The Fleischner lecture: computed tomography of diffuse pulmonary disease.

Area of Science:

• Radiology
• Pulmonary Medicine
• Medical Imaging

Background:

• Computed tomography (CT) provides high resolution for gross pulmonary anatomy and pathology.
• CT densitometry faces challenges in diffuse lung disease assessment due to partial volume errors from varied intrathoracic densities.

Purpose of the Study:

• To evaluate the utility of CT densitometry and morphology in diagnosing diffuse lung diseases.
• To explore the role of anteroposterior density gradients and mean lung density in specific patient groups.

Main Methods:

• Analysis of CT scans focusing on gross pulmonary anatomy, pathology, and densitometry.
• Correlation of conventional roentgenogram patterns with CT imaging findings.
• Evaluation of density measurements in normal and abnormal lungs.

Main Results:

• CT is superior for gross pulmonary anatomy and pathology compared to densitometry for diffuse disease.
• Anteroposterior density gradients and mean lung density are beneficial for suspected high-density disease.
• Morphologic patterns of diffuse high-density lung disease on conventional radiographs closely match CT depictions.
• Lung medulla may serve as a reservoir for blood flow adjustments.
• CT densitometry and morphology effectively identify and differentiate diseases causing oligemia.

Conclusions:

• CT is the premier radiographic tool for pulmonary anatomy and pathology, with densitometry valuable in select high-density conditions.
• Integrated imaging, including plain radiographs, isotopic scans, and CT scans, may be necessary for complex high- and low-density lung diseases.