간질성폐질환에서 고해상컴퓨터단층촬영의 적용과 해석: 간질성폐질환 프로토콜
Application and Interpretation of High-Resolution Computed Tomography for the Diagnosis of Interstitial Lung Disease (ILD): ILD Protocol
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Interstitial lung disease (ILD) encompasses a heterogeneous group of over 200 diffuse parenchymal lung diseases. Accurate diagnosis of ILD is essential for appropriate treatment but can be challenging to achieve. For patients with suspected ILD, high-resolution computed tomography (HRCT) is a minimally invasive approach that allows for convenient repeat imaging. Compared to a conventional computed tomography (CT) protocol, the HRCT protocol for ILD patients involves two additional series with different technical requirements: a prone inspiration scan, and a supine expiration scan. The prone scan is useful when dependent opacification is observed on a supine chest CT scan. It facilitates the diagnosis of honeycombing, reducing observer variation in diagnosing idiopathic pulmonary fibrosis. The expiratory scan is useful for identifying air trapping, which is essential for the diagnosis of hypersensitivity pneumonitis. It is used to assess the three-density sign, which is specific for hypersensitivity pneumonitis and characterized by patchy distribution of normal-appearing lobules, ground glass opacities, and lobules with reduced lung density and vessel size. The HRCT ILD protocol should be performed regularly to assess changes in the extent of fibrosis and to diagnose lung cancer or acute exacerbation when clinically indicated.
Abstract
Interstitial lung disease (ILD) encompasses a heterogeneous group of over 200 diffuse parenchymal lung diseases. Accurate diagnosis of ILD is essential for appropriate treatment but can be challenging to achieve. For patients with suspected ILD, high-resolution computed tomography (HRCT) is a minimally invasive approach that allows for convenient repeat imaging. Compared to a conventional computed tomography (CT) protocol, the HRCT protocol for ILD patients involves two additional series with different technical requirements: a prone inspiration scan, and a supine expiration scan. The prone scan is useful when dependent opacification is observed on a supine chest CT scan. It facilitates the diagnosis of honeycombing, reducing observer variation in diagnosing idiopathic pulmonary fibrosis. The expiratory scan is useful for identifying air trapping, which is essential for the diagnosis of hypersensitivity pneumonitis. It is used to assess the three-density sign, which is specific for hypersensitivity pneumonitis and characterized by patchy distribution of normal-appearing lobules, ground glass opacities, and lobules with reduced lung density and vessel size. The HRCT ILD protocol should be performed regularly to assess changes in the extent of fibrosis and to diagnose lung cancer or acute exacerbation when clinically indicated.
참고문헌 (10)
- Demedts M, "ATS", ERS international multidisciplinary consensus classification of the idiopathic interstitial pneumonias, 2002, pp.19, 794~796
- Cottin V, "Multidisciplinary teams in the clinical care of fibrotic interstitial lung disease : current perspectives", Eur Respir Rev, 31, pp.220003~ (2022)
- 이상훈, "Korean Guidelines for Diagnosis and Management of Interstitial Lung Diseases: Part 2. Idiopathic Pulmonary Fibrosis", Tuberculosis and Respiratory Diseases, 82(2), pp.102~117 (2019), 대한결핵및호흡기학회[DOI]
- American Thoracic Society, "American Thoracic Society", European Respiratory Society international multidisciplinary consensus classification of the idiopathic interstitial pneumonias, 2002, pp.165, 277~304
- Travis WD, "An official American Thoracic Society", European Respiratory Society statement : update of the international multidisciplinary classification of the idiopathic interstitial pneumonias, 2013, pp.188, 733~748
- Raghu G, "Diagnosis of idiopathic pulmonary fibrosis. An official ATS", ERS, ALAT clinical practice guideline, pp.Am J Respir Crit Care Med, 2018[DOI]
- Lynch DA, "Diagnostic criteria for idiopathic pulmonary fibrosis : a Fleischner Society White Paper", Lancet Respir Med, 6, pp.138~153 (2018)
- Raghu G, "Diagnosis of hypersensitivity pneumonitis in adults. An official ATS", JRS, Am J Respir Crit Care Med, pp.2020, 202[DOI]
- Magee AL, "Imaging of hypersensitivity pneumonitis", Radiol Clin North Am, 54, pp.1033~1046 (2016)
- Raghu G, "Idiopathic pulmonary fibrosis(an update)and progressive pulmonary fibrosis in adults : an official ATS", ERS, ALAT clinical practice guideline, pp.Am J Respir Crit Care Med, 2022[DOI]