肺气肿诊断中定量 CT 和目测 CT 评估结果不一致。
Discordant Quantitative and Visual CT Assessments in the Diagnosis of Emphysema.
机构信息
University of Iowa, Roy J. and Lucille A. Carver College of Medicine, Department of Internal Medicine, Division of Pulmonary, Critical Care, and Occupational Medicine, Iowa City, IA, USA.
University of Iowa, Roy J. and Lucille A. Carver College of Medicine, Department of Internal Medicine, Division of General Internal Medicine, Iowa City, IA, USA.
出版信息
Int J Chron Obstruct Pulmon Dis. 2021 May 3;16:1231-1242. doi: 10.2147/COPD.S284477. eCollection 2021.
PURPOSE
Visual assessment of computed tomography (CT) of the lung is routinely employed in the diagnosis of emphysema. Quantitative CT (QCT) can complement visual CT but must be well validated. QCT emphysema is defined as ≥5% of lung volume occupied by low attenuation areas ≤-950 Hounsfield units (LAA-950). Discordant visual and QCT assessments are not uncommon. We examined the association between visual and quantitative chest CT evaluation within a large cohort of subjects to identify variables that may explain discordant visual and QCT findings.
MATERIALS AND METHODS
Volumetric inspiratory CT scans of 1221 subjects enrolled in phase 1 of the COPDGene study conducted at the University of Iowa were reviewed. Participants included never smokers, smokers with normal spirometry, preserved ratio impaired spirometry, and Global Initiative for Obstructive Lung Disease (GOLD) stages I-IV. CT scans were quantitatively scored and visually interpreted by both the COPDGene Imaging Center and the University of Iowa radiologists. Individual-level visual assessments were compared with QCT measurements. Agreement between the two sets of radiologists was calculated using kappa statistic. We assessed variables associated with discordant results using regression methods.
RESULTS
There was a fair agreement for the presence or absence of emphysema between our center's radiologists and QCT (61% concordance, kappa 0.22 [0.17-0.28]). Similar comparisons showed a slight agreement between the COPDGene Imaging Center and QCT (56% concordance, kappa 0.16 [0.11-0.21]), and a moderate agreement between both sets of visual assessments (80% concordance, kappa 0.60 [0.54-0.65]). Current smoking and female gender were significantly associated with QCT-negative but visually detectable emphysema.
CONCLUSION
The slight-to-fair agreement between visual and quantitative CT assessment of emphysema highlights the need to utilize both modalities for a comprehensive radiologic evaluation. Discordant results may be attributable to one or more factors that warrant further exploration in larger studies.
CLINICAL TRIAL REGISTRATION
ClinicalTrials.gov Identifier NCT000608764.
目的
肺部计算机断层扫描（CT）的视觉评估常用于肺气肿的诊断。定量 CT（QCT）可以补充视觉 CT，但必须经过良好的验证。QCT 肺气肿定义为低衰减区域（≤-950 个亨氏单位（LAA-950））占肺体积的≥5%。视觉和 QCT 评估不一致并不少见。我们在一个大型研究对象队列中检查了视觉和定量胸部 CT 评估之间的关联，以确定可能解释视觉和 QCT 结果不一致的变量。
材料和方法
对在爱荷华大学进行的 COPDGene 研究第一阶段入组的 1221 名受试者的容积吸气 CT 扫描进行了回顾性分析。参与者包括从不吸烟者、肺功能正常的吸烟者、比值保留性肺功能障碍的吸烟者和全球倡议慢性阻塞性肺疾病（GOLD）I-IV 期的吸烟者。CT 扫描由 COPDGene 成像中心和爱荷华大学放射科医生进行定量评分和视觉解读。个体水平的视觉评估与 QCT 测量值进行比较。两位放射科医生的一致性通过kappa 统计进行计算。我们使用回归方法评估与不一致结果相关的变量。
结果
我们中心的放射科医生与 QCT 之间对肺气肿的存在或不存在的评估存在中等程度的一致性（61%的一致性，kappa 值为 0.22[0.17-0.28]）。类似的比较显示，COPDGene 成像中心与 QCT 之间存在轻度一致性（56%的一致性，kappa 值为 0.16[0.11-0.21]），而两种视觉评估之间存在中度一致性（80%的一致性，kappa 值为 0.60[0.54-0.65]）。目前吸烟和女性性别与 QCT 阴性但视觉上可检测到的肺气肿显著相关。
结论
视觉和定量 CT 评估肺气肿之间的轻度至中度一致性突出表明需要同时使用这两种模式进行全面的放射学评估。不一致的结果可能归因于一个或多个需要在更大的研究中进一步探讨的因素。
临床试验注册
ClinicalTrials.gov 标识符 NCT000608764。
Zotero 插件