Schaal Marysa, Severac François, Labani Aissam, Jeung Mi-Young, Roy Catherine, Ohana Mickaël
Service de Radiologie, Centre Hospitalier de Haguenau, Haguenau, France.
Service de Santé Publique, Hôpital Civil, Strasbourg, France.
PLoS One. 2016 Dec 29;11(12):e0168979. doi: 10.1371/journal.pone.0168979. eCollection 2016.
To evaluate the diagnostic performance of Ultra-Low-Dose Chest CT (ULD CT) for the detection of any asbestos-related lesions (primary endpoint) and specific asbestos-related abnormalities, i.e. non-calcified and calcified pleural plaques, diffuse pleural thickening, asbestosis and significant lung nodules (secondary endpoints).
55 male patients (55.7±8.1 years old) with occupational asbestos exposure for at least 15 years and where CT screening was indicated were prospectively included. They all underwent a standard unenhanced chest CT (120kV, automated tube current modulation), considered as the reference, and an ULD CT (135kV, 10mA), both with iterative reconstruction. Two chest radiologists independently and blindly read the examinations, following a detailed protocol. Sensitivity, specificity, positive predictive value, negative predictive value, accuracy and error rate of ULD CT were calculated using the exact method of Pearson with a confidence interval of 95%.
Radiation dose was 17.9±1.2mGy.cm (0.25mSv) for the ULD-CT versus 288.8 ±151mGy.cm (4mSv); p <2.2e-16. Prevalence of abnormalities was 20%. The ULD CT's diagnostic performance in joint reading was high for the primary endpoint (sensitivity = 90.9%, specificity = 100%, positive predictive value = 100%, negative predictive value = 97.8%), high for lung nodules, diffuse pleural thickening and calcified pleural plaques (sensitivity, specificity, PPV and NPV = 100%) and fair for asbestosis (sensitivity = 75%, specificity = 100%, PPV = 00%, NPV = 98.1%). Intra-reader accuracy between the ULD CT and the reference CT for the primary endpoint was 98% for the senior and 100% for the junior radiologist. Inter-reader agreement for the primary endpoint was almost perfect (Cohen's Kappa of 0.81).
ULD CT in the screening of asbestos exposure related diseases has 90.9% sensitivity and 100% specificity, and could therefore be proposed as a first line examination.
评估超低剂量胸部CT（ULD CT）检测任何石棉相关病变（主要终点）和特定石棉相关异常，即非钙化和钙化胸膜斑、弥漫性胸膜增厚、石棉肺和显著肺结节（次要终点）的诊断性能。
前瞻性纳入55例职业性接触石棉至少15年且有CT筛查指征的男性患者（55.7±8.1岁）。他们均接受了标准的非增强胸部CT（120kV，自动管电流调制）作为参考，以及ULD CT（135kV，10mA），两者均采用迭代重建。两名胸部放射科医生按照详细方案独立且盲法阅读检查结果。使用Pearson精确方法计算ULD CT的灵敏度、特异度、阳性预测值、阴性预测值、准确度和错误率，置信区间为95%。
ULD CT的辐射剂量为17.9±1.2mGy.cm（0.25mSv），而标准CT为288.8±151mGy.cm（4mSv）；p<2.2e - 16。异常患病率为20%。对于主要终点，ULD CT联合阅片时的诊断性能较高（灵敏度=90.9%，特异度=100%，阳性预测值=100%，阴性预测值=97.8%），对于肺结节、弥漫性胸膜增厚和钙化胸膜斑诊断性能高（灵敏度、特异度、阳性预测值和阴性预测值均=100%），对于石棉肺诊断性能一般（灵敏度=75%，特异度=100%，阳性预测值=00%，阴性预测值=98.1%）。对于主要终点，资深放射科医生在ULD CT和参考CT之间的阅片者内准确度为98%，初级放射科医生为100%。主要终点的阅片者间一致性几乎完美（Cohen's Kappa为0.81）。
ULD CT在石棉暴露相关疾病筛查中灵敏度为90.9%，特异度为100%，因此可作为一线检查方法。
