High resolution CT in Interstitial Lung Diseasesby Dr
High resolution CT in Interstitial Lung Diseasesby Dr
High resolution CT in Interstitial Lung Diseasesby Dr
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HR<strong>CT</strong> <strong>in</strong> <strong>Interstitial</strong> <strong>Lung</strong><br />
Disease<br />
<strong>Dr</strong>.S.Weerakoon
In Diffused <strong>Lung</strong> Disease<br />
CXR<br />
Limitations<br />
Cannot Clearly Depict the Alteration of<br />
lung parenchyma<br />
Radiographic Pattern of Diffuse<br />
<strong>Lung</strong> Disease is Often Non Specific<br />
Inability of Resolv<strong>in</strong>g Small Differences<br />
<strong>in</strong> Density
HR<strong>CT</strong> improves<br />
Sensitivity<br />
Specificity<br />
Diagnostic Accuracy<br />
HR<strong>CT</strong> images of the lung correlate closely<br />
with the macroscopic appearance of<br />
pathologic specimen
Scan Collimation<br />
Narrow<br />
Collimation<br />
Technique<br />
Volume<br />
Averag<strong>in</strong>g<br />
With<strong>in</strong> the<br />
Section<br />
Spatial<br />
Resolution<br />
•Resolution is Optimized by Us<strong>in</strong>g Th<strong>in</strong> Sections -<br />
1 – 1.5 mm are obta<strong>in</strong>ed from the apex to lung<br />
bases with the patient sup<strong>in</strong>e.<br />
•Sections are Usually Separated by 1 – 4 cm. S<strong>in</strong>ce<br />
Most Infiltrative <strong>Lung</strong> Diseases are Diffuse.<br />
•<strong>Lung</strong> Nodules may be missed Unless HR<strong>CT</strong> is<br />
Supplemented with Contigous Imag<strong>in</strong>g
Anatomy Of <strong>Lung</strong><br />
The Secondary Pulmonary Lobule is the<br />
Smallest Unit of the <strong>Lung</strong><br />
The Secondary Pulmonary Lobule is Wrapped<br />
with connective Tissue Septae.<br />
It conta<strong>in</strong>s Ve<strong>in</strong>s / Lymphatics Vessels. A<br />
Secondary Bronchus & Accompany<strong>in</strong>g Artery<br />
Situated Centrally
Bronchi & Pulmonary Arteries run &<br />
Branch Together Through Out the <strong>Lung</strong><br />
They Taper Slightly as They Travel<br />
Radialy<br />
At any Given Level the Diameter of the<br />
Bronchus is the Same of its<br />
Accompany<strong>in</strong>g Pulmonary Artery
Patterns Of Diffuse <strong>Lung</strong><br />
Disease<br />
Reticular and short lenear<br />
pattern<br />
HR<strong>CT</strong> Patterns<br />
Nodular density<br />
Ground glass density/<br />
consolidations<br />
Cystic spaces and areas<br />
of decreased lung<br />
density
Reticular And Short Lenear<br />
Pattern<br />
Due to thicken<strong>in</strong>g of<br />
<strong>in</strong>terstitial fibre network/<br />
pulmonary lymphatics by<br />
Fluid<br />
Fibrosis<br />
Cells<br />
Other materials….<br />
Conditions associated<br />
with Dialatation of<br />
pulmonary ve<strong>in</strong>s.
Cont’d Reticular and …<br />
Interlobular Septal Thicken<strong>in</strong>g<br />
Normal<br />
only few septae should be seen<br />
Abnormal<br />
presence of numerous clearly visible<br />
<strong>in</strong>terlobular septae, almost always <strong>in</strong>dicates<br />
and <strong>in</strong>terstitial abnormality<br />
Abnormally thickened septea outl<strong>in</strong>e part or<br />
entire lobule.
Septal thicken<strong>in</strong>g<br />
1.Smooth<br />
Pul. Oedema<br />
Lymphangitic CA<br />
Leukaemia<br />
Amyloidosis<br />
Lymphocytic<br />
<strong>in</strong>terstitial pneumonia<br />
Alveolarmicrolithiasis
2. Nodular ( Beaded)<br />
Lymphangitic Spread of CA<br />
Sarcoidosis, Silicosis<br />
CWP<br />
Amyloidosis<br />
Milliary TB
Interface Sign
Parenchymal Bands<br />
Asbestosis<br />
Sarcoidosis<br />
Silicosis<br />
Tuberculosis
Intra Lobular Septal Thicken<strong>in</strong>g
Peribroncho Vascular <strong>Interstitial</strong><br />
Thicken<strong>in</strong>g
Peribroncho Vascular <strong>Interstitial</strong><br />
Thicken<strong>in</strong>g
Honey Comb<strong>in</strong>g<br />
Extensive <strong>in</strong>terstitial & Alveolar Fibrosis<br />
Alveolar disruption & Bronchiectasis<br />
Honey Comb <strong>Lung</strong>
Honey Comb<strong>in</strong>g<br />
Subpleural,Posterior /<br />
lower lobe<br />
predom<strong>in</strong>ance<br />
• IPF – 60%<br />
• Collagen disease<br />
• Hypersensitivity pneumonitis<br />
• Asbestosis<br />
• <strong>Dr</strong>ug <strong>in</strong>duced fibrosis<br />
• Sarcoidosis<br />
Central / Upper lobe<br />
predom<strong>in</strong>ance<br />
• Sarcoidosis<br />
• Hypersensitivity pneumonitis<br />
• Radiation<br />
• IPF<br />
• Collagen disease<br />
• <strong>Dr</strong>ug <strong>in</strong>duced fibrosis
Nodules / Nodular<br />
Nodules<br />
Discrete densities rang<strong>in</strong>g from 2mm to 10mm <strong>in</strong><br />
diameter.<br />
With<strong>in</strong><br />
Interstitium<br />
Air spaces
Distribution<br />
Perilymphatic<br />
Centrilobular<br />
Random
Reticular Nodular pattern <strong>in</strong> Sarcoidosis
Nodules / Nodular<br />
Perilymphatic
Perylymphatic Distribution<br />
Sarcoidosis<br />
Lymphangitic CA<br />
Lymphoproliferative Disordes<br />
Amyloidosis
Nodules / Nodular<br />
Centrilobular<br />
• Hypersensitivity<br />
pneumonitis<br />
• Sarcoidosis<br />
•Langerhan cell<br />
histiocytosis<br />
•Silicosis
Centrilobular<br />
Nodules / Nodular<br />
Sarcoidosis<br />
Respiratory<br />
bronchiolitis<br />
<strong>in</strong>terstitial<br />
lung<br />
disease
Nodules / Nodular<br />
Random<br />
• MiliaryTB<br />
• Haematogenous<br />
spread of CA<br />
• Milliary fungal<br />
<strong>in</strong>fections.<br />
• Dissem<strong>in</strong>ated viral<br />
<strong>in</strong>fections.
Large Nodules <strong>in</strong> Sarcoidosis
Large Nodules / Masses<br />
Nodules < 1 cm<br />
Masses > 3 cm
Increased <strong>Lung</strong> Density<br />
Ground glass patterns<br />
Hazy <strong>in</strong>crease <strong>in</strong> the density of lung<br />
parenchyma – Air space patterns<br />
E.g. Fibros<strong>in</strong>g Alveolitis (Active phase)<br />
DIP<br />
BOOP<br />
Pneucystis Carr<strong>in</strong>i <strong>in</strong>fection<br />
Diffuse pulmonary H’ge
DIP
AIP
Alveolar protenosis<br />
Pneumocystis carr<strong>in</strong>i <strong>in</strong>fection<br />
ARDS<br />
Pul.Oedema<br />
Pul.Haemorrhage<br />
Mycoplasma pnumonia<br />
NSIP/UIP
Increased<br />
<strong>Lung</strong> Density<br />
Consolidation
Cont’d… Increased <strong>Lung</strong> Density<br />
Consolidation<br />
Increased lung<br />
attenuation with<br />
obliteration of<br />
pulmonary vessels
Decreased <strong>Lung</strong> density / Cystic<br />
spaces
Destruction of Alveolar walls of distal air<br />
spaces.<br />
Panlobular Emphysema<br />
Centrilobular Emphysema<br />
ParaseptaL Emphysema<br />
Lymphangiomyomatosis<br />
Langerhans cell Histiocytosis
L<br />
I<br />
P
Decreased <strong>Lung</strong> density / Cystic<br />
spaces
Bibliography<br />
IMAGING OF THE DISIEASES OF THE<br />
CHEST –David.M.Hansell,Peter<br />
Armstrong,David.A.Lynch,H.Page<br />
McAdams<br />
<strong>High</strong> Resolution <strong>CT</strong> of the <strong>Lung</strong>-W.Richard<br />
Webbs,Nestor L.Mǖller,David.P.Naidich<br />
Radiol Cl<strong>in</strong> N Am 43(2005)<br />
American Journal of Respiratory & Critical<br />
Care Medic<strong>in</strong>e. Vol.165 2004
Thank You …!
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