolismand4cases'Behcet'ssyndrome.TheDGGOhadpresentedmosaic-fashion'sshadowortheDGGOhaddistributedthroughoutonelaterallung.37caseswerethediseaseswithtwoorsuper-twokingsofabnormity,including25cases'chronicobstructivepulmonarydisease,7cases'pulmonaryalveolarproteinosisand5cases'viralpneumonia.TheDGGOhadpresentedmosaic-fashion'sshadoworgeographicchangeorcrazingpavingpattern,ortheDGGOhadcentrallydistributedwithlobularcentralnode,acinosenodeandinterstitialfibrosis.Conclusion　DGGOmaybeseeninvariousdiseases.Toanalyzethemorphology,distribution,concomitantsignsanddynamicchangesofDGGOcanpreliminarilycomprehenditspathologicalbasisandpatho-genicmechanism.Incombinationwithclinicalmaterials,therangeofdiagnosticpossibilitiescanbeshrinked.[Keywords]　Lungdisease;Ground-glassopacity;Tomography,X-raycomputedCT雷志丹,葛英辉*,史大鹏(1.,　450003)[　]　　CT,。　121CT、HRCT,CT,CTHRCT。　121,185,、,。:10、5、32,、,、。215,,;,。114,,,。25、711472007238　ChinJMedImagingTechnol,2007,Vol23,No8DOI牶牨牥牣牨牫牴牪牴牤j牣牨牥牥牫牠牫牪牳牴牣牪牥牥牱牣牥牳牣牥牫牳5,-,,;,。　,、、,,。[]　;;,X[]　R814.42;R563　[]　A　　[]　1003-3289(2007)08-1147-05　　(ground-glassopacity,GGO)CT,。GGO,[1-4],(diffuseground-glasso-pacity,DGGO),。20011-2006126513121,CT、HRCT,DGGOCT,。1　1.1　121DGGO,83,38,19～73,47。121。、、(1)。1.2　XCT,67HRCT,112CTPA,831～3/CT。XCRDR。CTLightSpeedPlus4CT。7.5mm,1.5∶1,5mm,,512×512,,。HRCTCT59CT(VHRCT)8,HRCT1.25mm,10mm,,,;VHRCT2.5mm,3∶1,1.25mm,,。CTPA2.5mm,3∶1,1.25mm,,512×512,(300mgI/ml)100ml,,3.0ml/s,18～22s。2cm2cm。,(MPR)、(MIP)、(SSD)、(VR)、(VE)。1.3　GGO,[1,2],DGGO。,。,。,2121、CTHRCT,5,3、CTPA1　UIP,DGGO,、　　2　,DGGO,(),　　3　　A.CT,DGGO,;B.HRCT,GGO、()　　4　　A.1CT,DGGO,;B.5HRCT,GGO　　5　,2CT、,GGO,,　　6　,DGGO()、()(),,()11482007238　ChinJMedImagingTechnol,2007,Vol23,No87　　A.DGGO,,,;B.DGGO,(),(),,　　8　,CTDG-GO,　　9　　A.VHRCTDGGO,;B.CTPA,()　　10　　A.,()GGO(),;B.VR,,　　11　。DGGO,()()1　121DGGO()23212237720191132013262332626261513215443737-3485,DGGOCT。2　2.1DGGO　121DGGO513,:23,185;20,10、5、32;26,21,5;15,114;37,25、75。DGGO,,1。2.2DGGO　①18(1),15DGGO,3,18、,13,1;2DGGO,、、、;2(2)1DGGO,,。②10(3)DGGO,,GGO,,GGO;5(4)DGGO,,;3(5),,GGO;2(6)DGGO,GGO、,。③21(7),DGGO,、,8,19,18,17,4;5(8)DGGO,3、,3,1。④11(9),7DG-GO,4DGGO,,10、7、54;4(10)DGGO,3,1。⑤25DGGO,,25,17(11);7DGGO“”(12);5DGGO,5,311492007238　ChinJMedImagingTechnol,2007,Vol23,No8GGO,2“”(13)。12　　DGGO“”　　13　　DGGO,(),GGO“”()2.3DGGO　83,9,、,6UIPDGGO,,3NSIP;22。85DGGO。21DGGO,5。114DGGO。10、DGGO;3,DGGO;3,DGGO,。3　3.1　、、。,,、,[5,6]。,DGGO。3.2DGGO、　GGO、-[2],GGO。DGGO,。DGGO,4,5。①185DGGO,GGO,、,GGO。,、,、,、,GGO,DGGO[7,8]。②105DG-GO,,GGO,DGGO[1,9];3DGGO、[6];2DGGO,GGO、,,DGGO、[10]。③21DGGO,、,、、,,,,DGGO[11];5DGGO,[12]。④11,7DGGO,,,[5,13],4DGGO,,GGO;4DGGO,[5]。⑤25DGGO,-DGGO[2,5];7DGGO“”,,GGO,DGGO[5,14];5DGGO,、“”,DGGO、[15,16]。3.3DGGO　83,6UIP10DGGO,-,GGO。67,、、、11502007238　ChinJMedImagingTechnol,2007,Vol23,No8,DGGO,。3.4DGGO　DGGO,DGGOGGO、、、,、。DGGO,、,,、,,、、。DG-GO,、,,、、,,,。DGGO、,、,,,。DGGO,,,。DGGO,、,、,,DGGO“”。DGGO、、、“”,,[15,16]。[]1　JiJLLiTYGroundglassopacityJJournalofClinicalRadiol-ogy1994133150-153J1994133150-1532　HeWMaDQFengJetalThediagnosticvalueofgroundglassopacityonHRCTofthelungJChinJRadiol200135152-55CTJ200135152-553　MaJXMaoJRLiJAnalysisofground-glassshadowinthelungwithchestXrayandCTJJPMI200234248-250XCTJ200234248-2504　ZhangCTCaiXQChenMQetalCTanalysisof12cases'pul-monaryfocalgroundglassopacityJChinJMisdiagn20066153022-302312CTJ20066153022-30235　LeiZDLuYSJiaWLetalClinicalsignificanceofnon-homog-enouspulmonarydensityinimagingdiagnosisoflungdiseaseJJournalofPracticalDiagnosisandTherapy2006202125-126J2006202125-1266　NakataMSaekiHTakataIeta