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High-Resolution Chest CT: Practical Clinical Applications

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

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High-Resolution Chest CT: Practical Clinical Applications

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  1. High-Resolution Chest CT: Practical Clinical Applications Paul L. Molina, M.D. Department of Radiology University of North Carolina at Chapel Hill

  2. Disclosures None

  3. 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

  4. HRCT - Indication • Evaluation of patients with suspected infiltrative lung disease but normal or nonspecific findings on CXR

  5. HRCT - Indication • Further characterization of known or suspected diffuse lung disease

  6. HRCT - Indication • Evaluation of patients in whom radiographic findings are not in keeping with clinical findings or pulmonary function tests

  7. HRCT - Indication • Delineation of disease prior to lung biopsy as a guide to the optimal type and site of biopsy

  8. HRCT Technique • Thin collimation (1 mm) • High spatial frequency reconstruction • Windows -700/1000-1500 HU • Prone scans – differentiate atelectasis • Expiratory scans – air trapping

  9. HRCT Findings • Septal thickening • Reticular densities • Nodules • Increased lung opacity • Decreased lung opacity

  10. Septal Thickening • Pulmonary edema • Lymphangiticcarcinomatosis • Sarcoidosis • Asbestosis • Idiopathic pulmonary fibrosis

  11. Reticular Densities • Idiopathic pulmonary fibrosis • Collagen vascular disease • Asbestosis • Chronichypersensitivity pneumonitis • Sarcoidosis

  12. UIP

  13. Nodular Opacities • Sarcoidosis • Silicosis • Coal worker’s pneumoconiosis • Hypersensitivity pneumonitis • Tuberculosis • Metastatic disease

  14. Nodular Opacities • Perilymphatic nodules • Random distribution • Centrilobular nodules

  15. Perilymphatic Nodules • Sarcoidosis • Silicosis • Lymphangitic Ca

  16. Silicosis

  17. Random Nodules • Miliary TB • Hematogenousmets

  18. Metastatic adenoca

  19. Centrilobular Nodules • Endobronchial spread of TB or other infection • Hypersensitivity pneumonitis • Endobronchial tumor spread

  20. Nodular Opacities • Perilymphatic nodules • Random distribution • Centrilobular nodules

  21. Increased Lung Opacity • Ground-glass opacity • Air-space consolidation

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