Kazuya Ichikado

High-resolution CT findings of lung disease in patients with polymyositis and dermatomyositis.

The purpose of this study was to determine the type and distribution of interstitial lung disease seen in patients with polymyositis and dermatomyositis, using high-resolution computed tomography (HRCT). The presence and distribution of high-resolution CT findings were retrospectively evaluated in 25 patients with polymyositis/dermatomyositis. In 14 patients, a pathological diagnosis of pulmonary disease was obtained. Three lung specimens were also studied. Results showed that 23 patients had abnormal HRCT showing the following abnormalities: ground glass opacities (92%), linear opacities (92%), irregular interfaces (88%), airspace consolidation (52%), parenchymal micronodules (28%), and honeycombing (16%). A relatively high prevalence of airspace consolidation (52%) and a low prevalence of honeycombing (16%) were observed. Two patients with extensive consolidation proved to have diffuse alveolar damage; eight patients with either subpleural band-like opacities (n = 5) and/or airspace consolidation (n = 7) had bronchiolitis obliterans organizing pneumonia; four patients with honeycombing had usual interstitial pneumonitis. We conclude that HRCT findings in patients with polymyositis/dermatomyositis are nonspecific. However, a high prevalence of airspace consolidation and a low prevalence of honeycombing were observed. Predominant HRCT patterns are suggestive of the pathologic processes occurring in polymyositis/dermatomyositis.

Acute Exacerbation of Chronic Interstitial Pneumonia: High-resolution Computed Tomography and Pathologic Findings

Purpose To review the high-resolution computed tomography (CT) and histologic findings of acute exacerbation of chronic interstitial pneumonia and to assess the potential value of CT and histologic findings in predicting prognosis. Materials and Methods The study included 24 patients with clinical and histologic diagnosis of acute exacerbation of chronic interstitial pneumonia who underwent CT within 1 month before biopsy or autopsy. The final diagnosis was acute exacerbation of idiopathic pulmonary fibrosis (n=12), usual interstitial pneumonia associated with connective tissue disorders (n=5), idiopathic nonspecific interstitial pneumonia (n=4), and nonspecific interstitial pneumonia associated with connective tissue disorders (n=3). Results The main CT findings consisted of bilateral ground-glass opacities (100%) and consolidation (71%) superimposed on a reticular pattern. The ground-glass opacities and/or consolidation were diffuse in 54% of the cases, multifocal in 21%, and peripheral in 25%. The histologic patterns of acute injury consisted of diffuse alveolar damage (n=20), acute organizing pneumonia (OP) (n=3), and extensive fibroblastic foci (n=1). Eight (33%) patients survived the acute episode, including all 3 patients with OP and the patient with extensive fibroblastic foci (P=0.01). The survivors included 3 of 13 (23%) patients with diffuse parenchymal opacification, 2 of 5 (40%) patients with multifocal, and 3 of 6 (50%) patients with peripheral opacification on CT. Conclusions The CT findings of acute exacerbation of chronic interstitial pneumonia consist of diffuse, multifocal, or peripheral parenchymal opacification superimposed on reticulation. Histologic findings of OP are superior to CT in predicting prognosis.

Lymphocytic interstitial pneumonia: follow-up CT findings in 14 patients.

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.

Acute exacerbation of idiopathic pulmonary fibrosis: high-resolution CT scores predict mortality

AbstractObjectivesTo determine high-resolution computed tomography (HRCT) findings helpful in predicting mortality in patients with acute exacerbation of idiopathic pulmonary fibrosis (AEx-IPF).MethodsSixty patients with diagnosis of AEx-IPF were reviewed retrospectively. Two groups (two observers each) independently evaluated pattern, distribution, and extent of HRCT findings at presentation and calculated an HRCT score at AEx based on normal attenuation areas and extent of abnormalities, such as areas of ground-glass attenuation and/or consolidation with or without traction bronchiectasis or bronchiolectasis and areas of honeycombing. The correlation between the clinical data including the HRCT score and mortality (cause-specific survival) was evaluated using the univariate and multivariate Cox-regression analyses.ResultsSerum KL-6 level, PaCO2, and the HRCT score were statistically significant predictors on univariate analysis. Multivariate analysis revealed that the HRCT score was an independently significant predictor of outcome (hazard ratio, 1.13; 95% confidence interval, 1.06–1.19, P = 0.0002). The area under receiver operating characteristics curve for the HRCT score was statistically significant in the classification of survivors or nonsurvivors (0.944; P < 0.0001). Survival in patients with HRCT score ≥245 was worse than those with lower score (log-rank test, P < 0.0001).ConclusionThe HRCT score at AEx is independently related to prognosis in patients with AEx-IPF. Key Points •High-Resolution Computed Tomography (HRCT) helps clinicians to assess patients with interstitial fibrosis. •The main abnormalities of acute exacerbation are ground-glass opacification and consolidation. •Extent of abnormalities on HRCT correlates with poor prognosis.

Expression of matrix metalloproteinases in pigs with hyperoxia-induced acute lung injury

The aim of this study was to determine the role of matrix metalloproteinases (MMPs) in the pathogenesis of acute lung injury induced by hyperoxia. Twenty-three pigs were exposed in sealed cages to >80% oxygen (for 24-120 h) or room air. Correlation between MMP-2/MMP-9 activity, measured by gelatin zymography in bronchoalveolar lavage fluid (BALF), and the histological findings and pathological parameters were examined in detail. Sources of these MMPs in the hyperoxic lung were analysed by immunohistochemistry. The histological progression of acute lung injury in this model ranged from the early exudative to the early proliferative phase of diffuse alveolar damage (DAD). MMP-2 and -9 activities were elevated under prolonged hyperoxic exposure. MMP-9 activity correlated significantly with the oxygen tension in arterial blood/inspiratory oxygen fraction, the lung wet-to-dry weight ratio, and the number of neutrophils in BALF, whereas MMP-2 activity did not correlate at all with these factors. MMP-9 activity correlated more closely with the pathological findings of DAD than did MMP-2 activity. Strong MMP-9 expression was observed in neutrophils, alveolar macrophages as well as alveolar lining epithelial cells. These results suggest that matrix metalloproteinase. which may derive from neutrophils recruited into airspaces, plays an important role in the pathogenesis of hyperoxic diffuse alveolar damage

Pulmonary involvement in mixed connective tissue disease: high-resolution CT findings in 41 patients.

The objective of this study was to describe the pulmonary abnormalities on high-resolution computed tomography (CT) in patients with mixed connective tissue disease (MCTD). The study included 41 patients who met the diagnostic criteria for MCTD and showed abnormal findings on high-resolution CT. The presence, extent, and distribution of various high-resolution CT findings were evaluated. The predominant abnormalities included areas of ground-glass attenuation (n = 41), subpleural micronodules (n = 40), and nonseptal linear opacities (n = 32). Other common findings included peripheral predominance (n = 40), lower lobe predominance (n = 39), intralobular reticular opacities (n = 25), architectural distortion (n = 20), and traction bronchiectasis (n = 18). Less common findings included honeycombing, ill-defined centrilobular nodules, airspace consolidation, interlobular septal thickening, thickening of bronchovascular bundles, bronchial wall thickening, bronchiectasis, and emphysema. Pulmonary involvement of MCTD is characterized by the presence of ground-glass attenuation, nonseptal linear opacities, and peripheral and lower lobe predominance. Ill-defined centrilobular opacities were uncommonly seen.

Acute respiratory distress syndrome and acute interstitial pneumonia : Comparison of thin-section CT findings

Purpose The purpose of this work was to compare the thin-section CT findings of acute respiratory distress syndrome (ARDS) with those of acute interstitial pneumonia (AIP). Method The thin-section CT scans from 25 patients with ARDS and 25 with AIP were independently assessed by two observers without knowledge of clinical and pathologic data. The presence, extent, and distribution of various CT findings were independently analyzed. Results Honeycombing was seen more frequently in lobes of patients with AIP (26%) than in lobes with ARDS (8%) (p < 0.001). Compared with patients with ARDS, a greater number of patients with AIP had a predominantly lower lung zone distribution (p < 0.05) and a symmetric distribution (p < 0.05) of the parenchymal abnormalities. Conclusion Patients with AIP have a greater prevalence of honeycombing and are more likely to have a symmetric bilateral distribution and a lower lung zone predominance than patients with ARDS. However, significant overlap exists among the CT findings.

Comparison of High Resolution Ct Findings of Sarcoidosis, Lymphoma, and Lymphangitic Carcinoma: Is There Any Difference of Involved Interstitium?

PURPOSE The purpose of this study was to determine distinguishing features of three diseases that are distributed along the lymphatics. METHOD CT scans of 40 patients with lymphangitic carcinomatosis, 41 with sarcoidosis, and 44 with malignant lymphoma were retrospectively reviewed. We evaluated the degree of involvement of the interlobular septa, bronchovascular structures, subpleural interstitium, and other CT findings. RESULTS The number of thickened interlobular septa and the extent of involvement of the subpleural interstitium in lymphangitic carcinomatosis were higher than those in sarcoidosis and malignant lymphoma (p<0.0001). Nodules of >1 cm in diameter were more often seen in malignant lymphoma (41.0%) than in the other two diseases (p < 0.001). Bilateral distribution was more common in sarcoidosis (100%) than in the others (p<0.001). CONCLUSION The major difference among lymphangitic carcinomatosis, sarcoidosis, and malignant lymphoma is the greater involvement of the interlobular septa and subpleural interstitium in lymphangitic carcinomatosis than in either sarcoidosis or malignant lymphoma.

Pathologic subgroups of nonspecific interstitial pneumonia: differential diagnosis from other idiopathic interstitial pneumonias on high-resolution computed tomography.

Objective: To determine whether the subtypes of nonspecific interstitial pneumonia (NSIP) could be differentiated from other idiopathic interstitial pneumonias (IIPs) on the basis of findings on high-resolution computed tomography (CT). Methods: Two observers evaluated the high-resolution CT findings in 90 patients with IIPs. The patients included 36 with NSIP, 11 with usual interstitial pneumonia (UIP), 8 with cryptogenic organizing pneumonia (COP), 10 with acute interstitial pneumonia (AIP), 14 with desquamative interstitial pneumonia (DIP) or respiratory bronchiolitis-associated interstitial lung disease (RB-ILD), and 11 with lymphoid interstitial pneumonia (LIP). The NSIP cases were subdivided into group 1 NSIP (n = 6), group 2 NSIP (n = 15), and group 3 NSIP (n = 15). Results: Observers made a correct diagnosis with a high level of confidence in 65% of NSIP cases, 91% of UIP cases, 44% of COP cases, 40% of AIP cases, 32% of DIP or RB-ILD cases, and 82% of LIP cases. Group 1 NSIP was misdiagnosed as AIP, DIP or RB-ILD, and LIP in 8.3% of patients, respectively. Group 2 NSIP was misdiagnosed as COP in 10% of patients, LIP in 6.7%, AIP in 3.3%, and DIP or RB-ILD in 3.3%. Group 3 NSIP was misdiagnosed as UIP in 6.7% of patients, COP in 6.7%, and DIP or RB-ILD in 3.3%. Conclusions: In most patients, NSIP can be distinguished from other IIPs based on the findings on high-resolution CT. Only a small percentage of patients with predominantly fibrotic NSIP (group 3 NSIP) show overlap with the high-resolution CT findings of UIP.

Interstitial pneumonia in progressive systemic sclerosis: serial high-resolution CT findings with functional correlation.

Purpose The aim of our study was to assess the serial high-resolution CT findings and their correlation with the results of pulmonary function tests in patients with progressive systemic sclerosis (PSS) and interstitial pneumonia. Method The study included 40 patients with symptoms or signs of PSS and interstitial pneumonia, who underwent serial high-resolution CT scans (mean follow-up period 39 months). Seventeen patients simultaneously had serial pulmonary function tests (mean follow-up period 40 months). On high-resolution CT, the pattern and extent of parenchymal abnormalities were retrospectively analyzed. Serial changes on high-resolution CT were correlated with the changes of pulmonary function tests. Results On initial CT, areas of ground-glass opacity (mean ± SD extent 17.7 ± 12.3% in all patients), irregular linear opacity (4.4 ± 4.4% in 36 patients), small nodules (3.9 ± 12.5% in 28), consolidation (1.9 ± 4.2% in 13), and honeycombing (1.9 ± 3.8% in 12) were seen. The total disease extent (p = 0.042) and extents of ground-glass opacity (18.9 ± 15.5%; p = 0.04) and honeycombing (5.0 ± 7.2%; p = 0.002) increased significantly on follow-up CT. Both forced vital capacity (from 2.4 ± 0.4 to 2.0 ± 0.4 L; p = 0.002) and forced expiratory volume in 1 s (from 2.0 ± 0.4 to 1.6 ± 0.3 L; p = 0.013) decreased significantly on follow-up examination. The increase in the extent of honeycombing on CT correlated significantly with the decrease in diffusing capacity for carbon monoxide (r = −0.411, p = 0.049). Conclusion In patients with PSS and interstitial pneumonia, the overall extent of disease and extents of honeycombing and ground-glass opacity increase significantly on follow-up CT. Increase of honeycombing correlates well with decrease of diffusing capacity for carbon monoxide.