College of Medical, Pharmaceutical & Health Sciences, Kanazawa University, 5-11-80 Kodatsuno, Kanazawa, Ishikawa, 920-0942 Japan.
Department of Radiology, Kanazawa University Hospital, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641 Japan.
Clin Radiol. 2022 Sep;77(9):e689-e696. doi: 10.1016/j.crad.2022.05.016. Epub 2022 Jun 29.
To assess the utility of dynamic chest radiography (DCR) during the preoperative evaluation of pleural adhesions.
Sequential chest radiographs of 146 patients with lung cancer were acquired during forced respiration using a DCR system. The presence of pleural adhesions and their grades were determined by retrospective surgery video assessment (absent: 121, present: 25). The maximum inspiration to expiration lung area ratio was used as an index for air intake volume. A ratio of ≥0.65 was regarded as insufficient respiration. Two radiologists assessed the images for pleural adhesions based on motion findings. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were compared for each adhesion grade and patient group (patients with sufficient/insufficient respiration). Pearson's chi-squared test compared the group. Statistical significance was set at p<0.05.
DCR correctly identified 22/25 patients with pleural adhesions, with 20 false-positive results (sensitivity, 88%; specificity, 83.5%; PPV, 52.4%; NPV, 97.12%). Although the diagnostic performances for the various adhesion grades were similar, specificity in patients with sufficient respiration increased to 93.9% (31/33), identifying all cases except for those with loose adhesions.
DCR images revealed restricted and/or distorted motions in lung structures and structural tension in patients with pleural adhesions. DCR could be a useful technique for routine preoperative evaluation of pleural adhesions. Further development of computerised methods can assist in the quantitative assessment of abnormal motion findings.
评估动态胸部 X 线摄影（DCR）在胸膜粘连术前评估中的作用。
采用 DCR 系统对 146 例肺癌患者进行强制呼吸时的连续胸部 X 线摄影。通过回顾性手术视频评估确定胸膜粘连的存在及其程度（无：121 例，有：25 例）。吸气末至呼气末的肺面积比作为进气量的指标。吸气末至呼气末的肺面积比≥0.65 被认为是呼吸不足。两位放射科医生根据运动发现对图像进行胸膜粘连评估。比较了每个粘连程度和患者组（呼吸充足/不足的患者）的灵敏度、特异性、阳性预测值（PPV）和阴性预测值（NPV）。Pearson χ²检验比较了组间差异。统计显著性设为 p<0.05。
DCR 正确识别了 25 例胸膜粘连中的 22 例，有 20 例假阳性结果（灵敏度 88%，特异性 83.5%，PPV 52.4%，NPV 97.12%）。虽然不同粘连程度的诊断性能相似，但呼吸充足患者的特异性提高至 93.9%（31/33），除了轻度粘连的患者外，其余病例均能识别。
DCR 图像显示胸膜粘连患者的肺结构运动受限和/或变形，以及结构张力。DCR 可能是胸膜粘连常规术前评估的有用技术。进一步开发计算机化方法可以协助对异常运动发现进行定量评估。
