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1 Department of Diagnostic Radiology, Yonsei University College of Medicine,
YongDong Severance Hospital, Seoul 135-270, Korea.
2 Department of Radiology and Center for Imaging Science, Samsung Medical
Center, Sungkyunkwan University School of Medicine, 50, Ilwon-Dong,
Kangnam-Ku, Seoul 135-710, Korea.
3 Research Institute of Radiologic Science, Yonsei University, Seoul 120-752,
Korea.
4 Department of Diagnostic Radiology, Yonsei University Wonju College of
Medicine, Wonju 220-701, Korea.
OBJECTIVE. The aim of our study was to evaluate the usefulness of the reversed halo sign on high-resolution CT in the diagnosis of cryptogenic organizing pneumonia.
MATERIALS AND METHODS. Between 1996 and 2001, we saw 31 patients with biopsy-proven cryptogenic organizing pneumonia. During the same period, we also saw 30 patients with non-cryptogenic organizing pneumonia diseases, from which cryptogenic organizing pneumonia should be differentiated: Wegener's granulomatosis (n = 14), diffuse bronchioloalveolar carcinoma (n = 10), chronic eosinophilic pneumonia (n = 5), and Churg-Strauss syndrome (n = 1). Two independent observers analyzed CT findings and recorded how frequently the so-called reversed halo sign (central ground-glass opacity and surrounding air-space consolidation of crescentic and ring shape) was seen on high-resolution CT.
RESULTS. The most common patterns of parenchymal abnormalities of cryptogenic organizing pneumonia were ground-glass opacity (28/31 patients, 90%) and consolidation (27/31, 87%). The ground-glass opacity pattern showed random distribution, and the consolidation pattern showed subpleural or peribronchovascular (20/27 patients, 74%) distribution with predominance in the middle or lower lung zone. The reversed CT halo sign was seen in six (19%) of 31 patients with cryptogenic organizing pneumonia and in none of the patients with the diseases that needed to be differentiated from cryptogenic organizing pneumonia on CT.
CONCLUSION. The reversed halo sign, although seen only in one fifth of patients with the disease, appears relatively specific to make a diagnosis of cryptogenic organizing pneumonia on CT.
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