Kahkouee Shahram, Khabbaz Shaghayegh S, Keshavarz Elham, Kiani Arda, Hajinasrollah Ghazal, Anvar Amine Ghaffari
Department of Radiology, National Research Institute of Tuberculosis and Lung Diseases, Masih Daneshvari Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Department of Radiology, Shohada-e-Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Pol J Radiol. 2019 May 9;84:e234-e239. doi: 10.5114/pjr.2019.87080. eCollection 2019.
Anthracosis, a form of pneumoconiosis commonly caused by air pollution and other environmental factors, is a new entity in respiratory disorders. Bronchoscopy and transbronchial lung biopsy (TBLB) are the gold standard of diagnosis. Herein, we evaluated the results of bronchoscopy and chest computed tomography (CT) scans of 187 anthracotic patients.
Between April 2016 and April 2017, 187 cases (99 males, mean age 65 ± 10.2 years) who underwent flexible bronchoscopy and TBLB for various indications were considered for this study. CT examinations of these patients were reported as "blind to bronchoscopy results" by two experienced board-certified radiologists.
According to the results of bronchoscopy and TBLB, 100 patients were diagnosed as anthracotic. CT scans confirmed 71 of these cases as anthracosis. Sensitivity, specificity, PPV, NPV, and accuracy of hyperdense non-calcified mediastinal and hilar lymph nodes, known as "brilliant lymph nodes", compared to bronchoscopy were 55%, 92%, 89%, 64%, and 72%, respectively (CI: 95%). Also, there was a positive correlation between anthracosis and brilliant lymph nodes (p-value = 0). Analysis of hyper-attenuated lung with bronchoscopy estimated sensitivity, specificity, PPV, NPV, and accuracy gave 41%, 94%, 89%, 58%, and 65%, respectively (CI: 95%). The specificity of brilliant lymph nodes, hyper-attenuated lung, and multi-segmental atelectasis as a diagnostic "triad of anthracosis" was 100%.
Based on our analyses, the triad of brilliant lymph nodes, hyper-attenuated lung, and multi-segmental atelectasis was identified as a reliable set of imaging findings for the diagnosis of anthracosis.
煤尘肺是尘肺病的一种形式，通常由空气污染和其他环境因素引起，是呼吸系统疾病中的一种新病症。支气管镜检查和经支气管肺活检（TBLB）是诊断的金标准。在此，我们评估了187例煤尘肺患者的支气管镜检查和胸部计算机断层扫描（CT）结果。
2016年4月至2017年4月期间，本研究纳入了187例（99例男性患者；平均年龄65±10.2岁）因各种适应症接受了可弯曲支气管镜检查和TBLB的患者。两名经验丰富的获得委员会认证的放射科医生在“对支气管镜检查结果不知情”的情况下报告了这些患者的CT检查结果。
根据支气管镜检查和TBLB的结果，100例患者被诊断为煤尘肺。CT扫描确诊其中71例为煤尘肺。与支气管镜检查相比，被称为“明亮淋巴结”的高密度非钙化纵隔和肺门淋巴结的敏感性、特异性、阳性预测值、阴性预测值和准确性分别为55%、92%、89%、64%和72%（95%置信区间）。此外，煤尘肺与明亮淋巴结之间存在正相关（p值 = 0）。经支气管镜检查分析肺高密度影的敏感性、特异性、阳性预测值、阴性预测值和准确性分别为41%、94%、89%、58%和65%（95%置信区间）。明亮淋巴结、肺高密度影和多节段肺不张作为诊断“煤尘肺三联征”的特异性为100%。
基于我们的分析，明亮淋巴结、肺高密度影和多节段肺不张三联征被确定为诊断煤尘肺的一组可靠影像学表现。
