High-resolution computed tomography (HRCT) is a type of

computed tomography A computed tomography scan (CT scan), formerly called computed axial tomography scan (CAT scan), is a medical imaging technique used to obtain detailed internal images of the body. The personnel that perform CT scans are called radiographers or ...

(CT) with specific techniques to enhance

image resolution Image resolution is the level of detail of an image. The term applies to digital images, film images, and other types of images. "Higher resolution" means more image detail. Image resolution can be measured in various ways. Resolution quantifies ...

. It is used in the diagnosis of various health problems, though most commonly for lung disease, by assessing the lung

parenchyma upright=1.6, Lung parenchyma showing damage due to large subpleural bullae. Parenchyma () is the bulk of functional substance in an animal organ such as the brain or lungs, or a structure such as a tumour. In zoology, it is the tissue that ...

. On the other hand, HRCT of the

temporal bone The temporal bone is a paired bone situated at the sides and base of the skull, lateral to the temporal lobe of the cerebral cortex. The temporal bones are overlaid by the sides of the head known as the temples where four of the cranial bone ...

is used to diagnose various

middle ear The middle ear is the portion of the ear medial to the eardrum, and distal to the oval window of the cochlea (of the inner ear). The mammalian middle ear contains three ossicles (malleus, incus, and stapes), which transfer the vibrations ...

diseases such as

otitis media Otitis media is a group of Inflammation, inflammatory diseases of the middle ear. One of the two main types is acute otitis media (AOM), an infection of rapid onset that usually presents with ear pain. In young children this may result in pullin ...

, cholesteatoma, and evaluations after ear operations.

Technique

HRCT is performed using a conventional CT scanner. However, imaging parameters are chosen so as to maximize spatial resolution: a narrow slice width is used (usually 1–2 mm), a high spatial resolution image reconstruction algorithm is used, field of view is minimized, so as to minimize the size of each pixel, and other scan factors (e.g. focal spot) may be optimized for resolution at the expense of scan speed. Depending on the suspected diagnosis, the scan may be performed in both inspiration and

expiration Expiration or expiration date may refer to: Expiration Expiration may refer to: *Death *Exhalation of breath, breathing out * Expiration (options), the legal termination of an option to take an action *Shelf life, or the time after which a product ...

. In inspiration images are taken in the

prone position Prone position () is a body position in which the person lies flat with the chest down and the back up. In anatomical terms of location, the dorsal side is up, and the ventral side is down. The supine position is the 180° contrast. Etymology T ...

. In ''expiratory HRCT'' the scan is taken in the

supine position The supine position () means lying horizontally, with the face and torso facing up, as opposed to the prone position, which is face down. When used in surgical procedures, it grants access to the peritoneal, thoracic, and pericardium, pericardial ...

(face up). As HRCT's aim is to assess a generalized lung disease, the test is conventionally performed by taking thin sections which are 10–40 mm apart from each other. The result is a few images that should be representative of the lungs in general, but that cover only approximately one tenth of the lungs. Intravenous contrast agents are not used for HRCT as the lung inherently has very high contrast (soft tissue against air), and the technique itself is unsuitable for assessment of the soft tissues and blood vessels, which are the major targets of contrast agents.

Impact of modern CT technology

The technique of HRCT was developed with relatively slow CT scanners, which did not make use of multi-detector (MDCT) technology. The parameters of scan duration, z-axis resolution and coverage were interdependent. To cover the chest in a reasonable time period with a conventional chest CT scan required thick sections (e.g., 10mm thick) to ensure contiguous coverage. As performing contiguous thin sections required unacceptably prolonged scan time, HRCT examination was performed with widely spaced sections. Because of the different scan parameters for conventional and HRCT examinations, if a patient required both, they had to be performed sequentially. Modern MDCT scanners are able to overcome this interdependence, and are capable of imaging at full resolution yet retain very fast coverage - images can then be reconstructed retrospectively from the volumetric raw data. Because of this, it may be possible to reconstruct inspiratory HRCT-like images from the data taken from a 'normal' chest CT scan. Alternatively, the scanner could be configured to perform contiguous 1mm sections for a HRCT examination - this provides greater diagnostic information as it examines the entire lung, and permits the use of multi-planar reconstruction techniques. However, it brings the expense of irradiating the entire chest (instead of approximately 10%) when performed using widely spaced sections.

Lung disease

HRCT is used for diagnosis and assessment of interstitial lung disease, such as pulmonary fibrosis, and other generalized lung diseases such as

emphysema Emphysema is any air-filled enlargement in the body's tissues. Most commonly emphysema refers to the permanent enlargement of air spaces (alveoli) in the lungs, and is also known as pulmonary emphysema. Emphysema is a lower respiratory tract di ...

and

bronchiectasis Bronchiectasis is a disease in which there is permanent enlargement of parts of the bronchi, airways of the lung. Symptoms typically include a chronic cough with sputum, mucus production. Other symptoms include shortness of breath, hemoptysis, co ...

Applications

Airways diseases, such as

or bronchiolitis obliterans, cause air trapping on expiration, even though they may cause only minor changes to lung structure in their early stages. To enhance sensitivity for these conditions, the scan may be performed in both inspiration and expiration. HRCT may be diagnostic for conditions such as emphysema or bronchiectasis. While HRCT may be able to identify pulmonary fibrosis, it may not always be able to further categorize the fibrosis to a specific pathological type (e.g.,

non-specific interstitial pneumonitis Signs and symptoms are diagnostic indications of an disease, illness, injury, or condition. Signs are objective and externally observable; symptoms are a person's reported subjective experiences. A sign for example may be a higher or lower tem ...

or desquamative interstitial pneumonitis). The major exception is UIP, which has very characteristic features, and may be confidently diagnosed on HRCT alone. Where HRCT is unable to reach a definitive diagnosis, it helps locate an abnormality, and so helps planning a

biopsy A biopsy is a medical test commonly performed by a surgeon, interventional radiologist, an interventional radiologist, or an interventional cardiology, interventional cardiologist. The process involves the extraction of sampling (medicine), sample ...

, which may provide the final diagnosis. Other miscellaneous conditions where HRCT is useful include lymphangitis carcinomatosa, fungal, or other atypical, infections, chronic pulmonary vascular disease,

lymphangioleiomyomatosis Lymphangioleiomyomatosis (LAM) is a rare, progressive and systemic disease that typically results in cystic lung destruction. It predominantly affects women, especially during childbearing years. The term sporadic LAM is used for patients with LA ...

, and

sarcoidosis Sarcoidosis (; also known as Besnier–Boeck–Schaumann disease) is a disease involving abnormal collections of White blood cell, inflammatory cells that form lumps known as granulomata. The disease usually begins in the lungs, skin, or lymph n ...

. Organ transplant patients, particularly lung, or heart-lung transplant recipients, are at relatively high risk of developing pulmonary complications of the long-term drug and immunosuppressive treatment. The major pulmonary complication is bronchiolitis obliterans, which may be a sign of lung graft rejection. HRCT has better sensitivity for bronchiolitis obliterans than conventional radiography. Some transplant centers may arrange annual HRCT to screen for this. Diagnostic imaging, including HRCT, is one of the main diagnostic tools for

COVID-19 Coronavirus disease 2019 (COVID-19) is a contagious disease caused by the coronavirus SARS-CoV-2. In January 2020, the disease spread worldwide, resulting in the COVID-19 pandemic. The symptoms of COVID‑19 can vary but often include fever ...

. There is some debate about the usefulness of CT compared to other methods and imaging modalities for diagnosis. Under HRCT scan, infected individuals generally showed a multifocal or unifocal involvement of ground-glass opacity (GGO).

Nodularity

The presence of lung nodules on high resolution CT is a keystone in understanding the appropriate differential. Typically, the distribution of nodules is divided into perilymphatic, centrilobular and random categories. Furthermore, nodules can be ill-defined, implying they are in the alveoli, or well defined, suggesting an interstitial position. Distribution and appearance allow understanding of the disease process relative to the secondary lobule of the lung, the smallest anatomic unit with surrounding connective tissue, usually 1–2 cm across. Perilymphatic nodularity deposits at the periphery of the secondary lobule and tends to respect pleural surfaces and fissures.

Sarcoidosis Sarcoidosis (; also known as Besnier–Boeck–Schaumann disease) is a disease involving abnormal collections of White blood cell, inflammatory cells that form lumps known as granulomata. The disease usually begins in the lungs, skin, or lymph n ...

, lymphangitic spread of carcinoma, silicosis, coal worker's pneumoconiosis, and more rare diagnoses such as lymphoid interstitial pneumonitis and

amyloidosis Amyloidosis is a group of diseases in which abnormal proteins, known as amyloid fibrils, build up in tissue. There are several non-specific and vague signs and symptoms associated with amyloidosis. These include fatigue, peripheral edema, weigh ...

are included in the differential. Centrilobular nodularity deposits at the center of the secondary lobule, but spares pleural surfaces. Differential includes endobronchial

tuberculosis Tuberculosis (TB), also known colloquially as the "white death", or historically as consumption, is a contagious disease usually caused by ''Mycobacterium tuberculosis'' (MTB) bacteria. Tuberculosis generally affects the lungs, but it can al ...

bronchopneumonia Bronchopneumonia is a subtype of pneumonia. It is the acute inflammation of the Bronchus, bronchi, accompanied by inflamed patches in the nearby lobules of the lungs. citing: Webster's New World College Dictionary, Fifth Edition, Copyright 2014 ...

, endobronchial spread of tumor, and again silicosis or coal workers’ pneumoconiosis. For randomly distributed nodules, the differential includes miliary tuberculosis,

fungal pneumonia Fungal pneumonia is an infection of the lungs by fungi. It can be caused by either endemic or opportunistic fungi or a combination of both. Case mortality in fungal pneumonias can be as high as 90% in immunocompromised patients, though immunoc ...

, hematogenous

metastasis Metastasis is a pathogenic agent's spreading from an initial or primary site to a different or secondary site within the host's body; the term is typically used when referring to metastasis by a cancerous tumor. The newly pathological sites, ...

and diffuse sarcoidosis.

Prone versus supine position

Because the bases of the lungs lie

posteriorly Standard anatomical terms of location are used to describe unambiguously the anatomy of humans and other animals. The terms, typically derived from Latin or Greek roots, describe something in its standard anatomical position. This position provi ...

in the chest, a mild degree of collapse under the lungs' own weight can occur when the patient lies on their back. As the very base of the lungs may be the first region affected in several lung diseases, most notably

asbestosis Asbestosis is long-term inflammation and pulmonary fibrosis, scarring of the human lung, lungs due to asbestos fibers. Symptoms may include shortness of breath, cough, wheezing, and chest pain, chest tightness. Complications may include lung canc ...

or usual interstitial pneumonia (UIP), the patient may be asked to lie prone to improve sensitivity to early changes of these conditions. The lung bases are often inconsistent in appearance in patients due to the potential for

atelectasis Atelectasis is the partial collapse or closure of a lung resulting in reduced or absence in gas exchange. It is usually unilateral, affecting part or all of one lung. It is a condition where the Pulmonary alveolus, alveoli are deflated down to l ...

causing positional ground glass or consolidative opacities. When the patient is positioned prone, or on their belly, the lung bases can expand further and help distinguish

from early fibrosis. In patients with normal chest radiographs, prone scans have been found useful in 17% of cases, particularly in excluding posterior lung abnormalities. In patients with abnormal findings on chest radiographs, prone scans are only useful in 4% of cases. The scans may be more useful in patients with basilar predominant disease processes, such as asbestosis and idiopathic pulmonary fibrosis.

Temporal bone diseases

HRCT temporal bone is used to determine the anatomy of chronic otitis media (middle ear is located inside the temporal bone), congenital abnormalities, and loss of surgical landmarks due to previous operation. Thus, HRCT is useful in surgical planning and management of temporal bone diseases.

References

External links

High-Resolution Computed Tomography in Interstitial Lung Disease

Understanding High-Resolution Computed Tomography
{{DEFAULTSORT:High Resolution Ct X-ray computed tomography Respiratory system imaging