Fatma DURMAZ, Mesut ÖZGÖKÇE, Aysel SÜNNETÇİOĞLU, İlyas Dündar, Cemil GÖYA

Akciğer bilgisayarlı tomografisinde sık görülen mozaik perfüzyon etyolojisinde radyolojik ipuçları

Amaç: Bu çalışmamızda günlük radyoloji pratiğinde akciğer bilgisayarlı tomografide (BT) sık karşılaştığımız mozaik atenuasyon (MA) paterni olan hastalarda altta yatan süreci tanımlamaya yönelik, görüntüleme bulgularının radyolojik ipuçlarını literatür eşliğinde sunmayı amaçladık.Gereç ve Yöntem: MA paterni olan 400 hastanın toraks BT’si retrospektif olarak incelendi. Görece lüsen alanların mı (mozaik perfüzyon); yoksa görece opak alanların mı (buzlu cam) anormal olduğunu belirlemek için öncelikle damar çaplarına bakıldı. Damar çapı lüsen alanda daha küçük ise bu alan patolojik kabul edildi. Sonra mozaik perfüzyon nedenleri vasküler mi küçük hava yolu hastalığı mı diye direkt ve indirekt bulgulara bakıldı. Mozaik perfüzyonun havayolu hastalığı bulgularından bronş duvarı kalınlaşması, tomurcuklanmış ağaç görünümü ve bronşektazi direk; santral yerleşim, lobüler görünüm, küçük ve keskin kenarlı lüsen alanlar ise indirekt bulgular olarak kabul edildi. Vasküler nedenli MA’nun direk bulguları trombüs ve pulmoner arter genişlemesi iken periferal yerleşim, daha büyük ve sınırları net olmayan lüsen alanlar ise indirek bulgular olarak kabul edildi. Daha sonra bulgular klinik sonuçlar ile de korele edildi.Bulgular: MA’nın nedeni 190 (%47.5) hastada buzlu cam olarak tespit edildi. Lüsen alanların patolojik olduğu 210 hastanın 140’ı (%67) küçük hava yolu ve 70’i (%33) vasküler nedenli idi. Hava yolu hastalığına bağlı mozaik perfüzyon olan hastalarda toraks BT’de en sık tomurcuklanmış ağaç, bronş duvarında kalınlaşma ve bronşektazi izlendi. Vasküler hastalığa bağlı mozaik perfüzyonda ise kronik pulmoner emboli ve pulmoner hipertansiyon bulguları eşlik etmekteydiSonuç: Mozaik atenuasyon paterni düşünüldüğü kadar nonspesifik bir bulgu olmayıp radyologlar tarafından sistematik bir yaklaşım ile BT bulguları değerlendirilerek ayırıcı tanıya ve tedaviye katkı sunulabilir.

Radiological clues in etıology of mosaic perfusion that is frequently seen in lung computed tomography

Objective: We aimed to present the radiological clues of computed tomography (CT) imaging findings of patients with mosaic attenuation (MA) pattern. Material and Methods: Thoracic CT images of 400 patients with MA pattern were retrospectively reviewed. First of all, we looked at vessel diameters to determine whether relative lucent areas (mosaic perfusion) or relative opaque areas (ground glass opacity) were pathological.If the vessel diameter was smaller in the lucent area, this area was considered pathological. Then, the direct and indirect findings were investigated whether the cause of mosaic perfusion was vascular disease or small airway disease. Bronchial wall thickening, tree-in-bud appearance and bronchiectasis were the direct signs of mosaic perfusion; central location, lobular appearance, small and sharp-edged lucent areas were accepted as indirect findings. The direct findings of MA due to vascular disease were thrombus and enlarged pulmonary artery; peripheral location, larger and unclear lucent areas were accepted as indirect findings. The findings were then correlated with clinical outcomes. Results: The cause of mosaic attenuation was found to be ground glass in 190 (47.5%) patients. Of the 210 patients whose lucent areas were pathological, 140 (67%) were caused by small airway disease and 70 (33%) were caused by vascular disease Conclusion: The mosaic attenuation pattern is not as nonspecific as it is thought, and radiologic evaluation of computerized tomography findings by a systematic approach may contribute to differential diagnosis and clinical treatment.

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