subject: High Resolution Ct Scans And Workers Exposed To Hazardous Asbestos [print this page] Each year asbestos related diseases such as Mesothelioma takes the lives of thousands. Important work is being done trying to better understand disease development.
One interesting study is called, Computed tomography in the evaluation of benign asbestos-related disorders - Department of Radiology, University of British Columbia, Vancouver, Canada - Radiol Clin North Am. 1992 Nov;30(6):1191-207. Here is an excerpt: Abstract - High-resolution CT is more sensitive than chest radiography and conventional CT in the detection and assessment of benign asbestos-related pleural and parenchymal diseases. The HRCT features of asbestosis correlate with clinical and functional restriction. The specificity of HRCT findings of asbestosis needs further evaluation. Given its low cost and availability, chest radiography remains the mainstay of imaging in benign asbestos-related diseases. CT (conventional or high-resolution) is not recommended as a universal screening test in asbestos-exposed workers. It has a useful role in identifying and quantitating pulmonary fibrosis distinct from emphysema and pleural disease, in distinguishing pleural disease from normal extrapleural soft tissues, and in clarifying the confusing chest radiograph or conflicting pulmonary function data. CT is useful in excluding a mass that may be obscured by extensive pleural and parenchymal fibrosis and is helpful in the follow-up of benign fibrotic masses or in the direction of their biopsy.
Another interesting study is called, Clinical features to stage alveolitis in asbestos workers by R. Bgin, MD, A. Cantin, MD, Y. Berthiaume, MD, R. Boileau, MD, G. Bisson, MD, G. Lamoureux, MD, M. Rola-Pleszczynski, MD, G. Drapeau, MSc, S. Mass, MD, M. Boctor, MD, J. Breault, MSc, S. Ploquin, BS, D. Dalle, PhD -
American Journal of Industrial Medicine - Volume 8 Issue 6, Pages 521 536. Here is an excerpt: Abstract - To analyze the clinical features of asbestos-induced alveolitis and stage its activity, we evaluated 217 asbestos workers by the usual clinical, radiological, and functional parameters and computerized gallium 67(Ga) lung scan; we obtained bronchoalveolar lavage (BAL) in 33 and lung biopsy in 6. In addition, we scored the profusion of lung rales and correlated it with other parameters of severity of asbestosis. In the 55 workers without asbestosis and normal 67Ga scan, BAL analyses were comparable to those of controls. Of the 56 without asbestosis but increased 67Ga lung uptake, BAL analyses in 8 documented a predominantly macrophagic alveolitis (confirmed on lung biopsy in 3), with the highest levels of BAL fibronectin. In the 106 workers with asbestosis, 67Ga lung uptake was increased in 75; BAL in 17 demonstrated a macrophagic and neutro-philic alveolitis with elevated fibronectin levels. Lung biopsy in 3 of the latter workers documented peribronchiolar fibrosing alveolitis. Rale scores in all workers or in those without asbestosis did not correlate with 67Ga scores; they correlated fairly well with profusion of parenchymal opacities (Rs = 0.42) and rigidity of the lung pressure-volume curve (Rs = 0.39). Thus, 67Ga lung uptake is an early indicator of chronic macrophagic alveolitis in asbestos workers, which usually progresses to asbestosis. In the disease, profusion of lung rales constitutes a simple clinical mode of assessment of disease severity that correlates better with radiological and functional parameters than with parameters of alveolitis.
A third study is called, The degree of roentgenographic parenchymal opacities attributable to smoking among asbestos-exposed subjects. by Barnhart S, Thornquist M, Omenn GS, Goodman G, Feigl P, Rosenstock L. - Am Rev Respir Dis. 1990 May;141(5 Pt 1):1102-6. Here is an excerpt: Abstract - Considerable controversy surrounds the question of whether cigarette smoking has the potential to increase the prevalence of small opacities on chest roentgenographs among asbestos-exposed workers. To compare the relative contribution of smoking with other predictors of the presence of roentgenographic small opacities, we examined 661 men enrolled in a double-blind, randomized trial designed to assess the efficacy of vitamin A and beta-carotene in the prevention of lung cancer among workers with heavy occupational asbestos exposure. Subjects in the study population had a mean latency of 35 yr from first asbestos exposure and a mean of 28 yr in their trade. The prevalence of roentgenographic abnormalities consistent with asbestos exposure was 26% for pleural abnormalities alone, 10% for parenchymal abnormalities alone, and 20% for pleural and parenchymal abnormalities together. We investigated occupation, age, latency from first asbestos exposure, and smoking status as predictors of roentgenographic small opacities. Smoking history, independent of latency, contributed to the prevalence and extent of small opacities, but its effect was less than that of latency. We conclude, that in the setting of heavy occupational exposure to asbestos, cigarette smoking confers added risk for the development of roentgenographic small opacities.
We all owe a debt of gratitude to these researchers. If you found any of these excerpts interesting, please read the studies in their entirety.
by: Mont Wrobleski
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