Nguyen-Kim Thi Dan Linh, Maurer Britta, Suliman Yossra A, Morsbach Fabian, Distler Oliver, Frauenfelder Thomas
Institute of Diagnostic and Interventional Radiology, Raemistrasse, Zurich, Switzerland.
Division of Rheumatology University Hospital Zurich, Raemistrasse, Zurich, Switzerland.
J Thorac Dis. 2018 Apr;10(4):2142-2152. doi: 10.21037/jtd.2018.04.39.
To evaluate usability of slice-reduced sequential computed tomography (CT) compared to standard high-resolution CT (HRCT) in patients with systemic sclerosis (SSc) for qualitative and quantitative assessment of interstitial lung disease (ILD) with respect to (I) detection of lung parenchymal abnormalities, (II) qualitative and semiquantitative visual assessment, (III) quantification of ILD by histograms and (IV) accuracy for the 20%-cut off discrimination.
From standard chest HRCT of 60 SSc patients sequential 9-slice-computed tomography (reduced HRCT) was retrospectively reconstructed. ILD was assessed by visual scoring and quantitative histogram parameters. Results from standard and reduced HRCT were compared using non-parametric tests and analysed by univariate linear regression analyses.
With respect to the detection of parenchymal abnormalities, only the detection of intrapulmonary bronchiectasis was significantly lower in reduced HRCT compared to standard HRCT (P=0.039). No differences were found comparing visual scores for fibrosis severity and extension from standard and reduced HRCT (P=0.051-0.073). All scores correlated significantly (P<0.001) to histogram parameters derived from both, standard and reduced HRCT. Significant higher values of kurtosis and skewness for reduced HRCT were found (both P<0.001). In contrast to standard HRCT histogram parameters from reduced HRCT showed significant discrimination at cut-off 20% fibrosis (sensitivity 88% kurtosis and skewness; specificity 81% kurtosis and 86% skewness; cut-off kurtosis ≤26, cut-off skewness ≤4; both P<0.001).
Reduced HRCT is a robust method to assess lung fibrosis in SSc with minimal radiation dose with no difference in scoring assessment of lung fibrosis severity and extension in comparison to standard HRCT. In contrast to standard HRCT histogram parameters derived from the approach of reduced HRCT could discriminate at a threshold of 20% lung fibrosis with high sensitivity and specificity. Hence it might be used to detect early disease progression of lung fibrosis in context of monitoring and treatment of SSc patients.
为了评估与标准高分辨率计算机断层扫描（HRCT）相比，层厚缩减的序贯计算机断层扫描（CT）在系统性硬化症（SSc）患者中对间质性肺疾病（ILD）进行定性和定量评估的可用性，具体涉及（I）肺实质异常的检测，（II）定性和半定量视觉评估，（III）通过直方图对ILD进行量化，以及（IV）20%截断值判别的准确性。
从60例SSc患者的标准胸部HRCT中回顾性重建层厚缩减为9层的计算机断层扫描（缩减HRCT）。通过视觉评分和定量直方图参数评估ILD。使用非参数检验比较标准HRCT和缩减HRCT的结果，并通过单变量线性回归分析进行分析。
在肺实质异常检测方面，与标准HRCT相比，缩减HRCT仅肺内支气管扩张的检测率显著降低（P = 0.039）。比较标准HRCT和缩减HRCT的纤维化严重程度和范围的视觉评分未发现差异（P = 0.051 - 0.073）。所有评分与标准HRCT和缩减HRCT得出的直方图参数均显著相关（P < 0.001）。发现缩减HRCT的峰度和偏度值显著更高（均P < 0.001）。与标准HRCT不同，缩减HRCT的直方图参数在20%纤维化截断值时显示出显著判别能力（峰度和偏度的敏感性为88%；峰度的特异性为81%，偏度的特异性为86%；截断峰度≤26，截断偏度≤4；均P < 0.001）。
缩减HRCT是一种评估SSc患者肺纤维化的可靠方法，辐射剂量最小，与标准HRCT相比，在肺纤维化严重程度和范围的评分评估上无差异。与标准HRCT不同，缩减HRCT方法得出的直方图参数能够在20%肺纤维化阈值时以高敏感性和特异性进行判别。因此，它可用于在SSc患者的监测和治疗中检测肺纤维化的早期疾病进展。
