系统性硬化症中的肺部CT密度测定：与肺功能、运动测试及生活质量的相关性

Lung CT densitometry in systemic sclerosis: correlation with lung function, exercise testing, and quality of life.

作者信息

Camiciottoli Gianna, Orlandi Ilaria, Bartolucci Maurizio, Meoni Eleonora, Nacci Francesca, Diciotti Stefano, Barcaroli Chiara, Conforti Maria Letizia, Pistolesi Massimo, Matucci-Cerinic Marco, Mascalchi Mario

机构信息

Respiratory Medicine Unit, Department of Critical Care, University of Florence, Florence, Italy.

Radiodiagnostic Section, Department of Clinical Physiopathology, University of Florence, Florence, Italy.

出版信息

Chest. 2007 Mar;131(3):672-681. doi: 10.1378/chest.06-1401.

DOI:10.1378/chest.06-1401

PMID:17356079

Abstract

BACKGROUND

To ascertain if analysis of lung density histograms in thin-section CT was more reproducible than visual assessment of lung changes in systemic sclerosis (SSc), and if such density histogram parameters as mean lung attenuation (MLA), skewness, and kurtosis could more closely reflect pulmonary function as well as exercise and quality of life impairment.

METHODS

The intraoperator and interoperator reproducibility of visual and densitometric lung CT analysis in 48 SSc patients examined with CT were evaluated by means of weighted kappa statistics. Univariate and multivariate regression analyses were applied to evaluate the relationship of visual and densitometric CT measurements with functional parameters including functional residual capacity (FRC), FVC, FEV(1), diffusion capacity of the lung for carbon monoxide (Dlco), 6-min walking testing (6MWT), and health-related quality of life questionnaire (QLQ) parameters.

RESULTS

The intraoperator and interoperator reproducibility of MLA (intraobserver weighted kappa = 0.97; interobserver weighted kappa = 0.96), skewness (intraobserver weighted kappa = 0.89; interobserver weighted kappa = 0.88), and kurtosis (intraobserver weighted kappa = 0.89; interobserver weighted kappa = 0.88) were higher than those of visual assessment (intraobserver weighted kappa = 0.71; interobserver weighted kappa = 0.69). In univariate analysis, only densitometric measurements were correlated with some exercise and QLQ parameters. In multivariate analysis, MLA (square regression coefficient corrected [R(2)c] = 0.70), skewness (R(2)c = 0.78), and kurtosis (R(2)c = 0.77) were predicted by FRC, FVC, Dlco, 6MWT, and QLQ parameters, while visual assessment was associated only with FRC and FVC (R(2)c = 0.40).

CONCLUSIONS

In SSc, densitometric analysis is more reproducible than visual assessment of lung changes in thin-section CT and more closely correlated to pulmonary function testing, 6MWT, and QLQ. Density histogram parameters may be useful for cross-sectional and longitudinal studies of lung involvement in SSc.

摘要

背景

旨在确定在系统性硬化症（SSc）中，薄层CT肺密度直方图分析是否比肺部改变的视觉评估更具可重复性，以及诸如平均肺衰减（MLA）、偏度和峰度等密度直方图参数是否能更密切地反映肺功能以及运动和生活质量损害。

方法

通过加权kappa统计评估48例接受CT检查的SSc患者视觉和密度测定肺CT分析的术者内和术者间可重复性。应用单变量和多变量回归分析来评估视觉和密度测定CT测量值与包括功能残气量（FRC）、用力肺活量（FVC）、第1秒用力呼气容积（FEV₁）、肺一氧化碳弥散量（Dlco）、6分钟步行试验（6MWT）和健康相关生活质量问卷（QLQ）参数在内的功能参数之间的关系。

结果

MLA（观察者内加权kappa = 0.97；观察者间加权kappa = 0.96）、偏度（观察者内加权kappa = 0.89；观察者间加权kappa = 0.88）和峰度（观察者内加权kappa = 0.89；观察者间加权kappa = 0.88）的术者内和术者间可重复性高于视觉评估（观察者内加权kappa = 0.71；观察者间加权kappa = 0.69）。在单变量分析中，只有密度测定测量值与一些运动和QLQ参数相关。在多变量分析中，FRC、FVC、Dlco、6MWT和QLQ参数可预测MLA（校正决定系数[R²c] = 0.70）、偏度（R²c = 0.78）和峰度（R²c = 0.77），而视觉评估仅与FRC和FVC相关（R²c = 0.40）。