Clinical Study Of CT In Diagnosis And Therapeutic Effect Of Diffuse Panbronchiolitis

PART1: The Manifestations of Diffuse Panbronchiolitis on CTObjective To improve cognition for manifestations of diffuse panbronchiolitis on CT.Materials and Methods Reviewing92cases from2001to2011in shanghaipulmonary hospital, the manifestations of CT were analyzed.Resultes1.CT revealed bilateral, diffuse lesions in84cases, and patchy distribution in6cases, and in2cases the nodules localized in both lower lobes.2.The main manifestationsof DPB on CT were as following:①all the92cases showed centrilobular nodule shadow,accompanied with tree-in-bud sign.②bronchiectasis with thick walls was detected in68cases, and mucus plugging in35cases.③peripheral air-trapping was found in58cases.④patchy distribution of parenchymal consolidation or ground-glass opacity wasseen in42cases, with right middle lobe atelectasis in2of them and ligular lobe atelectasisin1case.⑤cavitation was presented in3cases.⑥others: complicated by pulmonaryinterstitial fibrosis in9or pulmonary hypertension in8cases, and thymoma oradenocarcinoma in1case respectively.3. TypeⅠ CT findings were found in patients withclinical stage2disease,type Ⅱ in those with stage2,and types Ⅲ and Ⅳin those withstage2or3.Conclusion CT plays an important role in the diagnosis of DPB, and it is useful indifferentiating from other diseases when considered with clinic.PART2: Comparison of Clinical and CT Characteristics between DiffusePanbronchiolitis and Bronchogenic Disseminated TuberculosisObjective To clarify the clinicoradiographic similarities as well as the differencesbetween DPB and bronchogenic disseminated tuberculosis.Materials and Methods The initial clinicoradiographic features of92patients withDPB were compared with those of122patients with the bronchogenic disseminatedtuberculosis.Resultes There was no significant difference of age(47.51±16.17vs.50.58±16.76yr,P=0.820) and gender(47.83%vs.45.90%yr,P=0.780) between DPB and bronchogenicdisseminated tuberculosis patients. A history of sinusitis was more common in patients with DPB than in those with bronchogenic disseminated tuberculosis (78.26%vs.5.73%,There was no significant difference of age(47.51±16.17vs.50.58±16.76yr,P=0.820)and gender(47.83%vs.45.90%yr, P=0.780) between DPB and bronchogenicdisseminated tuberculosis patients. A history of sinusitis was more common in patientswith DPB than in those with bronchogenic disseminated tuberculosis (78.26%vs.5.73%,P<0.001). The main presenting symptoms were cough and sputum in both groups. Therewas no significant difference of hemoptysis between DPB and bronchogenic disseminatedtuberculosis patients(29.35%vs.25.41%,P=0.521),while exertional dyspnea (96.74%vs19.67%,P<0.001) and coarse crackles (100%vs36.89%, P<0.001) were more common inpatients with DPB. The WBC counts of peripheral blood and the serum levels of IgAwere significantly higher in patients with DPB than in those with bronchogenicdisseminated tuberculosis.The patients with FEV1/FVC <70%, or arterial oxygenation<80mmHg were more commonly diagnosed with DPB than bronchogenic disseminatedtuberculosis.The lesions were bilateral in all patients with DPB and in84.43%of patientswith bronchogenic disseminated tuberculosis(P＜0.001). The most common CT findingswere the presence of bronchiolitis and bronchiectasis. However, the involvement ofbronchiolitis and bronchiectasis on chest CT was more extensive in patients with DPB.Bronchiolitis and bronchiectasis were observed in more lobes in patients with DPB than inthose with bronchogenic disseminated tuberculosis (P<0.001, P<0.001, respectively).However, parenchymal consolidation opacity(87.70%vs.45.65%,P＜0.001) or a cavity(or cavities)(80.33%vs3.26%,P＜0.001)was more commonly found in patients withbronchogenic disseminated tuberculosis.Conclusion There is considerable overlap in the clinical and CT appearances of theDPB and bronchogenic disseminated tuberculosis, although some clinicoradiographicfeatures differ between two diseases. The correct diagnosis, including aggressivemicrobiologic evaluation, should be made for the appropriate management of patientspresenting with bilateral bronchiolitis and bronchiectasis.PART3:Effect of Azithromycin on Patients with Diffuse Panbronchiolitis:Evaluation with CTObjective To clarify what kind of airway lesions on CT change with the clinicaleffectiveness induced by azithromycin.Materials and Methods We devised a method for scoring findings on computed tomography (CT) to aid in the objective evaluation of the airway lesions in patients withDPB. The43patients with DPB were treated with oazithromycin. All patients wereevaluated by CT and pulmonary function tests before and after6months of therapy.Resultes1.Characteristic CT findings in all the patients with DPB pretherapy weresmall nodules and airway ectasia. Small centrilobular nodules and airway ectasia werefound in all43patients. Small nodular opacities scored as3were found in37cases(86.05%), and those scored as2were found in the remaining6cases. The extent of airwayectasia was scored as3in nineteen cases (44.19%),2in seven cases (16.28%), and as1inthe remaining seventeen cases(39.53%). Severe airway ectasia scored as3was found inonly5cases (11.63%), moderate ectasia scored as2was found in7cases(16.28%), andmild ectasia scored as1was found in the remaining31cases (72.09%). Periairwaythickening was found in38cases (88.37%), and mucus plugging was found in35cases(81.39%). Peripheral air-trapping was found in31cases(72.09%), and atelectasis orconsolidation was found in20cases(46.51%).The pretreatment CT scores were10.53±4.56.2.Following treatment with azithromycin, the CT scores decreasedsignificantly compared with pretreatment scores (p<0.01). In the individual categories ofCT findings, the scores for the extent of small nodular opacities, that of airway ectasia andmucoid impaction, and the severity of periairway thickening significantly diseased afterazithromycin therapy (small nodular opacities, p<0.01; airway ectasia, p<0.01; mucoidimpaction, p=0.016; periairway thickening, p<0.01). However, the scores for the severityof airway ectasia showed no significant decrease after treatment.3.The FVC%, FEV1%,and PaO2all increased significantly after azithromycin therapy(FVC,71.05±18.64～87±21.01,p<0.01; FEV1%,58.72±18.19～73.58±19.85, p<0.01;PaO2,70.00±5.88～84.42±10.81mmHg, p<0.01).4.The CT scores were significantly correlated with thepercent predicted values for FVC (r=-0.743,p<0.01), the percent predicted values of FEV1(r=-0.723,p<0.01), and the Pa02(r=-0.469,p<0.01), respectively. Following treatment withazithromycin, the△CT scores for the extent of small nodular opacities were significantlycorrelated with the△F VC%(r=-0.683,p<0.01)and△F EV1%(r=-0.579,p<0.01).Conclusion The CT scoring method is useful for evaluating the severity of airwaydisease in patients with DPB. The centrilobular nodule, mucoid impaction, and periairwaythickening were reversible airway lesions, while the central airway ectasia was irreversible.The reduction of centrilobular nodules, which reflects the obstructive lesions ofbronchioles, was the main cause of pulmonary function improvement after azithromycintherapy.