Barile Maria, Hida Tomoyuki, Hammer Mark, Hatabu Hiroto
Departments of Radiology, Brigham and Women's Hospital, Boston, MA, United States.
Department of Radiology at University of Massachusetts Memorial Medical Center, Worcester, MA, United States.
Eur J Radiol Open. 2020 Oct 30;7:100273. doi: 10.1016/j.ejro.2020.100273. eCollection 2020.
To determine the accuracy of quantitative CT to diagnose pulmonary edema compared to qualitative CT and CXR and to determine a threshold Hounsfield unit (HU) measurement for pulmonary edema on CT examinations.
Electronic medical records were searched for patients with a billing diagnosis of heart failure and a Chest CT and CXR performed within three hours between 1/1/2016 to 10/1/2016, yielding 100 patients. CXR and CT examinations were scored for the presence and severity of edema, using a 0-5 scale, and CT HU measurements were obtained in each lobe. Polyserial correlation coefficients evaluated the association between CT HUs and CXR scores, and receiver operating characteristic (ROC) curve analysis determined a cutoff CT HU value for identification of pulmonary edema.
Correlation between CT HU and CXR score was moderately strong (r = 0.585-0.685) with CT HU measurements demonstrating good to excellent accuracy in differentiating between no edema (grade 0) and mild to severe edema (grades 1-5) in every lobe, with AUCs ranging between 0.869 and 0.995. The left upper lobe demonstrated the highest accuracy, using a cutoff value of -825 HU (AUC of 0.995, sensitivity = 100 % and specificity = 95.1 %). Additionally, qualitative CT evaluation was less sensitive (84 %) than portable CXR in identifying pulmonary edema. However, quantitative CT evaluation was as sensitive as portable CXR (100 %) and highly specific (95 %).
Quantitative CT enables the identification of pulmonary edema with high accuracy and demonstrates a greater sensitivity than qualitative CT in assessment of pulmonary edema.
与定性CT和胸部X线摄影（CXR）相比，确定定量CT诊断肺水肿的准确性，并确定CT检查中肺水肿的阈值亨氏单位（HU）测量值。
检索电子病历中2016年1月1日至2016年10月1日期间计费诊断为心力衰竭且在三小时内进行胸部CT和CXR检查的患者，共获得100例患者。使用0-5分制对CXR和CT检查的水肿存在情况和严重程度进行评分，并在每个肺叶中获取CT HU测量值。多序列相关系数评估CT HU与CXR评分之间的关联，受试者操作特征（ROC）曲线分析确定用于识别肺水肿的CT HU截止值。
CT HU与CXR评分之间的相关性中等强度（r = 0.585 - 0.685），CT HU测量值在区分每个肺叶无水肿（0级）和轻度至重度水肿（1 - 5级）方面显示出良好至优异的准确性，曲线下面积（AUC）在0.869至0.995之间。左上叶的准确性最高，截止值为-825 HU（AUC为0.995，敏感性 = 100%，特异性 = 95.1%）。此外，定性CT评估在识别肺水肿方面比便携式CXR敏感性更低（84%）。然而，定量CT评估与便携式CXR一样敏感（100%）且特异性高（95%）。
定量CT能够高精度识别肺水肿，并且在评估肺水肿方面比定性CT具有更高的敏感性。
