Radiation semiotics of disseminated pulmonary tuberculosis

The aim of the study was to optimize the radiation diagnosis and differentiation of disseminated pulmonary tuberculosis (DTL) by studying the ray lung semiotics using multislice computed tomography (MSCT), radionuclide diagnostics (RND) with the use of a radiopharmaceutical (RFP) 99mTc-technetril and identifying the most informative for disseminated tuberculosis MSCT- RIA criteria. Materials and methods. The analysis of MSCT data was performed in 67 patients who had X-ray signs of pulmonary dissemination. The study was conducted on a multislice computer tomograph Somatom Emotion 16 from Siemens. 23 patients underwent a radionuclide study with a 99mTc-technetril radiopharmaceutical on the Nucline Spirit gamma camera in the planar and single-photon emission computerized tomography (SPECT) mode. The statistical processing of the data was carried out using the MicrosoftExcel software package. The reliability of the differences between the qualitative indices of the compared groups was determined using the χ2 criterion. Results. The distribution of foci of dissemination according to MSCT using the high resolution algorithm (HRCT) was characterized by localization of dissemination foci in the structures of the primary, secondary pulmonary lobe, perivascular and peribronchial, involvement of pleura piles of various degrees and reactive changes in the intrathoracic lymph nodes (VGLU). In 55.7% of cases, foci with DTL were distributed in intralobular structures, lobular septa and endobronchial. In 86.3%, fragmentary infiltration of axial interstitium was noted. There was also marked infiltration of pleura sheets involving extrapuleural fat tissue in 50.7% of cases. Hyperplasia of the intrathoracic lymph nodes was established in 12.5% of cases. According to planar and SPECT studies in 21.0%, the prevalence of dissemination by CT correlated with accumulation of RFP in the lungs according to planar research and topically - in VGLU according to SPECT. In 81.8% of cases of hyperplasia of lymph nodes revealed by CT, there was an accumulation of RFP by SPECT. In 42.1% of cases of limited dissemination, according to CT, there was a diffuse accumulation of RFP following the results of planar scintigraphy. Conclusion Interpretation of the obtained data, taking into account the level of damage to the structural units of the lung with the definition of activity and prevalence in the application of different radiotherapy techniques, allows to optimize the diagnosis and differential diagnosis of disseminated pulmonary tuberculosis.Цель исследования - оптимизация лучевой диагностики и дифференциации диссеминированного туберкулеза легких (ДТЛ) посредством изучения лучевой семиотики лёгких методом мультисрезовой компьютерной томографии (МСКТ), радионуклидной диагностики (РНД) с применением радиофармпрепарата (РФП) 99mTс-технетрила и выявление наиболее информативных для диссеминированного туберкулёза МСКТ-РНД критериев. Материалы и методы. Проведен анализ данных МСКТ исследования 67 больных, у которых определялись рентгенологические признаки легочной диссеминации. Исследование проведено на мультисрезовом компьютерном томографе Somatom Emotion 16 фирмы Siemens. 23 пациентам проведено радионуклидное исследование с радиофармпрепаратом 99mTс-технетрилом на гамма-камере Nucline Spirit в планарном и однофотонном эмиссионном компьютерном томографическом (ОФЭКТ) режиме. Статистическую обработку данных осуществляли с помощью пакета программ «MicrosoftExcel». Определение достоверности различий между качественными показателями сравниваемых групп проводили с помощью критерия в2. результаты. распределение очагов диссеминации по данным МСКТ с использованием алгоритма высокого разрешения (КТВР), характеризовалось локализацией очагов диссеминации в структурах первичной, вторичной легочной дольки, периваскулярно и перибронхиально, вовлечении листков плевры различной степени и реактивными изменениями внутригрудных лимфатических узлов (ВГЛУ). В 55,7% случаев очаги при ДТЛ распространялись во внутридольковых структурах, дольковых перегородках и эндобронхиально. В 86,3% отмечалась фрагментарная инфильтрация аксиального интерстиция. отмечалась также выраженная инфильтрация листков плевры с вовлечением экстраплевральной жировой клетчатки в 50,7% случаев. Гиперплазия внутригрудных лимфатических узлов установлена в 12,5% случаев. По данным планарного и ОФЭКТ исследования в 21,0% распространенность диссеминации по КТ коррелировала с накоплением РФП в легких по данным планарного исследования и топически - во ВГЛУ по данным ОФЭКТ. В 81,8% выявленных по КТ случаях гиперплазии лимфатических узлов отмечено накопление РФП по ОФЭКТ. В 42,1% случаев ограниченной диссеминации по данным КТ отмечалось диффузное накопление РФП по результатам планарной сцинтиграфии. Заключение Интерпретация полученных данных с учетом уровня поражения структурных единиц легкого с определением активности и распространенности при применении разных лучевых методик позволяет оптимизировать диагностику и дифференциальную диагностику диссеминированного туберкулеза легких

DIFFICULTIES IN THE RADIODIAGNOSIS OF LUNG INJURIES IN PHTHISIATRIC PRACTICE

The paper describes clinical cases of concomitant lung and intrathoracic lymph node involvements as evidenced by conventional radiography and computed tomography (CT). It shows difficulties in the differential diagnosis of different nosological entities in pulmonary tuberculosis. The x-ray semiotics of concomitant lung injuries is also depicted

COMPARATIVE ANALYSIS OF THE SEMIOTICS OF DISSEMINATED PULMONARY TUBERCULOSIS AND EXOGENOUS ALLERGIC ALVEOLITIS IN ACCORDANCE WITH THE DATA OF COMPUTED TOMOGRAPHY

Objective: to improve the differential diagnosis of disseminated pulmonary tuberculosis (DPT) and exogenous allergic alveolitis (EAA) via comparative investigation of their computed tomography (CT) semiotics and identification of the most informative diagnostic criteria. Material and methods. 70 patients, including 40 patients with DPT in a phase of infiltration and 30 patients with acute EAA, were studied using a Somatom Emotion 16 multi-slice spiral CT scanner (Siemens). All the patients underwent spiral scanning from the upper chest aperture to the costodiaphragmatic recesses with a high CT algorithm at 0.8-mm slice thickness and a 1.5-mm step. Results. Analysis of the spread of dissemination foci established that pathological changes were peribronchovascularly located in both nosological entities and characterized by a preponderance of septal and intrabronchial locations in DPT and by a centrilobular distribution in EAA. Centrilobular foci were more commonly poorly defined in EAA and mixed foci were observed in DPT. In the latter, peribronchovascular, centrilobular foci were revealed at a distance from the visceral pleura (the boundary of the deep and superficial lymphatic network, respectively) in 38% and more than half of the cases (62%) with the involvement of the visceral and parietal pleura; in EAA, the centrilobular foci were more often combined with the involvement of the visceral pleura in more than 92% of cases. The tree-in-bud sign was significantly more common in DPT. The latter was mostly characterized by apicocaudal regression of dissemination. In EAA, the foci were more frequently located asymmetrically. Monomorphic foci with destruction, as well as their polymorphism were seen in DPT; those without destruction were predominantly observed in EAA. CT ground glass and mosaic perfusion syndromes were significantly more often in EAA. In DPT, the visceral and parietal pleuras were involved in the process in 62% of cases and changes were also more common in the extrapleural fat. Conclusion. In addition to the peribronchovascular location of foci, the characteristic CT signs for DPT are a preponderance of intrabronchial and septal locations of foci, their apicocaudal regression, the presence of the CT tree-in-bud sign, and thickened extrapleural fat. EAA showed a prevalence of asymmetrical foci with centrilobular location with the involvement of the visceral pleura into the process, with the presence of CT ground glass and mosaic perfusion syndromes, as well as the bronchial lumen visualized in the peripheral segments of the lung

A COMPLEX CASE OF DIFFERENTIAL DIAGNOSIS OF PULMONARY TUBERCULOSIS AND A NEUROENDOCRINE TUMOR

Pathomorphosis of tuberculosis and other lung diseases that have a similar clinical radiological and morphological picture leads to considerable difficulties and mistakes in the differential diagnosis of pulmonary processes. In particular, there are difficulties in the differential diagnosis of neuroendocrine lung tumors (NET) and pulmonary tuberculosis.A clinical case of timely diagnosis of a neuroendocrine tumor in a young female patient without clinical symptoms typical for NETs has been described. The main manifestations revealed by chest CT scanning were single focal consolidations. The diagnosis was confirmed by histological studies of surgery samples

Clinical and Radiological Features of Various Variants of Extrinsic Allergic Alveolitis

Objective. To optimize diagnosis of various variants of morphologically verified extrinsic allergic alveolitis (EAA), by determining the most significant clinical and radiological indicators of its development.Material and methods.  Examinations were made in 82 patients  with morphologically confirmed EAA, including 10 people with acute EAA, 38 with subacute EAA, 26 with chronic EAA, and 8 with recurrent EAA. Their medical history data were studied; physical examination, clinical blood, pulmonary function (PF), and lung diffusing capacity tests, and high-resolution  computed tomography (HRCT) of the chest were performed. Transbronchial and/or  video-assisted thoracoscopic lung biopsies were used for morphological studies.Results. Four disease course variants were identified. Disease duration, adherence to a specific antigenic effect, and the clinical, radiological, and morphological patterns of the disease were determined for its each variant.Conclusions. 1. Acute EAA is characterized by an abrupt onset and rapid (no more than 3 months) development with a preponderance of intoxication syndrome (Cumulative Index (CI), 2.1 ± 0.2 scores); subacute EAA is characterized by a slower (8.5–10 months) development with a predominance of respiratory symptoms (CI, 2.5 ± 0.1 scores), the steady progression of which is observed in chronic EAA (CI, 2.9 ± 0.2 scores). Recurrent EAA  in  previously cured  patients  is  accompanied  by both  syndromes simultaneously  (CI, 2.7 ± 0.3). 2. The characteristic feature of acute EAA on HRCT of the chest is the extent of ground-glass opacity in both lungs (more than 3 segments) and perivascular infiltrates; that of subacute EAA is microfocal dissemination; that of chronic EAA is macrofocal changes in the presence of interlobular septal thickening, as well all the development of cystic changes in the subpleural zones. In recurrent EAA, all the listed symptoms may appear. 3. Enlarged intrathoracic lymph nodes are most common in subacute EAA in 45.9% of cases and less common in acute and chronic EAA in 20 and 23.8% of cases, respectively. In all disease variants, lymph node hypertrophy affects the bifurcation and paratracheal groups and less often the bronchopulmonary and tracheobronchial groups; the sizes vary from 11 to 20 mm with means of 13.0 ± 1.2 mm

X-RAY MORPHOLOGICAL SEMIOTICS OF NON-TUBERCULOUS MYCOBACTERIAL PULMONARY DISEASE

Objective: to evaluate the X-ray radiological features of nontuberculous mycobacterial pulmonary disease (NTMPD) versus morphological findings.Material and methods. The investigation enrolled 37 patients, in whom the radiographic signs of dissemination were determined and various types of NTMPD were identified. The investigation was conducted on a Siemens Somatom Emotion 16 multislice computed tomography (MSCT) scanner using a high-resolution algorithm (Quick Time Virtual Reality). To clarify the activity of pathological changes in the thoracic organs, 16 (43.2%) patients underwent a radionuclide study with 99mTc-technetrile on a Nucline Spirit gamma camera in planar and single photon emission computed tomography modes.The diagnosis was verified by sputum smear microscopy and clinical laboratory and bronchologic examinations: bronchoalveolar lavage in 11 (29.7%) patients, various types of bronchial biopsies in 17 (46.0%), morphological examinations, and videoassisted thoracoscopic surgery for pulmonary resection in 9 (24.3%).Results. The dissemination foci in mycobacterial diseases were characterized by their location in the lung parenchyma with vascular and bronchial involvement and reactive changes in the pulmonary pleurae and intrathoracic lymph nodes (ITLN). In 92.7% of cases, the detected foci were predominantly centrilobular with endobronchial localization. Their contours were mixed with clear and fuzzy outlines in 98.7% of cases. In 70.3% of cases, the foci were asymmetrically localized mainly in the subpleural areas of the lung and 12.3% of cases were accompanied by reactive involvement of the visceral pleura.CT study revealed a tree-in-bud sign in 96.7% of cases, frosted glass in 10.2%, and mosaic perfusion in 13.2%. A more than 10-mm increase in ITLN was found in 11.7% of cases.In a number of cases, it was difficult to speak about the activity of the pathological process in the lung and ITLN, as shown by MSCT. In this case, a lung radionuclide study with 99mTc-technetrile was carried out in the planar mode. The degree of tracer accumulation, localization, and extent were analyzed in the planar mode.Conclusion. Thus, the CT typical signs of NTMPD are the asymmetric location of its foci with an endobronchial extension, peribronchovascular localization of foci; the presence of a CT tree-in-bud sign; and the slight involvement of the pulmonary pleurae in the process. 99mTs-technetril radionuclide study has established that the most active inflammatory process is located in the lung and the tracer accumulates in the pathologically altered lymph nodes