Huuskonen O, Kivisaari L, Zitting A, Taskinen K, Tossavainen A, Vehmas T
Finnish Institute of Occupational Health, Helsinki.
Scand J Work Environ Health. 2001 Apr;27(2):106-12. doi: 10.5271/sjweh.596.
This study tested a new high-resolution computed tomography (HRCT) scoring method for asbestos-induced parenchymal changes in the lung.
HRCT scans of 602 asbestos-exposed workers and 49 referents were reviewed by 3 radiologists. Structured forms were filled out for a semiquantitative HRCT fibrosis score based on several specified parenchymal abnormalities scored separately. Observer agreement was studied with the use of the quadratic-weighted kappa (kappaqw). The HRCT fibrosis score (from 0 to V with definitions and index images given retrospectively) was compared with the radiographic classification of the International Labour Office (ILO) for the same patients. Receiver-operating characteristic (ROC) curves were computed to compare the tests for diagnosing asbestosis.
Good inter- and intraobserver agreements were achieved (kappaqw = 0.64 and 0.72, respectively) as regards the HRCT fibrosis score. All the specified computed tomography findings explained 86% of the variance in the HRCT fibrosis score. Age and occupational group were significant predictors of fibrosis. The area under the ROC curve was significantly greater for the HRCT fibrosis score (0.89) than for the ILO radiographic classification (0.76). The sensitivity (70%) and specificity (91%) of the HRCT fibrosis score (classes I/II-V representing asbestosis) were better than those of the classification published by the International Labour Office (51% and 89%, respectively, score > or = 1/0 representing asbestosis).
The examined HRCT scoring method proved to be a simple, reliable, and reproducible method for classifying lung fibrosis and diagnosing asbestosis also in large populations with occupational disease, and it would be possible to use it as a part of an international classification.
本研究测试了一种用于评估石棉所致肺实质改变的新型高分辨率计算机断层扫描（HRCT）评分方法。
3位放射科医生对602名石棉接触工人和49名对照者的HRCT扫描结果进行了评估。根据分别计分的几种特定实质异常情况，填写结构化表格以得出HRCT纤维化半定量评分。采用二次加权kappa（kappaqw）研究观察者间的一致性。将HRCT纤维化评分（范围为0至V，定义和索引图像为回顾性给出）与同一患者的国际劳工组织（ILO）放射学分类进行比较。计算受试者操作特征（ROC）曲线以比较诊断石棉肺的各项检测。
就HRCT纤维化评分而言，观察者间和观察者内均达成了良好的一致性（kappaqw分别为0.64和0.72）。所有指定的计算机断层扫描结果解释了HRCT纤维化评分中86%的变异。年龄和职业组是纤维化的显著预测因素。HRCT纤维化评分的ROC曲线下面积（0.89）显著大于ILO放射学分类的ROC曲线下面积（0.76）。HRCT纤维化评分（I/II - V级表示石棉肺）的敏感性（70%）和特异性（91%）优于国际劳工组织公布的分类（分别为51%和89%，评分≥1/0表示石棉肺）。
所研究的HRCT评分方法被证明是一种简单、可靠且可重复的方法，可用于对肺纤维化进行分类以及在患有职业病的大量人群中诊断石棉肺，并且有可能将其用作国际分类的一部分。
