High resolution computed tomography of the lungs
- Paul Stark, MD
Paul Stark, MD
- Professor of Radiology
- University of California San Diego
- Section Editors
- Talmadge E King, Jr, MD
Talmadge E King, Jr, MD
- Editor-in-Chief — Pulmonary and Critical Care Medicine
- Section Editor — Interstitial Lung Disease
- Dean, School of Medicine
- Vice Chancellor, Medical Affairs
- University of California San Francisco
- Nestor L Muller, MD, PhD
Nestor L Muller, MD, PhD
- Section Editor — Pulmonary Imaging
- Professor of Radiology
- University of British Columbia
- Deputy Editors
- Geraldine Finlay, MD
Geraldine Finlay, MD
- Deputy Editor — Pulmonary, Critical Care, and Sleep Medicine
- Associate Professor
- Tufts University School of Medicine
- Susanna I Lee, MD, PhD
Susanna I Lee, MD, PhD
- Associate Professor of Radiology
- Harvard Medical School
- Massachusetts General Hospital
The initial imaging tool for the lung parenchyma remains the chest radiograph. It is unsurpassed in the amount of information it yields in relation to its cost, radiation dose, availability, and ease of performance. However, the chest radiograph has its limitations. It is normal in 10 to 15 percent of symptomatic patients with proven infiltrative lung disease, in up to 30 percent of those with bronchiectasis, and in close to 60 percent of patients with emphysema . In several studies, the chest radiograph has been shown to have an overall sensitivity of 80 percent and a specificity of 82 percent for detection of diffuse lung disease . Chest radiography could provide a confident diagnosis in only 23 percent of cases, and those confident diagnoses proved correct only in 77 percent of cases.
For these reasons, high resolution computed tomography (HRCT, also called thin-section CT scanning), is frequently used to help clarify specific problems. The clinical applications of HRCT will be reviewed here. The principles of CT imaging are discussed separately. (See "Principles of computed tomography of the chest".)
CLINICAL APPLICATION OF HRCT
HRCT, which has a sensitivity of 95 percent and a specificity approaching 100 percent [2-5], can often provide more information than either chest radiography or conventional CT scanning. A confident diagnosis is possible in roughly one-half of cases, and these are proven correct an estimated 93 percent of the time.
HRCT may be particularly useful in the following settings:
●It can detect lung disease in symptomatic patients with a normal chest radiograph.
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- CLINICAL APPLICATION OF HRCT
- Normal anatomy
- HRCT PATTERNS
- Reticular pattern
- Perilobular pattern
- Nodular pattern
- - Perilymphatic nodules
- - Random, hematogenous, or perivascular nodules
- - Centrilobular nodules
- - Airspace nodules
- - General approach
- Increased attenuation
- - Ground glass opacification
- - Consolidation or airspace filling
- Decreased attenuation
- Mosaic attenuation
- Cystic lung disease
- HRCT DISEASE DISTRIBUTION
- PULMONARY DISEASES
- - Bullous disease
- Airways diseases
- - Airway caliber
- - Bronchiectasis
- - Bronchiolitis
- Lymphangitic carcinomatosis
- Idiopathic interstitial pneumonias
- Langerhans cell histiocytosis
- Pulmonary alveolar proteinosis
- Pneumocystis pneumonia
- Hypersensitivity pneumonia
- HRCT OF INTERLOBULAR SEPTAL THICKENING
- HRCT IN FOCAL LUNG DISEASE
- EFFECTS OF NORMAL AGING
- EFFECTS OF SMOKING
- SUMMARY AND RECOMMENDATIONS