Fingerle Alexander A, De Marco Fabio, Andrejewski Jana, Willer Konstantin, Gromann Lukas B, Noichl Wolfgang, Kriner Fabian, Fischer Florian, Braun Christian, Maack Hanns-Ingo, Pralow Thomas, Koehler Thomas, Noël Peter B, Meurer Felix, Deniffel Dominik, Sauter Andreas P, Haller Bernhard, Pfeiffer Daniela, Rummeny Ernst J, Herzen Julia, Pfeiffer Franz
Department of Diagnostic and Interventional Radiology, School of Medicine & Klinikum rechts der Isar, Technical University of Munich, 81675, Munich, Germany.
Chair of Biomedical Physics, Department of Physics and Munich School of BioEngineering, Technical University of Munich, 85748, Garching, Germany.
Eur Radiol Exp. 2019 Jul 11;3(1):25. doi: 10.1186/s41747-019-0104-7.
Although x-ray dark-field imaging has been intensively investigated for lung imaging in different animal models, there is very limited data about imaging features in the human lungs. Therefore, in this work, a reader study on nine post-mortem human chest x-ray dark-field radiographs was performed to evaluate dark-field signal strength in the lungs, intraobserver and interobserver agreement, and image quality and to correlate with findings of conventional x-ray and CT.
In this prospective work, chest x-ray dark-field radiography with a tube voltage of 70 kVp was performed post-mortem on nine humans (3 females, 6 males, age range 52-88 years). Visual quantification of dark-field and transmission signals in the lungs was performed by three radiologists. Results were compared to findings on conventional x-rays and 256-slice computed tomography. Image quality was evaluated. For ordinal data, median, range, and dot plots with medians and 95% confidence intervals are presented; intraobserver and interobserver agreement were determined using weighted Cohen κ.
Dark-field signal grading showed significant differences between upper and middle (p = 0.004-0.016, readers 1-3) as well as upper and lower zones (p = 0.004-0.016, readers 1-2). Median transmission grading was indifferent between all lung regions. Intraobserver and interobserver agreements were substantial to almost perfect for grading of both dark-field (κ = 0.793-0.971 and κ = 0.828-0.893) and transmission images (κ = 0.790-0.918 and κ = 0.700-0.772). Pulmonary infiltrates correlated with areas of reduced dark-field signal. Image quality was rated good for dark-field images.
Chest x-ray dark-field images provide information of the lungs complementary to conventional x-ray and allow reliable visual quantification of dark-field signal strength.
尽管X射线暗场成像已在不同动物模型中针对肺部成像进行了深入研究，但关于人类肺部成像特征的数据非常有限。因此，在本研究中，对九张尸检后的人类胸部X射线暗场射线照片进行了阅片者研究，以评估肺部的暗场信号强度、观察者内和观察者间的一致性、图像质量，并与传统X射线和CT的结果进行关联。
在这项前瞻性研究中，对九名人类（3名女性，6名男性，年龄范围52 - 88岁）进行了尸检后的胸部X射线暗场摄影，管电压为70 kVp。由三名放射科医生对肺部的暗场和透射信号进行视觉量化。将结果与传统X射线和256层计算机断层扫描的结果进行比较。评估图像质量。对于有序数据，给出中位数、范围以及带有中位数和95%置信区间的点图；使用加权Cohen κ确定观察者内和观察者间的一致性。
暗场信号分级显示上肺与中肺之间存在显著差异（p = 0.004 - 0.016，阅片者1 - 3）以及上肺与下肺区域之间存在显著差异（p = 0.004 - 0.016，阅片者1 - 2）。所有肺区域之间的透射分级无差异。观察者内和观察者间对暗场（κ = 0.793 - 0.971和κ = 0.828 - 0.893）和透射图像（κ = 0.790 - 0.918和κ = 0.700 - 0.772）分级的一致性从中等到几乎完美。肺部浸润与暗场信号降低的区域相关。暗场图像的图像质量被评为良好。
胸部X射线暗场图像提供了与传统X射线互补的肺部信息，并允许对暗场信号强度进行可靠的视觉量化。
