High-Resolution Chest CT: Practical Clinical Applications

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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 for
• performance 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 of
• known 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 scans differentiate atelectasis
• Expiratory scans air 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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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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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