Ariani Alarico, Carotti Marina, Gutierrez Marwin, Bichisecchi Elisabetta, Grassi Walter, Giuseppetti Gian Marco, Salaffi Fausto
Clinica Reumatologica, Dipartimento di Scienze Cliniche e Molecolari, Università Politecnica delle Marche, Ospedale "A. Murri", Via dei Colli, 52 Jesi, 60035, Ancona, Italy.
Rheumatol Int. 2014 Apr;34(4):511-6. doi: 10.1007/s00296-013-2845-6. Epub 2013 Aug 15.
To investigate the utility of an open-source Digital Imaging and Communication in Medicine viewer software-OsiriX-to assess pulmonary fibrosis (PF) in patients with systemic sclerosis (SSc). Chest high-resolution computed tomography (HRCT) examinations obtained from 10 patients with diagnosis of SSc were analysed by two radiologists adopting a standard semiquantitative scoring for PF. Pulmonary involvement was evaluated in three sections (superior, middle and inferior). For the assessment of the extension of PF, the adopted semiquantitative HRCT score ranged from 0 to 3 (0 = absence of PF; 1 = 1-20 % of lung section involvement; 2 = 21-40 % of lung section involvement; 3 = 41-100 % of lung section involvement). Further, a quantitative assessment (i.e. parameters of distribution of lung attenuation such as kurtosis and mean lung attenuation) of PF was independently performed on the same sections by a rheumatologist, independently and blinded to radiologists' scoring, using OsiriX. The results obtained were compared with those of HRCT semiquantitative analysis. Intra-reader reliability of HRCT findings and feasibility of OsiriX quantitative segmentation was recorded. A significant association between the median values of kurtosis by both the quantitative OsiriX assessment and the HRCT semiquantitative analysis was found (p < 0.0001). Moreover, kurtosis correlated significantly with the mean lung attenuation (Spearman's rho = 0.885; p = 0.0001). An excellent intra-reader reliability of HRCT findings among both readers was obtained. A significant difference between the mean time spent on the OsiriX quantitative analysis (mean 1.85 ± SD 1.3 min) and the mean time spent by the radiologist for the HRCT semiquantitative assessment (mean 8.5 ± SD 4.5 min, p < 0.00001) was noted. The study provides the new working hypothesis that OsiriX may be a useful and feasible tool to achieve a quantitative evaluation of PF in SSc patients.
为了研究开源的医学数字成像和通信Viewer软件——OsiriX，用于评估系统性硬化症（SSc）患者的肺纤维化（PF）的效用。对10例诊断为SSc的患者进行胸部高分辨率计算机断层扫描（HRCT）检查，由两名放射科医生采用标准的半定量评分法对PF进行分析。在三个层面（上、中、下）评估肺部受累情况。对于PF范围的评估，采用的半定量HRCT评分为0至3分（0分=无PF；1分=肺段受累1%-20%；2分=肺段受累21%-40%；3分=肺段受累41%-100%）。此外，一名风湿病学家使用OsiriX在相同层面上独立进行PF的定量评估（即肺衰减分布参数，如峰度和平均肺衰减），且对放射科医生的评分不知情。将获得的结果与HRCT半定量分析结果进行比较。记录HRCT结果的阅片者内可靠性以及OsiriX定量分割的可行性。发现OsiriX定量评估和HRCT半定量分析的峰度中位数之间存在显著相关性（p<0.0001）。此外，峰度与平均肺衰减显著相关（Spearman相关系数ρ=0.885；p=0.0001）。两位阅片者的HRCT结果均具有出色的阅片者内可靠性。注意到OsiriX定量分析的平均用时（平均1.85±标准差1.3分钟）与放射科医生进行HRCT半定量评估的平均用时（平均8.5±标准差4.5分钟，p<0.00001）之间存在显著差异。该研究提出了新的工作假设，即OsiriX可能是对SSc患者的PF进行定量评估的有用且可行的工具。
