Center for Pulmonary Imaging Research, Division of Pulmonary Medicine and Department of Radiology, Cincinnati Children's Hospital Medical Center, Ohio, Cincinnati, USA.
The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
Pediatr Transplant. 2023 Dec;27(8):e14594. doi: 10.1111/petr.14594. Epub 2023 Sep 1.
Organ size matching is an important determinant of successful allocation and outcomes in lung transplantation. While computed tomography (CT) is the gold standard, it is rarely used in an organ-donor context, and chest X-ray (CXR) may offer a practical and accurate solution in estimating lung volumes for donor and recipient size matching. We compared CXR lung measurements to CT-measured lung volumes and traditional estimates of lung volume in the same subjects.
Our retrospective study analyzed clinically obtained CXR and CT lung images of 250 subjects without evidence of lung disease (mean age 9.9 ± 7.8 years; 129 M/121F). From CT, each lung was semi-automatically segmented and total lung volumes were quantified. From anterior-posterior CXR view, each lung was manually segmented and areas were measured. Lung lengths from the apices to the mid-basal regions of each lung were measured from CXR. Quantified CT lung volumes were compared to the corresponding CXR lung lengths, CXR lung areas, height, weight, and predicted total lung capacity (pTLC).
There are strong and significant correlations between CT volumes and CXR lung areas in the right lung (R = .89, p < .0001), left lung (R = .87, p < .0001), and combined lungs (R = .89, p < .0001). Similar correlations were seen between CT volumes and CXR measured lung lengths in the right lung (R = .79, p < .0001) and left lung (R = .81, p < .0001). This correlation between anatomical lung volume (CT) and CXR was stronger than lung-volume correlation to height (R = .66, p < .0001), weight (R = .43, p < .0001), or pTLC (R = .66, p < .0001).
CXR measures correlate much more strongly with true lung volumes than height, weight, or pTLC. The ability to obtain efficient and more accurate lung volume via CXR has the potential to change our current listing practices of using height as a surrogate for lung size, with a case example provided.
器官大小匹配是肺移植成功分配和结果的重要决定因素。虽然计算机断层扫描（CT）是金标准，但在器官捐献者中很少使用，而胸部 X 射线（CXR）可能是一种实用且准确的方法，可以估计供体和受体的肺体积以进行大小匹配。我们比较了 CXR 肺测量值与 CT 测量的肺体积以及同一受试者的传统肺体积估计值。
我们的回顾性研究分析了 250 名无肺部疾病临床获得的 CXR 和 CT 肺图像的受试者（平均年龄 9.9±7.8 岁；129 名男性/121 名女性）。从 CT 上，每个肺被半自动分割，量化了总肺体积。从前后位 CXR 视图中，手动分割每个肺并测量面积。从 CXR 测量每个肺的尖到中基底部的长度。将 CT 量化的肺体积与相应的 CXR 肺长度、CXR 肺面积、身高、体重和预测的总肺活量（pTLC）进行比较。
右肺（R=0.89，p<0.0001）、左肺（R=0.87，p<0.0001）和双肺（R=0.89，p<0.0001）中 CT 体积与 CXR 肺面积之间存在很强的正相关。在右肺（R=0.79，p<0.0001）和左肺（R=0.81，p<0.0001）中，CT 体积与 CXR 测量的肺长度之间也存在类似的相关性。解剖肺体积（CT）与 CXR 之间的这种相关性强于肺体积与身高（R=0.66，p<0.0001）、体重（R=0.43，p<0.0001）或 pTLC（R=0.66，p<0.0001）的相关性。
CXR 测量值与真实肺体积的相关性强于身高、体重或 pTLC。通过 CXR 获得更有效和更准确的肺体积的能力有可能改变我们目前使用身高作为肺大小替代物的清单实践，提供了一个案例示例。
