Abstract：
BACKGROUND: Asbestosis and fibrotic hypersensitivity pneumonitis (FHP) share the pathogenetic mechanisms induced bronchiolocentric fibrotic process secondary to inhalation exposure. Under the occupational and environmental mixed exposures, asbestosis and FHP are needed to make the differential diagnoses on high-resolution computed tomography (HRCT), especially in the countries still using asbestos. The study aimed to analyze the HRCT features of asbestosis versus FHP.
METHODS: The patients with asbestosis or with HP were sequentially recruited in this comparative study at Beijing Chaoyang Hospital between January 2006 and December 2016. Patients\' clinical data were obtained from a predesigned charts. The international classification of HRCT for occupational and environmental respiratory diseases was used to categorize chest imaging findings in patients. The calculation of test statistics was used to compare the imaging features of asbestosis and FHP.
RESULTS: 341 patients with asbestosis and 158 patients with HP were sequentially recruited, among which 204 patients with asbestosis and 74 patients with FHP were eligible for data analysis. Patients with asbestosis were older and had a longer latent period until disease manifestation than those with FHP. Asbestosis was characterized by irregular and/or linear opacities, with lower lung preponderance, accompanied by ground-glass opacities and mosaic attenuation. Notably, 98.5% of patients with asbestosis showed benign pleural abnormalities, and 39.7% of these patients had diffuse pleural thickening with parenchymal bands and/or rounded atelectasis. Abnormalities of the mediastinal and diaphragmatic pleura were observed only in cases of asbestosis, and this finding showed high specificity for the diagnosis for asbestosis compared with that for FHP. Subpleural dots or diaphragmatic pleural abnormalities showed moderate sensitivity and high specificity for diagnosis of asbestosis compared with that for FHP. Interobserver reliability was good for evaluation of imaging findings including honeycombing, pleural calcification, lymphadenectasis, and lymph node calcification.
CONCLUSIONS: HRCT-based imaging findings can distinguish between asbestosis and FHP to a certain extent, particularly with regard to subpleural dots and diaphragmatic pleural abnormalities that characterize the former.
METHODS: The patients with asbestosis or with HP were sequentially recruited in this comparative study at Beijing Chaoyang Hospital between January 2006 and December 2016. Patients\' clinical data were obtained from a predesigned charts. The international classification of HRCT for occupational and environmental respiratory diseases was used to categorize chest imaging findings in patients. The calculation of test statistics was used to compare the imaging features of asbestosis and FHP.
RESULTS: 341 patients with asbestosis and 158 patients with HP were sequentially recruited, among which 204 patients with asbestosis and 74 patients with FHP were eligible for data analysis. Patients with asbestosis were older and had a longer latent period until disease manifestation than those with FHP. Asbestosis was characterized by irregular and/or linear opacities, with lower lung preponderance, accompanied by ground-glass opacities and mosaic attenuation. Notably, 98.5% of patients with asbestosis showed benign pleural abnormalities, and 39.7% of these patients had diffuse pleural thickening with parenchymal bands and/or rounded atelectasis. Abnormalities of the mediastinal and diaphragmatic pleura were observed only in cases of asbestosis, and this finding showed high specificity for the diagnosis for asbestosis compared with that for FHP. Subpleural dots or diaphragmatic pleural abnormalities showed moderate sensitivity and high specificity for diagnosis of asbestosis compared with that for FHP. Interobserver reliability was good for evaluation of imaging findings including honeycombing, pleural calcification, lymphadenectasis, and lymph node calcification.
CONCLUSIONS: HRCT-based imaging findings can distinguish between asbestosis and FHP to a certain extent, particularly with regard to subpleural dots and diaphragmatic pleural abnormalities that characterize the former.
摘要：
背景：石棉肺和纤维化过敏性肺炎（FHP）具有共同的致病机制，可诱发继发于吸入暴露的以支气管为中心的纤维化过程。在职业和环境混合暴露下，在高分辨率计算机断层扫描（HRCT）上进行鉴别诊断时，需要石棉沉着症和FHP，特别是在仍在使用石棉的国家。本研究旨在分析石棉沉滞症与FHP的HRCT特征。
方法：于2006年1月至2016年12月在北京朝阳医院连续招募石棉肺或HP患者。患者的临床数据来自预先设计的图表。职业和环境呼吸系统疾病的HRCT国际分类用于对患者的胸部影像学检查结果进行分类。试验统计量的计算用于比较石棉沉滞症和FHP的影像学特征。
结果：依次招募了341名石棉肺患者和158名HP患者，其中204例石棉肺病患者和74例FHP患者符合数据分析条件.石棉肺病患者比FHP患者年龄更大，潜伏期更长，直到疾病表现。石棉肺的特征是不规则和/或线性混浊，肺部优势较低，伴随着毛玻璃混浊和马赛克衰减。值得注意的是,98.5%的石棉肺患者表现为良性胸膜异常,39.7%的患者有弥漫性胸膜增厚伴实质带和/或圆形肺不张。纵隔和膈肌胸膜异常仅在石棉沉着症的病例中观察到，与FHP相比，这一发现对石棉肺的诊断具有很高的特异性。与FHP相比，胸膜下斑点或膈胸膜异常对石棉肺的诊断具有中等敏感性和高特异性。观察者间的可靠性对于评估包括蜂窝成像在内的影像学发现很好，胸膜钙化,淋巴结肿大，淋巴结钙化.
结论：基于HRCT的影像学表现可以在一定程度上区分石棉沉着症和FHP，特别是关于胸膜下斑点和膈胸膜异常的特征。
方法：于2006年1月至2016年12月在北京朝阳医院连续招募石棉肺或HP患者。患者的临床数据来自预先设计的图表。职业和环境呼吸系统疾病的HRCT国际分类用于对患者的胸部影像学检查结果进行分类。试验统计量的计算用于比较石棉沉滞症和FHP的影像学特征。
结果：依次招募了341名石棉肺患者和158名HP患者，其中204例石棉肺病患者和74例FHP患者符合数据分析条件.石棉肺病患者比FHP患者年龄更大，潜伏期更长，直到疾病表现。石棉肺的特征是不规则和/或线性混浊，肺部优势较低，伴随着毛玻璃混浊和马赛克衰减。值得注意的是,98.5%的石棉肺患者表现为良性胸膜异常,39.7%的患者有弥漫性胸膜增厚伴实质带和/或圆形肺不张。纵隔和膈肌胸膜异常仅在石棉沉着症的病例中观察到，与FHP相比，这一发现对石棉肺的诊断具有很高的特异性。与FHP相比，胸膜下斑点或膈胸膜异常对石棉肺的诊断具有中等敏感性和高特异性。观察者间的可靠性对于评估包括蜂窝成像在内的影像学发现很好，胸膜钙化,淋巴结肿大，淋巴结钙化.
结论：基于HRCT的影像学表现可以在一定程度上区分石棉沉着症和FHP，特别是关于胸膜下斑点和膈胸膜异常的特征。
