The potentials of multi-slice computed tomography (MSCT) and single-photon emission computed tomography (SPECT) in differentiation of pulmonary granulomatoses

Introduction: Errors in diagnosis of pulmonary granulomatoses reach 75%. Treatment effectiveness depends on timely diagnosis, course and activity of the disease. Aim: To perform differential diagnosis of disseminated pulmonary TB (DPT), hypersensitivity pneumonitis (HP), pulmonary sarcoidosis (PS) and pulmonary non-tuberculous mycobacterioses (NTM) by MSCT and SPECT scanning with 99m Tc-technetril. Methods: The analysis of MSCT and SPECT with 99m Tc-technetril data on 130 cases: DPT – 40; PS, HP and NTM – 30 in each group. We used the Siemens MSCT scanner “Somatom Emotion 16”; the gamma camera "Nucline Spirit” in the planar and SPECT mode. Results: We established that granulomas mainly localized in the peribronchovascular interstitium. In 55.2% of DPT cases peribronchovascular localization was accompanied by septal and intrabronchial foci. In 63.7% of HP cases – by centrilobular foci. In 68.3% of PS cases – by septal and centrilobular foci. In 90.4% of NTM cases there were also subpleural and intrabronchial foci (p Conclusions: 1. MSCT findings demonstrate the diagnostic value of predominant sites of granulomas in the structure of the bronchopulmonary system. 2. Use of SPECT scanning with technetril enables to establish activity, phase and stage of the pathological process.