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Ma R, Li S, Wang Y, Yang S, Bao N, Ye Q. High-resolution computed tomography features of asbestosis versus fibrotic hypersensitivity pneumonitis: an observational study. BMC Pulm Med 2022; 22:207. [PMID: 35614422 PMCID: PMC9131664 DOI: 10.1186/s12890-022-01967-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 04/25/2022] [Indexed: 11/18/2022] Open
Abstract
Background Asbestosis and fibrotic hypersensitivity pneumonitis (FHP) share the pathogenetic mechanisms induced bronchiolocentric fibrotic process secondary to inhalation exposure. Under the occupational and environmental mixed exposures, asbestosis and FHP are needed to make the differential diagnoses on high-resolution computed tomography (HRCT), especially in the countries still using asbestos. The study aimed to analyze the HRCT features of asbestosis versus FHP. Methods The patients with asbestosis or with HP were sequentially recruited in this comparative study at Beijing Chaoyang Hospital between January 2006 and December 2016. Patients’ clinical data were obtained from a predesigned charts. The international classification of HRCT for occupational and environmental respiratory diseases was used to categorize chest imaging findings in patients. The calculation of test statistics was used to compare the imaging features of asbestosis and FHP. Results 341 patients with asbestosis and 158 patients with HP were sequentially recruited, among which 204 patients with asbestosis and 74 patients with FHP were eligible for data analysis. Patients with asbestosis were older and had a longer latent period until disease manifestation than those with FHP. Asbestosis was characterized by irregular and/or linear opacities, with lower lung preponderance, accompanied by ground-glass opacities and mosaic attenuation. Notably, 98.5% of patients with asbestosis showed benign pleural abnormalities, and 39.7% of these patients had diffuse pleural thickening with parenchymal bands and/or rounded atelectasis. Abnormalities of the mediastinal and diaphragmatic pleura were observed only in cases of asbestosis, and this finding showed high specificity for the diagnosis for asbestosis compared with that for FHP. Subpleural dots or diaphragmatic pleural abnormalities showed moderate sensitivity and high specificity for diagnosis of asbestosis compared with that for FHP. Interobserver reliability was good for evaluation of imaging findings including honeycombing, pleural calcification, lymphadenectasis, and lymph node calcification. Conclusions HRCT-based imaging findings can distinguish between asbestosis and FHP to a certain extent, particularly with regard to subpleural dots and diaphragmatic pleural abnormalities that characterize the former. Supplementary Information The online version contains supplementary material available at 10.1186/s12890-022-01967-3.
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Affiliation(s)
- Ruimin Ma
- Department of Occupational Medicine and Toxicology, Clinical Center for Interstitial Lung Diseases, Beijing Institute of Respiratory Medicine, Beijing Chao-Yang Hospital, Capital Medical University, No. 8 Workers' Stadium South Road, Chao-Yang District, Beijing, China
| | - Shuang Li
- Department of Occupational Medicine and Toxicology, Clinical Center for Interstitial Lung Diseases, Beijing Institute of Respiratory Medicine, Beijing Chao-Yang Hospital, Capital Medical University, No. 8 Workers' Stadium South Road, Chao-Yang District, Beijing, China.,Department of Respiratory Medicine, Beijing Shunyi Hospital, Beijing, China
| | - Yuanying Wang
- Department of Occupational Medicine and Toxicology, Clinical Center for Interstitial Lung Diseases, Beijing Institute of Respiratory Medicine, Beijing Chao-Yang Hospital, Capital Medical University, No. 8 Workers' Stadium South Road, Chao-Yang District, Beijing, China
| | - Shuqiao Yang
- Department of Respiratory Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Na Bao
- Department of Radiology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Qiao Ye
- Department of Occupational Medicine and Toxicology, Clinical Center for Interstitial Lung Diseases, Beijing Institute of Respiratory Medicine, Beijing Chao-Yang Hospital, Capital Medical University, No. 8 Workers' Stadium South Road, Chao-Yang District, Beijing, China.
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Lennartz S, Le Blanc M, Zopfs D, Große Hokamp N, Abdullayev N, Laukamp KR, Haneder S, Borggrefe J, Maintz D, Persigehl T. Dual-Energy CT-derived Iodine Maps: Use in Assessing Pleural Carcinomatosis. Radiology 2019; 290:796-804. [PMID: 30644812 DOI: 10.1148/radiol.2018181567] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Purpose To evaluate the use of spectral CT for differentiation between noncalcified benign pleural lesions and pleural carcinomatosis. Materials and Methods In this retrospective study, patients who underwent contrast agent-enhanced late venous phase spectral CT of the chest between June 1, 2016, and July 1, 2018 with histopathologic and/or imaging confirmation of noncalcified pleural lesions were evaluated. Conventional images, iodine overlay (IO) images, and virtual monoenergetic images at 40 keV (hereafter, VMI40keV) were reconstructed from contrast-enhanced spectral chest CT. Four blinded radiologists determined lesion presence and indicated lesion conspicuity and diagnostic certainty. Hounsfield unit attenuation from conventional images and iodine concentration (IC) (in milligrams per milliliter) from IO images were determined. Area under the receiver operating characteristics curve determined thresholds for quantitative lesion differentiation and cutoff values were validated in an independent data set. Results Eighty-four patients were included (mean age, 66.2 years; 54 men and 30 women; 44 patients with cancer with confirmed pleural carcinomatosis and 40 patients with benign pleural lesions). The area under the receiver operating characteristics curve for IC was greater than that of conventional Hounsfield units (0.96 vs 0.91; P ≤ .05, respectively). The optimal IC threshold was 1.3 mg/mL, with comparable sensitivity and specificity when applied to the test data set. The sensitivities to depict pleural carcinomatosis with spectral reconstructions versus conventional CT were 96% (199 of 208) and 83% (172 of 208), respectively, with specificities of 84% (161 of 192) and 63% (120 of 192), respectively (P ≤ .001 each). Conclusion Compared with conventional images, spectral CT with iodine maps improved both quantitative and qualitative determination of pleural carcinomatosis versus noncalcified benign pleural lesions. © RSNA, 2019 See also the editorial by K. S. Lee and H. Y. Lee .
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Affiliation(s)
- Simon Lennartz
- From the Department of Diagnostic and Interventional Radiology, University Hospital Cologne, Cologne, Germany (S.L., M.L.B., D.Z., N.G.H., N.A., K.R.L., S.H., J.B., D.M., T.P.); and Department of Radiology, Case Western Reserve University and University Hospitals, Cleveland, Ohio (N.G.H., K.R.L.)
| | - Markus Le Blanc
- From the Department of Diagnostic and Interventional Radiology, University Hospital Cologne, Cologne, Germany (S.L., M.L.B., D.Z., N.G.H., N.A., K.R.L., S.H., J.B., D.M., T.P.); and Department of Radiology, Case Western Reserve University and University Hospitals, Cleveland, Ohio (N.G.H., K.R.L.)
| | - David Zopfs
- From the Department of Diagnostic and Interventional Radiology, University Hospital Cologne, Cologne, Germany (S.L., M.L.B., D.Z., N.G.H., N.A., K.R.L., S.H., J.B., D.M., T.P.); and Department of Radiology, Case Western Reserve University and University Hospitals, Cleveland, Ohio (N.G.H., K.R.L.)
| | - Nils Große Hokamp
- From the Department of Diagnostic and Interventional Radiology, University Hospital Cologne, Cologne, Germany (S.L., M.L.B., D.Z., N.G.H., N.A., K.R.L., S.H., J.B., D.M., T.P.); and Department of Radiology, Case Western Reserve University and University Hospitals, Cleveland, Ohio (N.G.H., K.R.L.)
| | - Nuran Abdullayev
- From the Department of Diagnostic and Interventional Radiology, University Hospital Cologne, Cologne, Germany (S.L., M.L.B., D.Z., N.G.H., N.A., K.R.L., S.H., J.B., D.M., T.P.); and Department of Radiology, Case Western Reserve University and University Hospitals, Cleveland, Ohio (N.G.H., K.R.L.)
| | - Kai Roman Laukamp
- From the Department of Diagnostic and Interventional Radiology, University Hospital Cologne, Cologne, Germany (S.L., M.L.B., D.Z., N.G.H., N.A., K.R.L., S.H., J.B., D.M., T.P.); and Department of Radiology, Case Western Reserve University and University Hospitals, Cleveland, Ohio (N.G.H., K.R.L.)
| | - Stefan Haneder
- From the Department of Diagnostic and Interventional Radiology, University Hospital Cologne, Cologne, Germany (S.L., M.L.B., D.Z., N.G.H., N.A., K.R.L., S.H., J.B., D.M., T.P.); and Department of Radiology, Case Western Reserve University and University Hospitals, Cleveland, Ohio (N.G.H., K.R.L.)
| | - Jan Borggrefe
- From the Department of Diagnostic and Interventional Radiology, University Hospital Cologne, Cologne, Germany (S.L., M.L.B., D.Z., N.G.H., N.A., K.R.L., S.H., J.B., D.M., T.P.); and Department of Radiology, Case Western Reserve University and University Hospitals, Cleveland, Ohio (N.G.H., K.R.L.)
| | - David Maintz
- From the Department of Diagnostic and Interventional Radiology, University Hospital Cologne, Cologne, Germany (S.L., M.L.B., D.Z., N.G.H., N.A., K.R.L., S.H., J.B., D.M., T.P.); and Department of Radiology, Case Western Reserve University and University Hospitals, Cleveland, Ohio (N.G.H., K.R.L.)
| | - Thorsten Persigehl
- From the Department of Diagnostic and Interventional Radiology, University Hospital Cologne, Cologne, Germany (S.L., M.L.B., D.Z., N.G.H., N.A., K.R.L., S.H., J.B., D.M., T.P.); and Department of Radiology, Case Western Reserve University and University Hospitals, Cleveland, Ohio (N.G.H., K.R.L.)
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