High-Resolution Chest CT:

Practical Clinical Applications

Paul L. Molina, M.D.

Department of Radiology
University of North Carolina at Chapel Hill
Disclosures


None
Objectives
Identify current clinical indications
for the use of HRCT
Review proper technique for
performance of HRCT
Summarize the characteristic
patterns of abnormality seen on
HRCT and the most common
diseases resulting in their formation
HRCT - Indication
Evaluation of patients with
suspected infiltrative lung
disease but normal or
nonspecific findings on CXR
HRCT - Indication
Further characterization of
known or suspected diffuse
lung disease
HRCT - Indication
Evaluation of patients in whom
radiographic findings are not
in keeping with clinical findings
or pulmonary function tests
HRCT - Indication
Delineation of disease prior to
lung biopsy as a guide to the
optimal type and site of biopsy
HRCT Technique
Thin collimation (1 mm)

High spatial frequency reconstruction
Windows -700/1000-1500 HU

Prone scans differentiate atelectasis
Expiratory scans air trapping
HRCT Findings
Septal thickening
Reticular densities
Nodules
Increased lung opacity
Decreased lung opacity
Septal Thickening
Pulmonary edema
Lymphangitic carcinomatosis
Sarcoidosis
Asbestosis
Idiopathic pulmonary fibrosis
Reticular Densities
Idiopathic pulmonary fibrosis
Collagen vascular disease
Asbestosis
Chronic hypersensitivity pneumonitis
Sarcoidosis
UIP
Nodular Opacities
Sarcoidosis
Silicosis
Coal workers pneumoconiosis
Hypersensitivity pneumonitis
Tuberculosis
Metastatic disease
Nodular Opacities
Perilymphatic nodules
Random distribution
Centrilobular nodules
Perilymphatic Nodules
Sarcoidosis
Silicosis
Lymphangitic Ca
Silicosis
Random Nodules
Miliary TB
Hematogenous mets
Metastatic adenoca
Centrilobular Nodules
Endobronchial spread of TB
or other infection
Hypersensitivity pneumonitis
Endobronchial tumor spread
Nodular Opacities
Perilymphatic nodules
Random distribution
Centrilobular nodules
Increased Lung Opacity
Ground-glass opacity
Air-space consolidation
Ground-glass Opacity
Hypersensitivity pneumonitis (subacute)
Desquamative interstitial pneumonitis
Non-specific interstitial pneumonitis
Sarcoidosis
Alveolar proteinosis
DIP

Non-specific Interstitial Pneumonitis
Crazy-Paving
Alveolar
Proteinosis
Mosaic Pefusion
Consolidation
Obscures underlying vessels
Solid, opaque
Air bronchograms
Consolidation
Chronic eosinophilic pneumonia
BOOP / COP
Bronchoalveolar cell carcinoma
Lymphoma
Chronic Eosinophilic Pneumonia
BOOP / COP
Decreased Lung Opacity
Emphysema
Cystic airspaces
Mosaic perfusion
Cystic Airspaces
Lymphangioleiomyomatosis (LAM)
Langerhans Cell Histiocytosis (EG)
End-stage (honeycomb) lung
LAM
EG
HRCT - Indications
Suspected infiltrative disease but
normal or nonspecific CXR
Further characterize diffuse disease
CXR findings not in keeping with
clinical findings or PFTs
Guide type and site of biopsy

HRCT Findings
Septal thickening
Reticular opacities
Nodular opacities
Increased lung opacity
Decreased lung opacity