Cavigli Edoardo, Camiciottoli Gianna, Diciotti Stefano, Orlandi Ilaria, Spinelli Cheti, Meoni Eleonora, Grassi Luca, Farfalla Carmela, Pistolesi Massimo, Falaschi Fabio, Mascalchi Mario
Radiodiagnostic Section, Department of Clinical Physiopathology, University of Florence, Viale Morgagni 85, Florence, 50134, Italy.
Eur Radiol. 2009 Jul;19(7):1686-92. doi: 10.1007/s00330-009-1320-y. Epub 2009 Feb 18.
We compared whole-lung densitometry with visual evaluation of pulmonary emphysema. Thirty patients with chronic obstructive pulmonary disease underwent multi-detector CT (150 mAs and 0.75 collimation) with double reconstruction: thick (5-mm) slices with smooth filter for whole-lung densitometry and thin (1 mm) slices with sharp filter for visual assessment (one of every ten slices). Densitometry and visual assessment were performed by three operators each, and the time required for assessment, the inter-observer agreement and the correlation with the results of the diffusion capacity of carbon monoxide (DL(CO)) in the same patients were computed. The average time for densitometry (8.49 +/- 0.13 min) was significantly longer (p < 0.0001) than that for visual evaluation (5.14 +/- 0.11 min). However, the inter-operator agreement ranged between "moderate" to "almost perfect" for densitometry (kappa range 0.58-0.87) and "slight" for visual (kappa = 0.20) assessment. The correlation coefficients of DL(CO) with relative area at -960 and -970 Hounsfield units (HU) (both r = -0.66) and of the first percentile point of lung density (r = 0.66) were slightly stronger than that of the visual score (r = -0.62). Densitometry should be preferred to visual assessment because it enables a more reproducible evaluation of the extent of pulmonary emphysema, which can be carried out on the entire lung in a reasonable amount of time.
我们将全肺密度测定法与肺气肿的视觉评估进行了比较。30例慢性阻塞性肺疾病患者接受了多排CT检查（管电流150 mAs，准直器0.75），采用双重重建：厚层（5 mm）平滑滤波切片用于全肺密度测定，薄层（1 mm）锐利滤波切片用于视觉评估（每十层取一层）。密度测定和视觉评估分别由三名操作人员进行，并计算评估所需时间、观察者间一致性以及与同一患者一氧化碳弥散量（DL(CO)）结果的相关性。密度测定的平均时间（8.49±0.13分钟）显著长于视觉评估（5.14±0.11分钟）（p<0.0001）。然而，密度测定的操作人员间一致性为“中等”至“几乎完美”（kappa值范围为0.58 - 0.87），而视觉评估的一致性为“轻微”（kappa = 0.20）。DL(CO)与-960和-970亨氏单位（HU）处相对面积的相关系数（两者r = -0.66）以及肺密度第一百分位数的相关系数（r = 0.66）略强于视觉评分的相关系数（r = -0.62）。与视觉评估相比，应优先选择密度测定法，因为它能够更可重复地评估肺气肿的范围，并且可以在合理的时间内对整个肺部进行评估。
