Diagnosis of interstitial lung diseases by HRCT
Moczová, J.(1), Kostolanská, K.(2), Plutinský, J.(3), Srbecký, M.(1), Belan, V.(1)
1 Rádiodiagnostická klinika , Nemocnica akad. L. Dérera, FNsP Bratislava
Prednosta: MUDr. Víťazoslav Belan, PhD., h. doc.
2 Klinika pracovného lekárstva, Nemocnica akad. L.Dérera, FNsP Bratislava
Prednosta: doc. MUDr. Igor Bátora, CSc.
3 Špecializovaná nemocnica sv. Svorada, Zobor, Nitra
Vedúci lekár: doc. MUDr. Ján Plutinský, CSc.
Interstitial lung disease is a feared complication of sarcoidosis (SA), extrinsic allergic alveolitis (EAA) and systemic disease as this chronic interstitial pneumonitis may lead to progressive fibrosis after variable duration and intensity of disease. This prospective study was designed to correlate results of quantitative CT histogram analysis (QCT) derived from HRCT scans and PULMO CT with those from bronchoalveolar lavage flow cytometry (BAL/FC) and pulmonary function tests (PFT) in a set of 113 patients with clinically suspected interstitial lung disease of SA, EAA and lung fibrosis. The diagnosis was estabilished by clinical examination, chest X-ray, PFT and in some cases, also from lymph nodes from neck, mediastinum or lung. All 113 patients underwent HRCT examination in full inspiration position. We began with a visual quantitative analysis from HRCT scans. Then we used PULMO CT evaluation package, (Siemens, Medical Systems) providing determination of mean lung density and histogram analysis. The criteria for diagnosis of disease were fulfilled with QCT mean lung density larger than -779 HU at least at one of three representative anatomical levels of the right lung, and BAL lymphocytosis CD4:CD8 was larger than 3,5 (SA) and smaller than 1,0 (EAA a lung fibrosis). We found a good linear correlation between QCT histogram analysis for C a D indices and BAL lymphocytosis CD4:CD8. The HRCT/QCT and PFT correlate only partially. HRCT/QCT histogram analysis is a very good method for quantitative evaluation of the lung density in an early stage alveolitis and fibrosis. HRCT/QCT combined with BAL/FC, PFT, clinical and other noninvasive methods is a sufficiently accurate and reliable diagnostic tool for the final diagnosis of ILD. Of the three diagnostic modalities HRCT/QCT, BAL/FC and PFT the follow-up HRCT appears to be the most appropriate for monitoring progression of disease or efficiency of therapy.
KEY WORDS:
Interstitial lung diseases, HRCT/QCT histogram analysis, BAL flow cytometry
