Aberle D R, Gamsu G, Ray C S
Department of Radiological Sciences, University of California Los Angeles School of Medicine 90024.
AJR Am J Roentgenol. 1988 Nov;151(5):883-91. doi: 10.2214/ajr.151.5.883.
We prospectively analyzed benign asbestos-related pleural and parenchymal abnormalities on high-resolution CT scans and correlated them with clinical diagnoses in 100 asbestos-exposed workers. All subjects had high-resolution CT scans in conjunction with conventional CT at the time of clinical evaluation. To evaluate for asbestosis, we ranked high-resolution CT scans as high, intermediate, or low probability of asbestosis on the basis of the multiplicity and extent of observed parenchymal changes. By linear regression analysis, the most distinctive high-resolution CT features of asbestosis included thickened nondependent interstitial short lines and parenchymal bands. In 45 subjects satisfying clinical criteria of asbestosis, high-resolution CT probability of asbestosis was high in 38 (84%), intermediate in five (11%), and low in two (4%). In 20 (36%) of 55 subjects without clinical asbestosis, parenchymal abnormalities indicative of a high probability of asbestosis were observed on high-resolution CT. High-resolution CT probability scores had a strong positive correlation with chest radiographic profusion scores (p less than .0001) and asbestos-related pleural thickening (p less than .0001). Significant inverse correlations were seen with forced vital capacity (p less than .006) and single-breath diffusing capacity (p less than .03), both functional measures of restrictive interstitial lung disease. Neither clubbing nor rales were sufficiently prevalent to have statistical correlation with high-resolution CT scores. High-resolution CT is sensitive in detecting both pleural and parenchymal abnormalities in the asbestos-exposed subject. Asbestos-related pleural changes are observed more frequently on high-resolution CT than on conventional CT or chest radiography. The probability of asbestosis based on high-resolution CT parenchymal features has a significant correlation with existing clinical determinants of disease, and high-resolution CT can detect abnormality when other methods are not diagnostic.
我们对100名接触石棉的工人进行了前瞻性分析，通过高分辨率CT扫描观察良性石棉相关的胸膜和实质异常，并将其与临床诊断结果进行关联。所有受试者在临床评估时均进行了高分辨率CT扫描及常规CT扫描。为评估石棉肺，我们根据观察到的实质改变的多样性和范围，将高分辨率CT扫描结果分为石棉肺高、中、低概率。通过线性回归分析，石棉肺最具特征性的高分辨率CT表现包括非下垂部位增厚的间质短线和实质带。在45名符合石棉肺临床标准的受试者中，高分辨率CT显示石棉肺高概率的有38例（84%），中概率的有5例（11%），低概率的有2例（4%）。在55名无石棉肺临床症状的受试者中，20例（36%）在高分辨率CT上观察到提示石棉肺高概率的实质异常。高分辨率CT概率评分与胸部X线片的渗出评分（p<0.0001）及石棉相关胸膜增厚（p<0.0001）呈强正相关。与限制性间质性肺疾病的两项功能指标，即用力肺活量（p<0.006）和单次呼吸弥散量（p<0.03）呈显著负相关。杵状指和啰音均未普遍到足以与高分辨率CT评分有统计学关联。高分辨率CT在检测接触石棉者的胸膜和实质异常方面很敏感。与常规CT或胸部X线摄影相比，在高分辨率CT上观察到的石棉相关胸膜改变更频繁。基于高分辨率CT实质特征的石棉肺概率与现有的疾病临床决定因素有显著相关性，并且当其他方法无法诊断时，高分辨率CT能够检测到异常。
