HRCT-AOCR.ppt

8/21/2019 HRCT-AOCR.ppt

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High-Resolution Chest CT:Practical Clinical Applications

Paul L. Molina, M.D.

Department of Radiology

University of North Carolina at Chapel Hill


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Disclosures

None


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Objectives

Identify current clinical indications

for the use of HRCT

Review proper technique forperformance of HRCT

Summarize the characteristic

patterns of abnormality seen on

HRCT and the most common

diseases resulting in their formation


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HRCT - Indication

Evaluation of patients with

suspected infiltrative lung

disease but normal or

nonspecific findings on CXR


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HRCT - Indication

Further characterization ofknown or suspected diffuse

lung disease


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HRCT - Indication

Evaluation of patients in whom

radiographic findings are not

in keeping with clinical findings

or pulmonary function tests


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HRCT - Indication

Delineation of disease prior to

lung biopsy as a guide to the

optimal type and site of biopsy


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HRCT Technique

Thin collimation (1 mm)

High spatial frequency reconstruction Windows -700/1000-1500 HU

Prone scansdifferentiate atelectasis Expiratory scansair trapping


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HRCT Findings

Septal thickening

Reticular densities Nodules

Increased lung opacity

Decreased lung opacity


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Septal Thickening

Pulmonary edema

Lymphangitic carcinomatosis Sarcoidosis

Asbestosis

Idiopathic pulmonary fibrosis


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Reticular Densities

Idiopathic pulmonary fibrosis

Collagen vascular disease

Asbestosis

Chronic hypersensitivity pneumonitis

Sarcoidosis


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UIP


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Nodular Opacities

Sarcoidosis

Silicosis

Coal workers pneumoconiosis

Hypersensitivity pneumonitis

Tuberculosis

Metastatic disease


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Nodular Opacities

Perilymphatic nodules

Random distribution

Centrilobular nodules


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Perilymphatic Nodules

Sarcoidosis

Silicosis

Lymphangitic Ca


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Silicosis


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Random Nodules

Miliary TB

Hematogenous mets


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Metastatic adenoca


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Centrilobular Nodules

Endobronchial spread of TB

or other infection

Hypersensitivity pneumonitis

Endobronchial tumor spread


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Nodular Opacities

Perilymphatic nodules

Random distribution

Centrilobular nodules


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Increased Lung Opacity

Ground-glass opacity

Air-space consolidation


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Ground-glass Opacity

Hypersensitivity pneumonitis (subacute)

Desquamative interstitial pneumonitis Non-specific interstitial pneumonitis

Sarcoidosis Alveolar proteinosis


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DIP


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Non-specific Interstitial Pneumonitis


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Crazy-Paving

Alveolar

Proteinosis


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M i P f i


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Mosaic Pefusion


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Consolidation

Obscures underlying vessels

Solid, opaque

Air bronchograms


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Consolidation

Chronic eosinophilic pneumonia

BOOP / COP

Bronchoalveolar cell carcinoma

Lymphoma


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Chronic Eosinophilic Pneumonia


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BOOP / COP


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Decreased Lung Opacity

Emphysema

Cystic airspaces

Mosaic perfusion


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Cystic Airspaces

Lymphangioleiomyomatosis (LAM)

Langerhans Cell Histiocytosis (EG)

End-stage (honeycomb) lung


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LAM


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EG


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EG


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HRCT - Indications

Suspected infiltrative disease but

normal or nonspecific CXR

Further characterize diffuse disease

CXR findings not in keeping with

clinical findings or PFTs

Guide type and site of biopsy


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HRCT Findings

Septal thickening

Reticular opacities

Nodular opacities

Increased lung opacity Decreased lung opacity

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