慢性阻塞性肺疾病：使用标准图像的基于肺叶的容积 CT 视觉评估——COPDGene 研究中与定量 CT 和肺功能测试的比较。
Chronic obstructive pulmonary disease: lobe-based visual assessment of volumetric CT by Using standard images--comparison with quantitative CT and pulmonary function test in the COPDGene study.
机构信息
Department of Radiology, Division of Biostatistics and Bioinformatics, and Department of Internal Medicine, National Jewish Health, University of Colorado Denver School of Medicine, Denver, Colorado, USA.
出版信息
Radiology. 2013 Feb;266(2):626-35. doi: 10.1148/radiol.12120385. Epub 2012 Dec 6.
PURPOSE
To provide a new detailed visual assessment scheme of computed tomography (CT) for chronic obstructive pulmonary disease (COPD) by using standard reference images and to compare this visual assessment method with quantitative CT and several physiologic parameters.
MATERIALS AND METHODS
This research was approved by the institutional review board of each institution. CT images of 200 participants in the COPDGene study were evaluated. Four thoracic radiologists performed independent, lobar analysis of volumetric CT images for type (centrilobular, panlobular, and mixed) and extent (on a six-point scale) of emphysema, the presence of bronchiectasis, airway wall thickening, and tracheal abnormalities. Standard images for each finding, generated by two radiologists, were used for reference. The extent of emphysema, airway wall thickening, and luminal area were quantified at the lobar level by using commercial software. Spearman rank test and simple and multiple regression analyses were performed to compare the results of visual assessment with physiologic and quantitative parameters.
RESULTS
The type of emphysema, determined by four readers, showed good agreement (κ = 0.63). The extent of the emphysema in each lobe showed good agreement (mean weighted κ = 0.70) and correlated with findings at quantitative CT (r = 0.75), forced expiratory volume in 1 second (FEV(1)) (r = -0.68), FEV(1)/forced vital capacity (FVC) ratio (r = -0.74) (P < .001). Agreement for airway wall thickening was fair (mean κ = 0.41), and the number of lobes with thickened bronchial walls correlated with FEV(1) (r = -0.60) and FEV(1)/FVC ratio (r = -0.60) (P < .001).
CONCLUSION
Visual assessment of emphysema and airways disease in individuals with COPD can provide reproducible, physiologically substantial information that may complement that provided by quantitative CT assessment.
目的
利用标准参考图像，为慢性阻塞性肺疾病（COPD）提供一种新的详细计算机断层扫描（CT）视觉评估方案，并将这种视觉评估方法与定量 CT 和几种生理参数进行比较。
材料与方法
本研究获得了每个机构的机构审查委员会的批准。对 COPDGene 研究的 200 名参与者的 CT 图像进行了评估。4 名胸部放射科医生对容积 CT 图像进行了独立的叶分析，用于评估肺气肿的类型（小叶中心型、全小叶型和混合性）和程度（6 分制）、支气管扩张的存在、气道壁增厚和气管异常。两位放射科医生生成的标准图像用于参考。使用商业软件在叶水平上对肺气肿、气道壁增厚和管腔面积进行量化。采用 Spearman 秩检验和简单及多元回归分析，比较视觉评估与生理和定量参数的结果。
结果
由 4 位读者确定的肺气肿类型显示出良好的一致性（κ = 0.63）。每个肺叶的肺气肿程度显示出良好的一致性（平均加权κ=0.70），并与定量 CT（r = 0.75）、1 秒用力呼气量（FEV1）（r = -0.68）、FEV1/用力肺活量（FVC）比值（r = -0.74）（P <.001）相关。气道壁增厚的一致性为中等（平均κ=0.41），有增厚支气管壁的肺叶数与 FEV1（r = -0.60）和 FEV1/FVC 比值（r = -0.60）相关（P <.001）。
结论
对 COPD 患者的肺气肿和气道疾病进行视觉评估可以提供可重复的、具有生理意义的信息，可能补充定量 CT 评估的结果。
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