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Thin-Section CT in Obstructive Pulmonary Disease: Discriminatory Value¹

¹ From the Department of Radiology, Hammersmith Hospital, London, England (S.J.C.); Department of Radiology (M.B.R., N.P.H., D.M.H.) and Interstitial Lung Disease Unit (A.U.W.), Royal Brompton Hospital, Sydney St, London SW3 6NP, England; Department of Radiology, Green Lane Hospital, Auckland, New Zealand (D.G.M.); and Department of Radiology, Vancouver General Hospital, Vancouver, British Columbia, Canada (N.L.M., J.C.). Received April 10, 2001; revision requested May 29; revision received August 31; accepted October 10. Address correspondence to D.M.H. (e-mail: d.hansell@rbh.nthames.nhs.uk).

View larger version (128K): [in a new window]   Figure 1. Transverse thin-section CT scan obtained in a patient with 1-antitrypsin deficiency shows coexisting centrilobular emphysema in the upper lobes (arrows). Typical features of panlobar emphysema (ie, mild bronchial dilatation, bronchial wall thickening, and panlobular pulmonary destruction) were seen in the lower zones of this patient.

View larger version (97K): [in a new window]   Figure 2. Transverse thin-section CT scan obtained in a healthy subject with normal pulmonary function shows bronchial wall thickening in the upper lobes (arrows). Both observers diagnosed asthma.

View larger version (88K): [in a new window]   Figure 3a. Transverse thin-section CT scans obtained in patients with (a) severe obliterative bronchiolitis and (b) panlobular emphysema. The features of decreased parenchymal attenuation (thick arrows), mild bronchial wall thickening (thin arrows), and bronchial dilatation (arrowheads) are similar. Observer A correctly diagnosed both cases, while observer B diagnosed a as panlobular emphysema and b as obliterative bronchiolitis.

View larger version (93K): [in a new window]   Figure 3b. Transverse thin-section CT scans obtained in patients with (a) severe obliterative bronchiolitis and (b) panlobular emphysema. The features of decreased parenchymal attenuation (thick arrows), mild bronchial wall thickening (thin arrows), and bronchial dilatation (arrowheads) are similar. Observer A correctly diagnosed both cases, while observer B diagnosed a as panlobular emphysema and b as obliterative bronchiolitis.

View larger version (118K): [in a new window]   Figure 4. Transverse thin-section CT scan obtained in a patient with panlobular emphysema as a result of 1-antitrypsin deficiency shows long lines (arrows). The increased prevalence and extent of long lines was highly significant in patients with panlobular emphysema in comparison to patients with obliterative bronchiolitis.