특발성 간질성 폐렴의 영상의학적 접근
Radiologic Approach to the Idiopathic Interstitial Pneumonias
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초록
특발성 간질성 폐렴은 7종류의 간질성 폐렴 질환을 포함한 질환군으로 각각의 질환은 임상증상, 영상소견, 조직소견, 예후 등에서 다양한 특성을 보인다. 이들 간질성 폐렴 각 질환을 분류하고 감별 진단하는 데 있어서 영상학적 소견은 주요한 역할을 하고 있다. 일부 간질성 질환에서는 CT 소견이 특징적이어서 매우 높은 진단적 가치를 갖는 반면 다른 예들에서는 영상소견이 서로 유사하여 CT상 정확한 진단을 하기 어려운 경우도 흔하다. 따라서 특발성 간질성 폐렴의 정확한 진단을 위해서는 임상적, 영상학적, 조직학적 소견들을 모두 종합하여 판단하여야 한다.
Abstract
Idiopathic interstitial pneumonias (IIP), a heterogeneous group of diffuse parenchymal lung diseases, include seven clinicopathologic entities: idiopathic pulmonary fibrosis (IPF), nonspecific interstitial pneumonia (NSIP), cryptogenic organizing pneumonia (COP), acute interstitial pneumonia (AIP), respiratory bronchiolitis (RB)-associated interstitial lung disease (ILD), desquamative interstitial pneumonia (DIP), and lymphoid interstitial pneumonia (LIP). Each of these entities has a typical histologic pattern that correlates well with imaging features. Thus, imaging plays an essential role in classifying and differentiating this group of diseases. The characteristic HRCT findings of IPF are reticular opacity with honeycombing and traction bronchiectasis in a predominantly basal and peripheral distribution. NSIP manifests as basal ground-glass opacity and reticular opacity. Honeycombing is rare. COP is characterized by patchy peripheral or peribronchovascular consolidation. AIP appears as extensive, mixed ground-glass opacity and consolidation. RB-ILD and DIP are smoking-related diseases associated with CT features of poorly defined centrilobular nodules and ground-glass opacity. LIP is a rare disease characterized by ground-glass opacity sometimes associated with perivascular cysts. Although some of idiopathic interstitial pneumonias may show diagnostic CT features, the final diagnosis of IIPs is usually made by means of evaluation of all the combined clinical, radiologic, and pathologic findings.
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