High-resolution CT In Patients Research Articles

Prognostic value of automated assessment of interstitial lung disease on CT in systemic sclerosis.

Stratifying the risk of death in SSc-related interstitial lung disease (SSc-ILD) is a challenging issue. The extent of lung fibrosis on high-resolution CT (HRCT) is often assessed by a visual semiquantitative method that lacks reliability. We aimed to assess the potential prognostic value of a deep-learning-based algorithm enabling automated quantification of ILD on HRCT in patients with SSc. We correlated the extent of ILD with the occurrence of death during follow-up, and evaluated the additional value of ILD extent in predicting death based on a prognostic model including well-known risk factors in SSc. We included 318 patients with SSc, among whom 196 had ILD; the median follow-up was 94 months (interquartile range 73-111). The mortality rate was 1.6% at 2 years and 26.3% at 10 years. For each 1% increase in the baseline ILD extent (up to 30% of the lung), the risk of death at 10 years was increased by 4% (hazard ratio 1.04, 95% CI 1.01, 1.07, P = 0.004). We constructed a risk prediction model that showed good discrimination for 10-year mortality (c index 0.789). Adding the automated quantification of ILD significantly improved the model for 10-year survival prediction (P = 0.007). Its discrimination was only marginally improved, but it improved prediction of 2-year mortality (difference in time-dependent area under the curve 0.043, 95% CI 0.002, 0.084, P = 0.040). The deep-learning-based, computer-aided quantification of ILD extent on HRCT provides an effective tool for risk stratification in SSc. It might help identify patients at short-term risk of death.

Correlation Between Neutrophil-Lymphocyte Ratio, Platelets-Lymphocyte Ratio, and High-Resolution CT in Patients with COVID-19

Background: COVID-19 is a highly infectious disease that necessitates simple and rapid methods for recognising severe patients. Aims: To correlate between chest lesions in CT, neutrophil-lymphocyte ratio (NLR), and platelets-lymphocytes ratio in patients with COVID-19, and to detect their cut-off values as an early warning of severe COVID-19 in Egyptian patients. Subjects and Methods: A cross-sectional study included 100 adult patients with COVID-19 attending Ahmed Maher Teaching Hospital, Cairo, Egypt. Clinical, laboratory, and radiological assessments were done. They were classified according to their CT grades into three groups: seven patients with a normal chest CT, 45 non-severe cases, and 48 severe cases. Results: Dyspnoea was the most common symptom among the severe cases (79.2%) and fever among non-severe cases (71.1%), while cough (85.7%) was the most common among cases with a normal CT. The age, NLR, C-reactive protein (CRP), and D-dimer of severe cases were significantly the highest, while the absolute lymphocytes were significantly the lowest. Highly significant positive correlations were found between CT grades with D-dimer, NLR, and CRP; significant positive correlation was found with age; and significant negative correlation with CT. Using receiver operating characteristic analysis, areas under the curve of D-dimer, NLR, age, CRP, ferritin, and platelet-lymphocyte ratio were 0.760, 0.698, 0.640, 0.627, 0.614, and 0.595, respectively. The optimal cut-off value of NLR was 2.50 with 0.74 specificity, 0.61 sensitivity, and 67.5 accuracy. Conclusion: NLR is a reliable and easy-to-use predictor of COVID-19 severity. NLR (>2.5) should prompt prescription of a chest CT as it could reveal essential lesions that influence further management.

A preliminary study on the dynamic image evolution of chest high resolution CT in patients with mild COVID-19

Objective To explorethe evolution of continuous dynamic chest high resolution CT (HRCT) image in patients with mild COVID-19. Methods The data of epidemiology, clinical data and continuous dynamic chest high-resolution CT images of the patients with mild COVID-19 were analyzed retrospectively. Twenty-five patients (including 24 ordinary patients and 1 light patient) were enrolled in the group, including 14 males and 11 females, with (42±12) years and hospital stay of (19±5) days. The basic image and dynamic image of HRCT were analyzed and compared by the radiologists. Results The clinical manifestations were fever (22 cases), cough (18 cases), expectoration (8 cases), pharyngeal pain (6 cases). Most laboratory tests lack specificity. There was no significant abnormality in chest CT of one light patient. HRCT findings of the common type patients were as follows: (1) the distribution of the lesions: most of the multiple lesions in both lungs (19 cases), the average number of involved lobes (3±1), most of which were located in the extra pulmonary zone near the pleura (22 cases); (2) the morphology and density of the lesions: most of the lesions were ground glass density foci (22 cases), which were patchy and massive (18 cases), nodular (10 cases) and arc broadband (7 cases); With the development of the disease, the density of some lesions increased with localized pulmonary consolidation (10 cases), accompanied by air bronchus sign (5 cases) and halo sign (5 cases). Dynamic changes of HRCT images in the chest: the positive manifestations were found on the 5 (5, 6) day after the onset of the disease, the progressive time of CT lesions was 5 (5, 7) days, the peak time of CT lesions was 11 (10, 13) days, and the turning time of CT lesions was 9 (8, 11) days. Conclusions Continuous dynamic chest HRCT can monitor the basic evolution process of patients with mild COVID-19, and provide a more intuitive basis for clinical early diagnosis and treatment. Key words: COVID-19; Tomography, X-ray computed

A preliminary study of lung abnormalities on HRCT in patients of rheumatoid arthritis-associated interstitial lung disease with progressive fibrosis.

This retrospective study evaluates lung abnormalities on high-resolution CT (HRCT) and clarifies which abnormality can predict the progressive fibrosis of rheumatoid arthritis (RA)-associated interstitial lung disease (ILD). We identified 1096 RA patients, and enrolled 213 patients with a diagnosis of RA-ILD who underwent serial chest HRCT. Clinical data of the patients were obtained. The presence, extent, and distribution of lung abnormalities were assessed on CT scans. Logistic regression analysis was used to determine positive indicators with predictive value for progressive fibrosis, and 2 × 2 contingency tables were constructed to assess their diagnostic efficiency. Of 213 RA-ILD patients, 106 (49.8%) were diagnosed as progressive fibrosis. The rates of advanced age, male, smoking history, shortness of breath, and anti-CCP antibody high titer positive were higher, and RA duration was shorter in progressive fibrosis patients. Reticular pattern (RP), peribronchovascular interstitium (PBVI) thickening, interlobular septal thickening, and traction bronchiolectasis were more common in the progressive fibrosis group (84.9% vs 42.1%, P<0.001; 79.3% vs 45.8%, P<0.001; 74.5% vs 43.9%, P<0.001; 67.0% vs 40.2%, P<0.001; respectively). Lung abnormalities demonstrated subpleural predominance, and the subpleural RP and/or interlobular septal thickening had a wide distribution in the progressive fibrosis group (71.7% vs 14.0%, P<0.001). The overall extent of lung abnormalities was more extensive in the progressive fibrosis group (18.4% vs 14.2%, P<0.05). Logistic regression analysis showed that a wide distribution of subpleural RP and/or interlobular septal thickening (OR, 18.15) and PBVI thickening (OR, 4.98) were independent risk factors predictive of progressive fibrosis. For the combination of these two CT abnormalities, sensitivity was 63.2%, specificity was 92.5%, positive likelihood ratio was 8.5, and negative likelihood ratio was 0.4 in predicting progressive fibrosis. A wide distribution of subpleural RP and/or interlobular septal thickening and PBVI thickening on HRCT appear predictive of progressive fibrosis in RA-ILD. The combined evaluation of these two CT abnormalities has a good judgment value. Key Points • We designed this study to investigate the risk factors for progressive fibrosis in patients with RA-ILD. Factors including clinical, physiological, radiological and therapeutic variables were all included in the data analysis. • Our results showed HRCT abnormalities, rather than other parameters, appeared predictive of progressive fibrosis in RA-ILD. • The methods and results of image evaluation in this article would provide reference to rheumatologists in identifying early stage of progressive fibrosis which helps to improve poor prognosis of RA-ILD.

Clinical spectrum and prognostic factors of possible UIP pattern on high-resolution CT in patients who underwent surgical lung biopsy.

BackgroundFew studies have reported the diagnostic variability in patients with a possible usual interstitial pneumonia (UIP) pattern on high-resolution CT (HRCT) who underwent surgical lung biopsy (SLB), and the prognostic factors for these patients have not been fully evaluated. We retrospectively investigated the frequency of idiopathic pulmonary fibrosis (IPF) and prognostic factors in patients with possible UIP pattern on HRCT.MethodsConsecutive patients who had a possible UIP pattern on HRCT, underwent SLB, and had a diagnosis of IIPs before SLB were retrospectively recruited from 10 hospitals. Diagnoses were made based on multidisciplinary discussion using the criteria for current IPF guidelines and multidisciplinary classification for IIPs in each hospital.Results179 patients who underwent SLB were enrolled. The diagnoses were IPF in 91 patients (51%), unclassifiable IIPs in 47 (26%), idiopathic NSIP in 18 (10%), and chronic hypersensitivity pneumonia in 17 (9%). One-year FVC changes showed significant differences between IPF and non-IPF (-138.6 mL versus 18.2 mL, p = 0.014). Patients with IPF had a worse mortality than those with non-IPF (Logrank test, p = 0.025). Multivariable Cox regression analysis demonstrated that diagnoses of IPF (HR, 2.961; 95% CI, 1.183–7.410; p = 0.02), high modified MRC score (HR, 1.587; 95% CI, 1.003–2.510; p = 0.049), and low %FVC (HR, 0.972; 95% CI, 0.953–0.992; p = 0.005).ConclusionsAbout a half of patients with a possible UIP pattern on HRCT had diagnoses other than IPF, and patients with IPF had a worse mortality than those with an alternative diagnosis. We reaffirmed that multidisciplinary discussion is crucial in patients with possible UIP pattern on HRCT.

Reliability of temporal bone high-resolution CT in patients with facial paralysis in temporal bone fracture

ObjectiveThis study aimed to investigate the reliability of temporal bone high-resolution CT (HRCT) in patients with traumatic facial paralysis. MethodsHRCT with cross-sectional scanning and multi-planar reformation (MPR) was performed on 26 cases with traumatic facial paralysis, and the preoperative imaging manifestations were compared with surgical findings. ResultsPreoperative HRCT revealed fallopian canal damage at the posterior genu in 1 case, geniculate ganglion in 22 cases, labyrinthine segment in 4 cases, tympanic segment in 13 cases and mastoid segment in 0 case, while surgical findings confirmed fallopian canal damage at the posterior genu in 7 cases, geniculate ganglion in 23 cases, labyrinthine segment in 4 cases, tympanic segment in 17 cases and mastoid segment in 7 cases. The accuracy of temporal bone HRCT in revealing damage at those segments of fallopian canal was 14.3%, 95.7%, 100%, 76.5, and 0%, respectively. ConclusionTemporal bone HRCT can generally estimate the extent of damage and provide important information for traumatic facial paralysis before surgery. However, it is unreliable in revealing the damage of fallopian canal at the posterior genu and mastoid segment.

Evaluation of the extent of ground-glass opacity on high-resolution CT in patients with interstitial pneumonia associated with systemic sclerosis: Comparison between quantitative and qualitative analysis

To verify whether quantitative analysis of the extent of ground-glass opacity (GGO) on high-resolution computed tomography (HRCT) could show a stronger correlation with the therapeutic response of interstitial pneumonia (IP) associated with systemic sclerosis (SSc) compared with qualitative analysis. Seventeen patients with IP associated with SSc received autologous peripheral blood stem cell transplantation (auto-PBSCT) and were followed up using HRCT and pulmonary function tests. Two thoracic radiologists assessed the extent of GGO on HRCT using a workstation. Therapeutic effect was assessed using the change of vital capacity (VC) and diffusing capacity of the lung for carbon monoxide (DLco) before and 12 months after PBSCT. Interobserver agreement was assessed using Spearman's rank correlation coefficient and the Bland-Altman method. Correlation with the therapeutic response between quantitative and qualitative analysis was assessed with Pearson's correlation coefficients. Spearman's rank correlation coefficient showed good agreement, but Bland-Altman plots showed that proportional error could be suspected. Quantitative analysis showed stronger correlation than the qualitative analysis based on the relationships between the change in extent of GGO and VC, and change in extent of GGO and DLco. Quantitative analysis of the change in extent of GGO showed stronger correlation with the therapeutic response of IP with SSc after auto-PBSCT than with the qualitative analysis.

Fibroproliferative changes on high-resolution CT in the acute respiratory distress syndrome predict mortality and ventilator dependency: a prospective observational cohort study

ObjectivesTo examine whether the extent of fibroproliferative changes on high-resolution CT (HRCT) scan influences prognosis, ventilator dependency and the associated outcomes in patients with early acute respiratory distress syndrome (ARDS).DesignA...

Assessment of Bullae with High-Resolution CT in Patients with Spontaneous Pneumothorax: Comparison with Video-Assisted Thoracoscopy

Assessment of Bullae with High-Resolution CT in Patients with Spontaneous Pneumothorax: Comparison with Video-Assisted Thoracoscopy

Assessment of Bullae with High-Resolution CT in Patients with Spontaneous Pneumothorax: Comparison with Video-Assisted Thoracoscopy

Purpose: The purpose of this study was to compare the findings on high-resolution CT (HRCT) of the chest with those on video-assisted thoracoscopy for the detection of bullae in patients who had undergone an operation for spontaneous pneumothorax, and we also wished to evaluate the relationship between the characteristics of bullae on HRCT and development of spontaneous pneumothorax. Materials and Methods: Fifty patients with spontaneous pneumothorax who had undergone both HRCT of the chest and video-assisted thoracoscopic surgery were included in the study. Spontaneous pneumothoraces were classified as either primary or secondary pneumothorax, and as initial or recurrent pneumothorax. The HRCT scans were obtained with 1 mm slice thickness and a 5 mm scan interval. Two radiologists retrospectively compared the HRCT findings of the chest with those findings on video-assisted thoracoscopy for the detection of bullae, and they evaluated the value of HRCT for diagnosing bullae. In addition, we assessed the size and number of bullae in these patients, and we also evaluated the relationship between those findings of bullae and the development of spontaneous pneumothorax. Results: Bullae were detected in 40 patients by using video-assisted thoracoscopy, and HRCT showed bullae in 38 of these patients. Bullae were not identified with video-assisted thoracoscopy in the remaining ten patients, and among these ten patients, bullae were not demonstrated by HRCT in eight of them. Therefore, the sensitivity and specificity of HRCT for the detection of bullae were 95% (38/40) and 80% (8/10), respectively. The average size of the bullae of the affected hemithorax and the contralateral un-affected hemithorax was 1.97 cm2.30 and 1.24 cm1.46, respectively. Pneumothorax was more frequently observed in the hemithorax with larger bullae (p1.60) was higher in the affected hemithorax than in the contralateral un-affected hemithorax (2.961.86), but there was no statistically significant difference between both groups of hemithoraces (p>0.05). The average size of bullae in patients with secondary pneumothorax and those bullae of patients with primary pneumothorax was 4.44 cm4.06 and 1.42 cm1.26, respectively. The bullae were significantly larger in the patients with secondary pneumothorax than in those patients with primary pneumothorax (p1.58) than in those patients with primary pneumothorax (3.241.61), the difference between two groups was not statistically significant (p>0.05). Conclusion: HRCT of the chest would be a useful modality for detecting the bullae of those patients with spontaneous pneumothorax. The development of spontaneous pneumothorax is associated with the size of bullae rather than the number of bullae.

High-resolution CT in chronic pulmonary changes after mustard gas exposure.

To identify the findings of high-resolution CT (HRCT) of the lung in patients with previous sulfur mustard gas exposure, and to correlate these findings with clinical and chest X-ray (CXR) results. 50 consecutive patients were studied prospectively. The clinical data were recorded. Standard p.a. CXR and HRCT of the lung and spirometry were performed. The findings of CXR, HRCT and clinical and spirometry results were scored between 0 and 3 according to the severity of the findings. HRCT abnormality was detected in all 50 patients (100%), while CXR was abnormal in 40 patients (80%). The most common HRCT findings was airway abnormalities (bronchial wall thickening in 100% of cases). Other important findings were suggestive of interstitial lung disease (ILD) (80%), bronchiectasis (26%), and emphysema (24%). A statistically significant correlation was found between the severity of clinical presentation and that of the HCTR scores in patients with bronchiectasis, bronchitis and ILD (p< 0.05), but not with severity scores of HRCT in patients with emphysema. No significant correlation was found between severity scores of CXR findings. HRCT evidence of bronchial wall thickening and with a lower frequency ILD were present despite normal CXR in 20% of the patients. The results of this study suggest that bronchial wall thickening, ILD and emphysema are common chronic pulmonary sequelae of sulfur mustard injury. HRCT of the chest should be considered as the imaging modality of choice in chemical war injury.

HIGH-Resolution CT in Chronic Pulmonary Changes after Mustard Gas Exposure

To identify the findings of high-resolution CT (HRCT) of the lung in patients with previous sulfur mustard gas exposure, and to correlate these findings with clinical and chest X-ray (CXR) results. 50 consecutive patients were studied prospectively. The clinical data were recorded. Standard p.a. CXR and HRCT of the lung and spirometry were performed. The findings of CXR, HRCT and clinical and spirometry results were scored between 0 and 3 according to the severity of the findings. HRCT abnormality was detected in all 50 patients (100%), while CXR was abnormal in 40 patients (80%). The most common HRCT findings was airway abnormalities (bronchial wall thickening in 100% of cases). Other important findings were suggestive of interstitial lung disease (ILD) (80%), bronchiectasis (26%), and emphysema (24%). A statistically significant correlation was found between the severity of clinical presentation and that of the HCTR scores in patients with bronchiectasis, bronchitis and ILD (p< 0.05), but not with severity scores of HRCT in patients with emphysema. No significant correlation was found between severity scores of CXR findings. HRCT evidence of bronchial wall thickening and with a lower frequency ILD were present despite normal CXR in 20% of the patients. The results of this study suggest that bronchial wall thickening, ILD and emphysema are common chronic pulmonary sequelae of sulfur mustard injury. HRCT of the chest should be considered as the imaging modality of choice in chemical war injury.

Association of Tumor Necrosis Factor-α Gene Promoter Polymorphism With Low Attenuation Areas on High-Resolution CT in Patients With COPD

Alveolar septal cell apoptosis may contribute to the pathogenesis of emphysema. Because tumor necrosis factor (TNF)-alpha is assumed to play an important role in the induction of apoptosis, and allele 2 of the polymorphism at position--308 in the promoter of the TNF-alpha gene has been associated with alteration of TNF-alpha secretion in vitro, we hypothesized that genotypes containing this allele would show more destructive emphysematous changes of the lung. The percentage ratio of the low attenuation area to the corresponding lung area was evaluated using a visual scoring system for CT findings in patients with COPD (n = 84), and these patients were classified into two groups: those with a visual score < 11 and those with a visual score > or = 11. A polymerase chain reaction-based assay was developed to determine the TNF-alpha genotype (TNF-alpha-308*1/2) between subjects with high and low visual scores on chest CT scans. The TNF-alpha-308*1/2 allele frequency tended to differ between patients with a visual score < 11 (0.90/0.10) and those with a visual score > or = 11 (0.81/0.19) [odds ratio, 2.15; 95% confidence interval, 0.87 to 5.30; p = 0.09]. These results indicate that the TNF-alpha-308 allele 2 may be partly associated with the extent of emphysematous changes in patients with COPD.

High-Resolution CT in Patients With Intraluminal Typical Bronchial Carcinoid Tumors Treated With Bronchoscopic Therapy

To evaluate the extent to which high-resolution CT (HRCT) can predict the clinical outcome of bronchoscopic treatment with curative intent in patients with intraluminal typical bronchial carcinoid tumors. An observational study. Bronchoscopy unit and radiology department of a university hospital. Eighteen patients with intraluminal typical bronchial carcinoid tumors in the absence of nodal and distant disease were treated with bronchoscopic electrocautery or Nd-YAG laser as an alternative to surgical resection. Prior to treatment, HRCT was performed. In 10 patients, HRCT showed no peribronchial tumor extension, and 9 of these patients were found to be tumor free after bronchoscopic treatment. So far during follow-up, none of these patients has had a recurrence of the tumor. The median duration of follow-up was 33 months (range, 13 to 68 months). In five patients, HRCT showed signs of peribronchial tumor extension. In three of these patients, specimens taken from biopsies performed after bronchoscopic treatment showed residual tumors, and salvage surgery was carried out. In three patients, HRCT was unable to assess peribronchial tumor extension: in two because of insufficient connective tissue contrast between the hilar structures and in one patient because of suboptimal scan technique. HRCT findings were complementary but not conclusive in patients with intraluminal typical bronchial carcinoid tumors treated with bronchoscopic therapy. However, in a category of patients in whom HRCT showed strictly intraluminal tumors, bronchoscopic resection as an alternative for surgical resection seems justified.

High-Resolution CT in Patients with Chronic Airflow Obstruction: Correlation with Clinical Diagnosis and Pulmonary Function Test

Purpose: To determine the utility of HRCT in the diagnosis of chronic airflow obstruction and to correlate the morphologic abnormalities revealed by this modality with functional impairment in patients with chronic airflow obstruction. Materials and Methods: This study involved 80 patients with chronic airflow obstruction who underwent HRCT and a pulmonary function test. Final clinical diagnosis in these patients was determined by a chest physician on the basis of clinical features, bronchoscopy, pulmonary function test, and HRCT. In order to diagnose and determine the extent of areas of decreased attenuation revealed by HRCT (the CT score), the findings of HRCT were retrospectively reviewed by two radiologists, who reached a consensus. Clinical and HRCT diagnoses were then compared, and the rate of agreement between them was calculated. The relationship between the extent of areas of decreased attenuation revealed by HRCT and by FEV1/FVC was evaluated using Correl’s account and Student’s unpaired t-test. Results: The agreement rate between clinical and HRCT diagnoses was 77.5% (62/80). The rates for bronchiectasis (88.9%, 24/27), emphysema (93.9%, 31/33), and bronchiolitis obliterans (100%, 6/6) were considerably higher than those for chronic bronchitis and bronchial asthma. The correlation rate between CT score and FEV1/FVC was significant in bronchiectasis (p0.05). Conclusion: HRCT is valuable in the diagnosis and prediction of physiologic impairment in patients with bronchiectasis and bronchiolitis obliterans, but has limited value in those with emphysema, chronic bronchitis or asthma.

Bronchiolar inflammatory diseases: high-resolution CT findings with histologic correlation.

Bronchiolar diseases pose a significant challenge to the clinician confronted with the evaluation and management of the affected patient. A variety of infectious and non-infectious diseases may affect the bronchioles causing either reversible or fixed bronchiolar obstruction. High-resolution CT (HRCT) is currently the best imaging modality for evaluation of small-airway disease. In fact, a wide spectrum of abnormalities are identified at HRCT in patients with bronchiolar diseases. These abnormalities are shown on HRCT in the presence of a normal or unclear chest radiograph. Additionally, HRCT performed at suspended full expiration may demonstrate the physiologic consequences of bronchiolar disease, e. g., air trapping. The differential diagnosis of pulmonary manifestations of bronchiolar diseases at HRCT is based on the different patterns of abnormality. Familiarity with the presentation of different bronchiolar inflammatory processes aid the radiologist in narrowing the differential diagnosis or even in suggesting a specific diagnosis. This article reviews the HRCT findings of various bronchiolar inflammatory diseases outlining their pathologic features. Knowledge of the underlying gross and microscopic pathologic features leads to a better understanding of their CT appearances.

Bronchiectasis: accuracy of high-resolution CT in the differentiation of specific diseases.

The aim of the study was to determine whether various causes of bronchiectasis can be differentiated by the pattern and distribution of abnormalities seen on high-resolution CT. The retrospective study included 82 consecutive patients who had a specific diagnosis of bronchiectasis proven by appropriate clinical and laboratory criteria. All patients underwent high-resolution CT scanning (1- to 1.5-mm collimation). The CT scans were assessed for the presence, extent, type, and anatomic distribution of bronchiectasis by two independent observers who were not aware of the clinical data. The observers recorded their most likely diagnosis and the degree of confidence in that diagnosis. The two independent observers made a correct diagnosis in 61% of cases (100/164 interpretations). On average, a correct diagnosis was made in 19 (68%) of 28 cases of cystic fibrosis, 16 (67%) of 24 cases of previous tuberculosis, six (43%) of 14 cases of previous childhood infection, five (56%) of nine cases of allergic bronchopulmonary aspergillosis, and four (57%) of seven cases of other causes of bronchiectasis. We found moderate agreement between the observers for the correct diagnosis (kappa = .53) and good agreement for the presence or absence of bronchiectasis in each lobe (kappa = .71). The pattern and distribution of abnormalities revealed by high-resolution CT in patients with bronchiectasis are influenced by the underlying cause. Bilateral, predominantly upper lobe, bronchiectasis is seen most commonly in patients with cystic fibrosis and allergic bronchopulmonary aspergillosis, unilateral upper lobe predominance in patients with tuberculosis, and lower lobe predominance in patients after childhood viral infection.

Plain radiographs and thoracic high-resolution CT in patients with ankylosing spondylitis.

The aims of this study were to identify the spectrum of abnormalities seen on high-resolution CT in patients with ankylosing spondylitis and to compare our findings with reports of plain film pulmonary manifestations of the disease. We prospectively studied 26 patients with documented ankylosing spondylitis. All patients underwent plain chest radiography (posteroanterior and lateral views), thoracic helical CT, high-resolution CT, and pulmonary function tests. High-resolution CT revealed abnormalities in 18 patients (69%), whereas plain chest radiography revealed abnormalities in four patients (15%). The most common abnormalities seen on CT were interstitial lung disease (ILD) (n = 4), bronchial wall thickening and bronchiectasis (n = 6), paraseptal emphysema (n = 3), mediastinal lymphadenopathy (n = 3), tracheal dilatation (n = 2), and apical fibrosis (n = 2). This study, which describes high-resolution CT findings in patients with ankylosing spondylitis, reveals a spectrum of abnormalities unlike those described in previous reports in which researchers used plain chest radiographs as the sole imaging technique. In addition to apical fibrosis, high-resolution CT revealed nonapical ILD, bronchiectasis, paraseptal emphysema, and tracheobronchomegaly. Of these new findings, we believe that identification of ILD is the most important. We suggest that nonapical ILD should be actively sought as an explanation for pulmonary symptoms developing in patients with ankylosing spondylitis. High-resolution CT should form an integral part of such workup.