Seminars in Roentgenology最新文献

英文中文

Pleuroparenchymal Fibroelastosis

IF 1.3 4区医学 Q4 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

Seminars in Roentgenology

Pub Date : 2026-01-01 DOI: 10.1053/j.ro.2025.08.002

Elizabeth Lee MD , Heather Chen-Yost MD , Jennifer M. Wang MD , Prachi P. Agarwal MBBS

引用次数: 0

Refining the Radiologic Recognition of Pulmonary Alveolar Proteinosis: A Crazy-Paving Pattern Approach 改进肺泡蛋白沉积症的放射学识别：一种疯狂铺路模式方法。

IF 1.3 4区医学 Q4 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

Seminars in Roentgenology

Pub Date : 2026-01-01 DOI: 10.1053/j.ro.2025.09.004

Aaron Cedric Llanes , Anshu Bandhlish , Sudhakar Pipavath , Ana Paula Santos Lima

Pulmonary alveolar proteinosis (PAP) is a rare airspace disease classically associated with the crazy-paving pattern on high-resolution computed tomography (HRCT). While highly suggestive, this imaging pattern is not pathognomonic and appears across a wide spectrum of pulmonary pathologies. In this review, we adopt a phenotype-first approach, using representative imaging cases to walk the reader through the differential diagnosis of crazy-paving, with attention to radiologic distribution, clinical context, and disease acuity. We emphasize distinguishing features between PAP and its mimics—including pulmonary edema, diffuse alveolar hemorrhage, organizing pneumonia, mucinous adenocarcinoma, exogenous lipoid pneumonia, acute fulminant PAP, and COVID-19 pneumonia—using side-by-side imaging and contextual pearls. Special attention is given to the radiologic clues favoring autoimmune versus secondary PAP, including geographic distribution of ground-glass opacities, subpleural sparing, and lower lobe predominance. The review concludes with a summary of diagnostic strategies, pathologic correlation, and treatment options, including insights from post-pandemic diagnostic pitfalls. This pattern-based framework is designed for the radiologist and serves as a practical guide for recognizing PAP within the broader spectrum of airspace diseases.

肺泡蛋白沉积症（PAP）是一种罕见的空域疾病，通常与高分辨率计算机断层扫描（HRCT）上的疯狂铺路模式有关。虽然高度提示，但这种影像学模式不是典型的，并且在广泛的肺部病变中出现。在这篇综述中，我们采用表型优先的方法，通过有代表性的影像学病例来引导读者了解疯狂铺路的鉴别诊断，并注意放射学分布、临床背景和疾病的敏锐度。我们强调区分PAP及其模拟物的特征-包括肺水肿，弥漫性肺泡出血，组织性肺炎，粘液腺癌，外源性脂质肺炎，急性暴发性PAP和COVID-19肺炎-使用并排成像和背景珍珠。特别关注自身免疫性PAP与继发性PAP的放射学线索，包括毛玻璃混浊的地理分布、胸膜下保留和下肺叶优势。该综述总结了诊断策略、病理相关性和治疗方案，包括大流行后诊断缺陷的见解。这个基于模式的框架是为放射科医生设计的，并作为在更广泛的空域疾病范围内识别PAP的实用指南。

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引用次数: 0

ILD Imaging: Beyond Patterns to Patient-Centered Care ILD成像：超越模式到以患者为中心的护理。

IF 1.3 4区医学 Q4 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

Seminars in Roentgenology

Pub Date : 2026-01-01 DOI: 10.1053/j.ro.2025.09.001

Prachi Agarwal MD, MD, FNASCI, FACR

引用次数: 0

Hypersensitivity Pneumonitis: Imaging Findings and Patterns 超敏性肺炎：影像学表现和模式。

IF 1.3 4区医学 Q4 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

Seminars in Roentgenology

Pub Date : 2026-01-01 DOI: 10.1053/j.ro.2025.08.001

Taylor Sellers MD, Maria Daniela Martin MD, Jeffrey P. Kanne MD

Recently published guidelines on the diagnosis of hypersensitivity pneumonitis from the American Thoracic Society/Japanese Respiratory Society/Asociación Latinoamericana de Tórax and the American College of Chest Physicians place increased importance on CT analysis as a component of the multidisciplinary diagnosis. Accurate identification and characterization of CT findings is critical as they have downstream effects on the rest of the diagnostic workup, which places imaging early in their diagnostic algorithms. Though the imaging features of hypersensitivity pneumonitis are well established, it remains a challenging diagnosis for radiologists due to its variable appearance and lack of specific CT findings.

This review summarizes the imaging features and patterns of nonfibrotic and fibrotic hypersensitivity pneumonitis using the newest guidelines and classifications as a framework. Additional information relevant to the interpreting radiologist is also briefly discussed, including progressive pulmonary fibrosis, acute exacerbation, and differentiating fibrotic hypersensitivity pneumonitis from a usual interstitial pneumonia pattern of fibrosis.

美国胸科学会/日本呼吸学会/Asociación Latinoamericana de Tórax和美国胸科医师学会最近发布的超敏性肺炎诊断指南越来越重视CT分析作为多学科诊断的组成部分。CT结果的准确识别和表征至关重要，因为它们对其余的诊断工作有下游影响，因此将成像置于诊断算法的早期。尽管超敏性肺炎的影像学特征已经确立，但由于其多变的外观和缺乏特异性的CT表现，对放射科医生来说仍然是一个具有挑战性的诊断。本文以最新的指南和分类为框架，综述了非纤维化性和纤维化性超敏性肺炎的影像学特征和模式。本文还简要讨论了与放射科医生解释相关的其他信息，包括进行性肺纤维化，急性加重，以及区分纤维化超敏性肺炎与通常的间质性肺炎纤维化模式。

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引用次数: 0

Interstitial Lung Abnormality: A Bayesian Approach for the Radiologist 肺间质性异常：放射科医生的贝叶斯方法。

IF 1.3 4区医学 Q4 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

Seminars in Roentgenology

Pub Date : 2026-01-01 DOI: 10.1053/j.ro.2025.09.002

Nandakumar G. Patnam MD, Mohamed Abdelmotleb MD, Sudhakar Pipavath MD

Interstitial lung abnormalities (ILA) refer to incidental changes seen on chest CT, usually in people without a formal diagnosis of interstitial lung disease (ILD). Interest in ILA has grown in recent years, partly because they may signal early fibrotic lung changes and partly because CT scans are being used more often for screening. Defined by the Fleischner Society and updated by the ATS, ILA encompasses 3 patterns: nonsubpleural, subpleural nonfibrotic, and subpleural fibrotic. Subpleural fibrotic ILA, marked by traction bronchiectasis and honeycombing, carries the greatest likelihood of progression and the poorest prognosis. Older age, smoking history, and certain genetic traits such as the MUC5B promoter variant increase the likelihood of finding ILA. The presence of ILA also appears to raise the risk of lung cancer. For management, current guidelines recommend tailoring follow-up based on individual risk, with closer surveillance for patients more likely to progress. Newer tools, including quantitative imaging and artificial intelligence, may help detect subtle disease earlier and refine risk assessment. Despite advances, challenges remain in defining progression thresholds and treatment strategies, highlighting the need for further research.

间质性肺异常（ILA）是指在胸部CT上看到的偶然变化，通常发生在没有正式诊断为间质性肺疾病（ILD）的人群中。近年来，人们对ILA的兴趣越来越大，部分原因是它们可能预示着早期纤维化肺变化，部分原因是CT扫描越来越多地用于筛查。由Fleischner学会定义并由ATS更新，ILA包括三种模式：非胸膜下、胸膜下非纤维化和胸膜下纤维化。以牵引性支气管扩张和蜂窝状为特征的胸膜下纤维化性ILA，其进展的可能性最大，预后最差。年龄较大、吸烟史和某些遗传特征（如MUC5B启动子变异）增加了发现ILA的可能性。ILA的存在似乎也会增加患肺癌的风险。对于管理，目前的指南建议根据个人风险进行量身定制的随访，对更有可能进展的患者进行更密切的监测。包括定量成像和人工智能在内的新工具可能有助于更早地发现细微疾病并改进风险评估。尽管取得了进展，但在确定进展阈值和治疗策略方面仍然存在挑战，这突出了进一步研究的必要性。

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引用次数: 0

Organizing Pneumonia Phenotype 组织性肺炎表型。

IF 1.3 4区医学 Q4 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

Seminars in Roentgenology

Pub Date : 2026-01-01 DOI: 10.1053/j.ro.2025.08.007

Muthu Kumar Sakthivel MD, FSCMR , Todd Richard Hazelton MD, MS , Frederic Barton Askin MD , Surekha Bantumilli MD , Shravan Sridhar MD, MS

Organizing pneumonia (OP) is a nonspecific lung parenchymal response to any form of injury, with its idiopathic variant coined as cryptogenic organizing pneumonia (COP). The hallmark pathological features are presence of polypoid granulation tissue, or Masson bodies, in the alveolar spaces, with lung architecture preserved in most patients with good clinical outcomes poststeroid treatment. Clinically, patients exhibit signs and symptoms of subclinical or subacute infection that do not respond to antibiotics. Computed Tomography (CT) plays a vital role in establishing the diagnosis, monitoring of OP, and for better understanding of its imaging phenotypes which are crucial for clinical decision making. This article highlights the 3 main imaging patterns of OP on CT, the classic, nodular and fibrotic forms. Identifying these diverse imaging features holds the key for precise diagnosis of OP.

组织性肺炎（OP）是对任何形式损伤的非特异性肺实质反应，其特发性变体被称为隐源性组织性肺炎（COP）。典型的病理特征是肺泡间隙存在息肉样肉芽组织或马松体，大多数患者在类固醇治疗后临床效果良好，肺结构保留。临床上，患者表现出对抗生素无反应的亚临床或亚急性感染的体征和症状。计算机断层扫描（CT）在建立OP的诊断、监测和更好地了解其成像表型方面发挥着至关重要的作用，这对临床决策至关重要。本文重点介绍了OP在CT上的三种主要表现形式：经典、结节和纤维化。识别这些不同的影像学特征是准确诊断OP的关键。

引用次数: 0

Usual Interstitial Pneumonia Spectrum: UIP, Probable UIP, and Indeterminate UIP 通常间质性肺炎谱：UIP、可能UIP和不确定UIP。

IF 1.3 4区医学 Q4 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

Seminars in Roentgenology

Pub Date : 2026-01-01 DOI: 10.1053/j.ro.2025.09.005

Furkan Ufuk MD, Lydia Chelala MD, Jonathan H. Chung MD

The usual interstitial pneumonia (UIP) pattern remains central to the diagnosis and management of fibrotic interstitial lung diseases (ILDs), particularly idiopathic pulmonary fibrosis (IPF). Thin-section computed tomography enables noninvasive characterization across the UIP spectrum, with structured pattern classification demonstrating strong correlation with histopathology and survival outcomes. In appropriate clinical settings, thin-section CT can obviate the need for surgical lung biopsy. Multidisciplinary discussion remains essential to integrate imaging, clinical, and pathologic findings for optimal therapeutic decision-making, including timely antifibrotic initiation and transplant referral. This review synthesizes current knowledge on the UIP imaging spectrum, emphasizing its diagnostic, prognostic, and clinical implications. We further outline recent advances in quantitative imaging, deep learning models, and molecular biomarkers that improve diagnostic precision and risk stratification. We also highlight emerging frontiers, including AI-driven spatiotemporal modeling and molecular imaging, that promise earlier detection, individualized prognostication, and precision-guided therapy.

通常的间质性肺炎（UIP）模式仍然是纤维化间质性肺病（ILDs），特别是特发性肺纤维化（IPF）的诊断和治疗的核心。薄层计算机断层扫描可以实现跨UIP谱的无创特征，结构化模式分类显示与组织病理学和生存结果有很强的相关性。在适当的临床条件下，薄层CT可以避免手术肺活检的需要。多学科的讨论对于整合影像学、临床和病理结果以做出最佳治疗决策至关重要，包括及时的抗纤维化起始和移植转诊。这篇综述综合了目前关于UIP成像谱的知识，强调其诊断、预后和临床意义。我们进一步概述了定量成像、深度学习模型和分子生物标志物方面的最新进展，这些进展可以提高诊断精度和风险分层。我们还重点介绍了新兴领域，包括人工智能驱动的时空建模和分子成像，这些技术有望实现早期检测、个性化预测和精确指导治疗。

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引用次数: 0

Radiologic Approach to Cystic Lung Diseases: From Cyst Definition to Diagnosis 肺囊性疾病的影像学诊断：从囊肿定义到诊断。

IF 1.3 4区医学 Q4 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

Seminars in Roentgenology

Pub Date : 2026-01-01 DOI: 10.1053/j.ro.2025.08.005

Harish Gudi MD , Dhiraj Baruah MD , Kavitha Yaddanapudi MD , Ismail M Kabakus MD, PhD

Cystic lung diseases represent a heterogeneous group of conditions characterized by the presence of multiple pulmonary cysts. Accurate recognition and differentiation of true cysts from their mimics (such as cavities, emphysema, bullae, blebs, and honeycombing) are essential, as management strategies and prognoses vary significantly. This review provides a systematic approach to the radiologic evaluation of cystic lung diseases, beginning with the definition and pathogenesis of pulmonary cysts and progressing through a structured diagnostic algorithm. We detail the characteristic imaging findings and clinical associations for major cystic lung diseases, including lymphangioleiomyomatosis (LAM), Birt-Hogg-Dubé syndrome (BHD), light-chain deposition disease (LCDD), lymphocytic interstitial pneumonia (LIP), desquamative interstitial pneumonia (DIP), pulmonary Langerhans cell histiocytosis (PLCH), and amyloidosis. Additionally, we discuss uncommon etiologies, such as cystic metastases, hypersensitivity pneumonitis, and cystic changes associated with genetic syndromes like neurofibromatosis type 1 (NF-1) and trisomy 21. The review emphasizes key imaging clues, such as cyst distribution, wall characteristics, associated nodules, and parenchymal abnormalities, that aid in narrowing the differential diagnosis. With the growing use of CT imaging, cystic lung diseases are increasingly identified in both symptomatic and asymptomatic patients. Familiarity with their imaging patterns, clinical contexts, and distinguishing features is essential for radiologists and clinicians alike. By following a stepwise, pattern-based approach, early and accurate diagnosis can be achieved, potentially improving patient outcomes through timely surveillance and targeted management.

囊性肺疾病是一种以多发肺囊肿为特征的异质性疾病。由于治疗策略和预后差异很大，因此准确识别和区分真正的囊肿和类似的囊肿（如空腔、肺气肿、大泡、水泡和蜂窝状）至关重要。本文综述了囊性肺疾病的影像学评估的系统方法，从肺囊肿的定义和发病机制开始，并通过结构化的诊断算法进行进展。我们详细介绍了主要囊性肺疾病的特征性影像学表现和临床相关性，包括淋巴管平滑肌瘤病（LAM）、birt - hogg - dub综合征（BHD）、轻链沉积病（LCDD）、淋巴细胞间质性肺炎（LIP）、脱屑性间质性肺炎（DIP）、肺朗格汉斯细胞组织细胞增多症（PLCH）和淀粉样变性。此外，我们还讨论了罕见的病因，如囊性转移、过敏性肺炎和与遗传综合征相关的囊性改变，如1型神经纤维瘤病（NF-1）和21三体。这篇综述强调了关键的影像学线索，如囊肿分布、壁特征、相关结节和实质异常，这些线索有助于缩小鉴别诊断范围。随着CT成像的日益普及，囊性肺疾病越来越多地出现在有症状和无症状的患者中。对放射科医生和临床医生来说，熟悉他们的成像模式、临床背景和显著特征是必不可少的。通过遵循逐步的、基于模式的方法，可以实现早期和准确的诊断，通过及时监测和有针对性的管理可能改善患者的预后。

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引用次数: 0

The Progressive Massive Fibrosis Phenotype: Causes, Pathophysiology, and Imaging 进行性块状纤维化表型：病因、病理生理学和影像学。

IF 1.3 4区医学 Q4 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

Seminars in Roentgenology

Pub Date : 2026-01-01 DOI: 10.1053/j.ro.2025.08.006

Leif Jensen MD, MPH , Cris A. Meyer MD

引用次数: 0

Autoimmune-Associated Interstitial Lung Disease: Imaging Phenotypes 自身免疫相关间质性肺疾病：影像学表型。

IF 1.3 4区医学 Q4 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

Seminars in Roentgenology

Pub Date : 2026-01-01 DOI: 10.1053/j.ro.2025.08.003

Christian W. Cox MD

Recognizing characteristic traits, or phenotypes, of Autoimmune-Associated Interstitial Lung Disease (AA-ILD) on HRCT imaging assists in diagnosis, prognosis, treatment decisions and imaging surveillance. The primary AA-ILD imaging phenotypes considered include pulmonary parenchymal patterns, extrapulmonary associated findings, clinical context and change over time. Focusing on the imaging appearance of the major interstitial pneumonia patterns by histopathologic categories, the localized imaging features defined by the secondary pulmonary lobule, and the growing list of sub-patterns or imaging signs, we begin to bridge the gap between the strictly defined categories studied in the literature with the often vague “feel” of AA-ILD imaging in clinical practice. Furthermore, this review explores the current and future applications of automated CT assessment in AA-ILD imaging phenotypes.

在HRCT成像上识别自身免疫相关间质性肺疾病（AA-ILD）的特征或表型有助于诊断、预后、治疗决策和影像学监测。考虑的主要AA-ILD影像学表型包括肺实质模式、肺外相关发现、临床背景和随时间的变化。关注主要间质性肺炎病理分类的影像学表现、肺次级小叶定义的局部影像学特征以及越来越多的亚模式或影像学征象，我们开始弥合文献研究中严格定义的分类与临床实践中AA-ILD影像学往往模糊的“感觉”之间的差距。此外，本文还探讨了自动CT评估在AA-ILD成像表型中的当前和未来应用。

引用次数: 0

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