Diagnostic imaging of diffuse infiltrative disease of the lung.
ABSTRACT Plain chest radiography remains the first diagnostic approach to diffuse infiltrative lung disease but has limited diagnostic sensitivity and specificity. Many diseases remain occult or are not correctly assessed using chest X-ray, appearing as a nonspecific 'reticulonodular pattern'. High-resolution CT (HRCT) is actually the recommended imaging technique in the diagnosis, assessment, and follow-up of these diseases, allowing also the evaluation of the effectiveness of the medical therapy and the selection of the type and the location of the biopsy when required. Appropriate techniques must be used to acquire high-quality HRCT scans, with the thin collimation and high spatial reconstruction algorithm being the most important factors. A nodular pattern, linear and reticular opacities, cystic lesions, ground-glass opacities and consolidations are the most common HRCT patterns of diffuse infiltrative lung disease. This article reviews the role of chest radiography and HRCT in the diagnosis and assessment of these diseases, the technical aspects of HRCT, its clinical indications and the radiological pattern of the most common types of chronic diffuse infiltrative lung disease.
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ABSTRACT: Twenty-seven consecutive breast cancer patients receiving tangential field radiation therapy were followed by high resolution CT (HRCT) in order to compare the accuracy of reduced-dose HRCT and conventional-dose HRCT in the evaluation of subtle pulmonary changes. Thin section 1-mm HRCT images were obtained at identical levels at 120 kVp, with 320 mAs, 200 mAs, 160 mAs, 120 mAs and 60 mAs settings. HRCT was performed during the planning of radiotherapy and 4, 8 and 24 weeks after the completion of radiotherapy. Radiation was administered according to an individual CT-based plan by tangential fields with 4 or 6 MV photons to the whole breast given with 5 fractions of 1.9 Gy weekly to a total dose of 50 Gy. The tumor bed was boosted by electrons to 60 Gy. Pathological changes were detected in 21 examinations of 10 patients: 9 patients out of 27 (33%) showed radiation induced changes; 1 patient developed metastases within the irradiated volume. Septal thickening appeared in 5 patients at 4 weeks and in another 5 patients at 8 weeks. Parenchymal consolidation was detected in 1 patient at 4 weeks and in 5 patients at 8 weeks. HRCT using 160 mAs yield good quality images of subtle radiation induced injuries. The diagnostic validity of HRCT using lower than 160 mAs depends on the detail analyzed.European Journal of Radiology 08/1995; · 2.51 Impact Factor
- Seminars in Roentgenology 02/2002; 37(1):5-16. · 0.56 Impact Factor
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ABSTRACT: High-resolution CT (HRCT) is the radiological imaging technique that most closely reflects changes in lung structure. It represents the radiological method of choice for the diagnostic work-up of patients with known or suspected diffuse interstitial lung disease. A single HRCT finding is frequently nonspecific, but the combination of the various HRCT findings together with their anatomic distribution can suggest the most probable diagnosis. The purpose of this article is to summarize the classic HRCT features of the most common diffuse interstitial lung diseases. Lists of differential diagnoses and distinguishing key features are provided to improve diagnostic confidence. The presence of classic HRCT features often obviates the need for biopsy. In patients with atypical findings, HRCT can be used to determine the most appropriate biopsy site.European Radiology 02/2001; 11(3):373-92. · 3.55 Impact Factor