| Part Ⅰ The cryptogenic organizing pneumonia: analysisof CT features and its prognostic factors【Objective】To investigate the CT features of Cryptogenic organizing pneumonia(COP)and its prognostic factors.【Methods】Choose 32 COP patients in our hospital between January 2012 and June 2017,through clinical-image-pathological diagnosis,who have been obtained specimens by operation or biopsy(22 males and 10 females,20-78 years old,average 60±13),and all undergo chest multi-slice spiral CT scans.Thereinto,20 patients have follow-up CT(range 1-43 months,the median time is 4 months).Analyze patients’ clinical manifestations and laboratory tests.Have a retrospective analysis on their initial CT images.The content of this analysis includes the location,shape,density,combined mediastinal lymph nodes,hydrothorax,etc.Evaluate each patient’s imaging findings through the score sheet.Evaluate imaging findings of follow-up CT after treatment and divide them into two groups,A group: the lesion was significantly absorbed,B group: the lesion was mildly absorbed,without any change or progress,relapse.The gender,clinical manifestation and laboratory abnormality of the two groups were analyzed by Fisher test.T test was used to analyze the age of patients between the two groups.The Mann-whitney U test was used to analyze the different imaging findings between groups and the time from symptom onset to diagnosis.【Results】The focus performances are consolidation(18/32,56.25%),ground glass opacity(21/32,66.67%),nodules(18/32,56.25%),mass(12/32,37.50%)and band-like opacities(23/32,71.88%).Among the 20 patients who have followed-up CT,13 cases in group A with the lesion was absorbed mostly,only with a few ground glass opacity and/or fibers remain;7 cases in group B,with mild absorption of of the lesion(n = 5),no significant change or progression in the lesion(n = 0),relapse(n=2).There was no significant difference in the scores of different signs,gender,age,clinical manifestations and laboratory abnormalities between the two groups(p> 0.05).There was significant difference in the time from symptom onset to diagnosis between two groups(p< 0.05).【Conclusion】The main imaging findings of COP is consolidation and ground glass opacity.There was no significant difference in the initial imaging findings between the different groups after glucocorticoid treatment,but the prognosis was related to the time from symptom onset to diagnosis.Therefore,it requires timely diagnosis and timely treatment.Part Ⅱ Radiologic-pathological contrast analysis of cryptogenic organizing pneumonia 【Objective】To investigate the contrast between the CT imaging findings and pathological features of cryptogenic organizing pneumonia(COP)and the method of obtain pathological specimens.【Methods】 A retrospective analysis of 32 patients with cryptogenic organizing pneumonia(22 males and 10 females,20-78 years old,60 ± 13)in our hospital between January 2012 and June 2017,through clinical-image-pathological diagnosis.Pathological specimens were obtained by surgery(n=10),CT guided biopsy(n=22)and bronchoscopic biopsy(n=2).All the specimens were sectioned,stained and observed under light microscopy.Then analyze the imaging findings of the corresponding lesion taken to be specimens and contrast them with the pathological findings.【Results】The imaging findings of the obtained pathological tissue were13 cases of consolidation,1 case of ground glass opacity,2 cases of consolidation and ground glass opacity,5 cases of nodules and 11 cases of masses.The consolidation,mass and nodule correspond to the typical pathological features of COP.The alveolar spaces and alveolar ducts are filled with granulation tissue(Masson body)composed of fibroblasts.Some of them can lead through the alveolar pores to the adjacent alveolar space,showing a "butterfly" sign.Necrotic tissue can appear in the nodules or masses.The pathological features of ground glass lesions were widening of the alveolar septum,infiltration of a small amount of inflammatory cells,proliferation of alveolar type II epithelial cells and a few granulation tissue can be seen in the alveolar space.【Conclusion】Most of the COP imaging findings were consolidation,ground glass opacity,nodules,masses and bands.A contrastive analysis of imaging and pathology candeepen their understanding.Puncture biopsy can be effectively diagnosed.Surgical methods can obtain more tissue for image-pathological comparison.Part Ⅲ Cryptogenic organizing pneumonia:analysis of solitary mass form in clinical,imaging and pathology 【Objective】To investigate the clinical,imaging and pathological characteristics of cryptogenic organizing pneumonia(COP)with solitary mass form.【Methods】Choose 10 patients of COP with solitary mass form,who have been obtained specimens by surgery or biopsy(8 males,2 females,range 52-78 years,average age 62±7)in our hospital between January 2012 and June 2017.Retrospective analyze patients’ clinical,imaging and pathological datas.Pathological specimens were obtained through surgery(n=5)and CT-guided biopsy(n=5).All the specimens were sectioned,stained and observed.Analyze the patient’s clinical symptoms,signs,laboratory examinations,lesion site,size,shape,edge features,internal structure,surrounding structures and accompanying signs.【Results】All of the 10 patients show cough and sputum symptoms,with 7 cases of hemoptysis.All lesions are adjacent to the pleura(diameter 3.2-6.1cm,4.2 ± 0.7cm);4 cases(40%)distributing in the upper left lobe;6 lesions with heterogeneous,of which 4 masses with cavity;4 cases of pleural indentation;7 cases with lymphadenopathy.All specimens can be seen mass or strip granulation tissue in the alveolar space,of which 4 cases with increased interstitial lymphocytes.【Conclusion】By symmarizing the clinical-imaging-pathological characteristics of COP with solitary mass form,the imaging can fully reflect the pathological features of the disease,the inflammatory and oraganing,combined with no clinical cause of the patients.We can diagnose most of COP with solitary mass form timely. |
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