化疗性肺损伤性肺炎（免疫检查点抑制剂ICI肺炎）亚型的影像学表现总结 ... ... ...

Axial CT demonstrates multifocal airspace and ground glass opacities in a subpleural distribution in the middle and lower lobes consistent with an organizing pneumonia pattern.

气腔（airspace）一词用于和实变、致密影、结节有连接处，以描述由病变所致的气腔充盈。

2.Nonspecific Interstitial Pneumonia Pattern 非特异性间质性肺炎（NSIP）特点

• Ground glass opacities with basilar predominance 磨玻璃样密度影，以基底段为著

• Reticular opacities 网状影

• Immediate subpleural sparing 邻近胸膜下区肺实质相对正常

• Apical-basilar gradient with lower lung predominance 病变由肺尖至肺底逐渐增多，以下肺为著

Axial CT demonstrates bilateral ground glass opacities within the subpleural lower lobes with several areas of subpleural sparing consistent with a nonspecific interstitial pneumonia pattern.

3.Hypersensitivity Pneumonitis Pattern 过敏性肺炎（HSP）特点

• Centrilobular ground glass nodules 小叶中央性磨玻璃结节

• Mid to upper lobe predominance 中上肺野多发

• Air trapping may also be seen 可能见到空气滞留征

• Septal thickening and pleural effusions may also be seen 可能见到小叶间隔间隔增厚和胸腔积液

Coronal CT demonstrating diffuse, although mid to upper lobe predominant, centrilobular ground glass nodularity (arrows) consistent with a hypersensitivity pneumonitis pattern.

空气潴留（air trapping）是指气道阻塞（常为部分性）导致的远处肺内的气体潴留。空气潴留见于呼气相末CT 扫描像上，表现为肺实质区的衰减较正常为少，且肺体积不缩小。当空气潴留轻度或弥漫性时，比较吸气相和呼气相CT 有价值。其通常难与阻塞性血管病（如慢性肺栓塞）低灌注所致的衰减减少区鉴别，但常有与血管病相对应的气道病的其他表现。

4.Acute Interstitial Pneumonia/ARDS Pattern 急性间质性肺炎（AIP）/ ARDS特点

• Severe manifestation with poor prognosis 临床表现重、预后差

• Diffuse or patchy ground glass opacities and consolidations 弥漫性或斑片状的磨玻璃密度影和实变

• Pleural effusions may be present 可能存在胸腔积液

• May be complicated by pneumonia/ abscess, pneumomediastinum, or pneumothorax 可能并发肺炎/脓肿、纵隔气肿或气胸

Axial CT demonstrating multifocal airspace consolidations (solid arrow) and ground glass opacities (dashed arrows) with almost no intervening normal lung parenchyma. 

5.Bronchiolitis Pattern 细支气管炎特点

• Small centrilobular nodules sparing the pleural surfaces  小叶中央性小结节，近胸膜表面相对正常

• Fill center of secondary pulmonary lobule 继发肺小叶的中心实变

• Tree-in-bud pattern 树芽征

• May see adjacent ground glass and/or consolidation 可能会见到邻近肺实质的磨玻璃密度影和/或实变

• Air trapping may also be seen 也可能见到空气潴留征

Axial CT demonstrating numerous right lower lobe centrilobular solid and ground glass nodules with sparing of the pleural surface (solid arrows). The patient’s primary lung tumor is seen within the left lower lobe (dashed arrow)