Brand P, Letzel S, Buchta M, Scheuch G, Windorfer K, Hilla W, Smith H J, Kraus T
GSF Research Center for Environment and Health, Institute for Inhalation Biology, Clinical Research Group: Aerosols in Medicine, Gauting, Germany.
J Aerosol Med. 2003 Summer;16(2):143-51. doi: 10.1089/089426803321919906.
The aerosol-derived airway morphometry technique (ADAM) can be used to assess non-invasively peripheral airspace dimensions. It has been shown that this technique can identify permanent peripheral airspace enlargement in patients with lung emphysema, but it is yet unknown if early stages of emphysema can be detected. In this study, 89 aluminum welders were investigated. Although all (except two subjects) showed normal spirometry, in 29% of the subjects visual signs of early emphysema were observed with high-resolution computed tomography (HRCT) in a previous study. Using the ADAM technique, 28% of the subjects showed increased peripheral airspace dimensions. However, both groups with positive findings overlapped only in about half of the cases. Peripheral airspace dimensions correlated significantly with the mean lung density calculated from the HRCT scans, and lung density was significantly decreased in the group with increased airspace dimensions. The poor overlap of the positive findings observed with both techniques can be explained if it is considered that the visual HRCT technique and ADAM focus on different aspects of emphysematous changes in the lungs. Whereas visual HRCT is a powerful tool to identify focal changes in lung density but cannot detect mild homogeneous emphysema, ADAM delivers a measure for homogeneously distributed emphysema but cannot detect focal emphysema or regions with emphysema which are badly ventilated. Since ADAM is easy to perform, non-invasive, and can be repeatedly applied to human subjects without radiological concerns, this technique might become a useful tool for the detection and monitoring of lung emphysema in occupational medicine, epidemiology, and pharmaceutics.
气溶胶衍生气道形态测量技术（ADAM）可用于无创评估外周气腔尺寸。研究表明，该技术能够识别肺气肿患者永久性外周气腔扩大，但肺气肿早期阶段能否被检测到尚不清楚。在本研究中，对89名铝焊工进行了调查。尽管所有受试者（除两名受试者外）的肺功能测定均显示正常，但在之前的一项研究中，通过高分辨率计算机断层扫描（HRCT）观察到29%的受试者有早期肺气肿的视觉征象。使用ADAM技术，28%的受试者外周气腔尺寸增大。然而，两组有阳性结果的受试者仅有约一半重叠。外周气腔尺寸与根据HRCT扫描计算出的平均肺密度显著相关，气腔尺寸增大组的肺密度显著降低。如果考虑到视觉HRCT技术和ADAM关注的是肺部肺气肿变化的不同方面，那么两种技术观察到的阳性结果重叠性差就可以得到解释。视觉HRCT是识别肺密度局灶性变化的有力工具，但无法检测轻度均匀性肺气肿，而ADAM可测量均匀分布的肺气肿，但无法检测局灶性肺气肿或通气不良的肺气肿区域。由于ADAM操作简便、无创，且可在无放射学顾虑的情况下反复应用于人体受试者，该技术可能成为职业医学、流行病学和制药学中检测和监测肺气肿的有用工具。
