Emoto Takuya, Matsumoto Tsuneo, Tanaka Nobuyuki, Miura Gouji, Kawamura Takeo, Matsunaga Naofumi
Department of Radiology, Yamaguchi University School of Medicine, Japan.
Radiat Med. 2003 Jan-Feb;21(1):7-15.
This study was designed to evaluate the diagnostic value of characteristic HRCT findings in the differential diagnosis of acute pulmonary complications (APCs) in immunocompromised patients and to investigate how to improve diagnostic accuracy.
We reviewed the chest CT images of 103 consecutive immunocompromised non-AIDS patients with APCs. The presence, extent, and anatomical distribution of the CT findings were assessed by two radiologists. The sensitivity and positive predictive value (PPV) of each criterion determined by the combination of CT findings that were characteristic in previous studies were calculated.
The average sensitivity of each criterion was 0.50 in the total cases. There were many false positives, and the PPVs of some criteria were low. Among the significantly less frequent CT findings, the frequency of bronchovascular bundle thickening was 0% in cytomegaloviral pneumonia (CMV P). The absence of this finding improved the diagnostic accuracy of CMV P.
Because the combination of only characteristic HRCT findings in each disease was of relatively limited value in making a diagnosis, infrequent findings should be also added to the CT criteria to improve accuracy.
本研究旨在评估高分辨率CT（HRCT）特征性表现对免疫功能低下患者急性肺部并发症（APC）鉴别诊断的价值，并探讨如何提高诊断准确性。
我们回顾了103例连续的免疫功能低下非艾滋病APC患者的胸部CT图像。两名放射科医生评估了CT表现的存在、范围及解剖分布。计算了先前研究中具有特征性的CT表现组合所确定的各标准的敏感性和阳性预测值（PPV）。
在所有病例中，各标准的平均敏感性为0.50。存在许多假阳性结果，且一些标准的PPV较低。在明显较少出现的CT表现中，支气管血管束增粗在巨细胞病毒性肺炎（CMV P）中的出现频率为0%。该表现的缺失提高了CMV P的诊断准确性。
由于每种疾病仅依靠HRCT特征性表现的组合在诊断中的价值相对有限，因此在CT诊断标准中也应加入不常见的表现以提高准确性。
