Stavngaard T, Shaker S B, Bach K S, Stoel B C, Dirksen A
Department of Clinical Physiology and Nuclear Medicine, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
Acta Radiol. 2006 Nov;47(9):914-21. doi: 10.1080/02841850600917170.
To compare objective and subjective assessment of the distribution of emphysema in unselected patients with chronic obstructive pulmonary disease (COPD).
167 patients were computed tomography (CT) scanned, and the relative area (RA-910) of emphysema in each CT slice was plotted against table position. The craniocaudal distribution was calculated as the slope of the regression line, and grouped as upper-lung-zone predominance (ULP), lower-lung-zone predominance (LLP), or mild/homogeneous distribution (MHE). CT scans were also classified as ULP, LLP, and MHE based on visual assessment of three high-resolution CT (HRCT) slices, and the leading pattern of emphysema was classified as centrilobular (CLE), paraseptal (PSE), panlobular (PLE), or no emphysema (NE).
By objective classification, scans were divided into almost equal numbers of ULP, LLP, and MHE, whereas visual evaluation classified more scans as ULP (P<0.001) and very few as LLP (P<0.0001). In patients with CLE, 49% had ULP by objective classification, whereas LLP was the commonest leading pattern in PSE, PLE, and NE.
We found significant discrepancies between the objective and subjective distributions of emphysema in various morphological patterns, which may be of clinical importance in, for instance, lung-volume-reduction surgery.
比较对未选择的慢性阻塞性肺疾病（COPD）患者肺气肿分布的客观评估和主观评估。
对167例患者进行计算机断层扫描（CT），将每个CT切片中肺气肿的相对面积（RA-910）与表格位置作图。计算头尾分布作为回归线的斜率，并分为上肺区优势（ULP）、下肺区优势（LLP）或轻度/均匀分布（MHE）。基于对三个高分辨率CT（HRCT）切片的视觉评估，CT扫描也分为ULP、LLP和MHE，肺气肿的主要类型分为小叶中心型（CLE）、间隔旁型（PSE）、全小叶型（PLE）或无肺气肿（NE）。
通过客观分类，扫描分为几乎相等数量的ULP、LLP和MHE，而视觉评估将更多扫描分类为ULP（P<0.001），很少分类为LLP（P<0.0001）。在CLE患者中，49%通过客观分类为ULP，而LLP是PSE、PLE和NE中最常见的主要类型。
我们发现不同形态模式下肺气肿的客观和主观分布之间存在显著差异，这在例如肺减容手术中可能具有临床重要性。
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