Akira Masanori, Toyokawa Kazushige, Inoue Yoshikazu, Arai Toru
Department of Radiology, National Hospital Organization, Kinki-Chuo Chest Medical Center, 1180 Nagasonecho, Kita-ku, Sakai City, Osaka 591-8555, Japan.
AJR Am J Roentgenol. 2009 Jan;192(1):267-72. doi: 10.2214/AJR.07.3953.
The purpose of this study was to determine whether measurements of lung attenuation at inspiration and expiration obtained from 3D lung reconstructions reflect the severity of chronic obstructive pulmonary disease.
Seventy-six patients with chronic obstructive pulmonary disease underwent MDCT with 3D postprocessing at full inspiration and full expiration. Inspiratory and expiratory mean lung density, percentage of lung volume with attenuation values less than -910 HU and -950 HU at inspiration and expiration, expiratory to inspiratory mean lung density ratio, and fifth and 15th percentiles of the lung attenuation distribution curve at inspiration and expiration were measured.
When forced expiratory volume in the first second of expiration (FEV(1)) was 50% or greater than predicted value, mean lung density and lower attenuation volume measured from inspiratory MDCT scans correlated better with FEV(1) and ratio of FEV(1) to forced vital capacity (FVC) than did those from expiratory scans. When FEV(1) was less than 50% of predicted value, mean lung density and lower attenuation volume measured from expiratory MDCT scans correlated better with FEV(1) and ratio of residual volume to total lung capacity than did those values from inspiratory scans. Fifth percentile and 15th percentile of the lung attenuation distribution curve at both full inspiration and full expiration correlated well with FEV(1)/FVC and diffusing capacity of the lung for carbon monoxide as a percentage of predicted value but not well with FEV(1) as a percentage of predicted value regardless of FEV(1).
Measurements of lung attenuation obtained at inspiration and visual score better reflect abnormal results of pulmonary function tests in patients with less severe chronic obstructive pulmonary disease than do measurements obtained at expiration. Measurements of lung attenuation obtained at expiration better reflect pulmonary function abnormalities in patients with severe chronic obstructive pulmonary disease.
本研究旨在确定从三维肺重建获得的吸气和呼气时肺衰减测量值是否反映慢性阻塞性肺疾病的严重程度。
76例慢性阻塞性肺疾病患者在完全吸气和完全呼气时接受了MDCT及三维后处理。测量吸气和呼气时的平均肺密度、吸气和呼气时衰减值低于-910 HU和-950 HU的肺体积百分比、呼气与吸气平均肺密度比值以及吸气和呼气时肺衰减分布曲线的第5和第15百分位数。
当第一秒用力呼气量（FEV(1)）为预计值的50%或更高时，吸气MDCT扫描测量的平均肺密度和较低衰减体积与FEV(1)以及FEV(1)与用力肺活量（FVC）的比值的相关性比呼气扫描更好。当FEV(1)低于预计值的50%时，呼气MDCT扫描测量的平均肺密度和较低衰减体积与FEV(1)以及残气量与肺总量的比值的相关性比吸气扫描的值更好。完全吸气和完全呼气时肺衰减分布曲线的第5百分位数和第15百分位数与FEV(1)/FVC以及一氧化碳肺弥散量占预计值的百分比相关性良好，但与FEV(1)占预计值的百分比相关性不佳，无论FEV(1)如何。
与呼气时获得的测量值相比，吸气时获得的肺衰减测量值和视觉评分能更好地反映轻度慢性阻塞性肺疾病患者肺功能测试的异常结果。呼气时获得的肺衰减测量值能更好地反映重度慢性阻塞性肺疾病患者的肺功能异常。
