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National Heart and Lung Institute and Division of Investigative Science, Imperial College School of Medicine, London and Department of Radiology, Royal Brompton Hospital, London, UK
CORRESPONDENCE: D.M. Hansell, Dept of Radiology, Royal Brompton Hospital, Sydney Street, London, SW3 6NP, UK. Fax: 44 2073518098
Keywords: computed tomography, obliterative bronchiolitis, small airways disease
Received: September 9, 2000
Accepted January 1, 2001
Abstract
Diseases affecting the small airways are difficult to detect by traditional diagnostic tests. Widespread involvement is needed before symptoms and abnormalities on pulmonary function testing or chest radiography become apparent. Obstruction of the bronchioles may be detected indirectly by computed tomography (CT) because regional under-ventilation results in reduced perfusion which in turn is shown as a mosaic attenuation pattern of the lung parenchyma. When there is inflammation of the bronchioles with accompanying exudate, the airways may become directly visible on CT, for example in cases of diffuse panbronchiolitis.
Quantification of the various morphological features of small airways disease is possible from CT images and this increased precision has aided investigations of structure/function relationships.
An understanding of the pathology and microscopic distribution of disease in relation to the airways allows some prediction of the likely computed tomography appearances in this wide spectrum of conditions, and thus helps to refine the differential diagnosis.
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