Pratt P C
Am J Med. 1987 May;82(5):998-1006. doi: 10.1016/0002-9343(87)90163-x.
Although recognizing that the subject is controversial, most authors of textbooks about diagnostic radiology conclude that chest radiography is of little value for either confirmation or exclusion of the diagnosis of emphysema. Yet several reports in the literature show a high degree of accuracy in the interpretation of films for presence of this disease. Some of the controversy results from continuing confusion over the current definition of emphysema in terms of lung structure rather than symptoms or physiologic evidence relating to impaired ventilation. Many autopsy studies have shown that emphysema is often present at postmortem examination and can involve as much as 30 percent of the lung tissue, even in subjects with no respiratory symptoms or impairment during life. Since radiographs deal with structure rather than function, interpreters of chest films should have the intention to recognize the presence of structural emphysema. The correct recognition of emphysema is useful even in a patient without symptoms, and the ability to exclude this diagnosis in symptomatic patients is of equal, if not greater value. The degree of success reported in various studies depends upon the criteria used and the strictness applied by the authors in matching their interpretations to the presence or absence of structural emphysema. This review of existing literature deals solely with papers in which radiographic observations have been related to morphologic evidence of emphysema in inflation-fixed autopsy lung specimens. It identifies reasons for discrepancies among reports and emphasizes the very high predictive value of validated radiographic criteria. Applications of radiographic interpretation both for diagnosis and for exclusion of emphysema in clinical situations are described.
尽管认识到这个问题存在争议，但大多数诊断放射学教科书的作者都认为，胸部X线摄影对于确诊或排除肺气肿的诊断价值不大。然而，文献中的几篇报告显示，在解读X线片以判断是否存在这种疾病方面具有高度的准确性。部分争议源于对目前肺气肿定义的持续混淆，这种定义是基于肺结构，而非与通气功能受损相关的症状或生理证据。许多尸检研究表明，肺气肿在尸检时经常存在，甚至可累及多达30%的肺组织，即使是生前没有呼吸道症状或功能损害的个体。由于X线片关注的是结构而非功能，胸部X线片的解读者应旨在识别结构性肺气肿的存在。即使对于无症状的患者，正确识别肺气肿也很有用，而在有症状的患者中排除该诊断的能力即使价值不更大，也同样重要。各项研究报告的成功程度取决于所使用的标准以及作者在将其解读与结构性肺气肿的存在与否进行匹配时所采用的严格程度。本对现有文献的综述仅涉及那些将X线影像学观察结果与充气固定尸检肺标本中肺气肿的形态学证据相关联的论文。它指出了报告之间存在差异的原因，并强调了经过验证的X线影像学标准具有很高的预测价值。文中还描述了X线影像学解读在临床情况下用于诊断和排除肺气肿的应用。
