Fang Jui, Shen Yu-Cheng, Ting Yen-Nien, Fang Hsin-Yuan, Chen Yi-Wen
Research & Development Center for x-Dimensional Extracellular Vesicles, China Medical University Hospital, Taichung City.
Division of Thoracic Surgery, Department of Surgery, China Medical University Hospital, Taichung City.
Quant Imaging Med Surg. 2024 Jan 3;14(1):123-135. doi: 10.21037/qims-23-636. Epub 2023 Nov 29.
Lung ultrasound (LUS) and diaphragm ultrasound (DUS) are the appropriate modalities for conservative observation to those patients who are with stable pneumothorax, as well as for the timely detection of life-threatening pneumothorax at any location, due to they are portable, real-time, relatively cost effective, and most important, without radiation exposure. The absence of lung sliding on LUS M-mode images and the abnormality of diaphragmatic excursion (DE) on DUS M-mode images are the most common and novel diagnostic criteria for pneumothorax, respectively. However, visual inspection of M-mode images remains subjective and quantitative analysis of LUS and DUS M-mode images are required.
Shannon entropy of LUS M-mode image (ShanEn) and DE based on the automated measurement (DE) are adapted to the objective pneumothorax diagnoses and the severity quantifications in this study. Mild, moderate, and severe pneumothoraces were induced in 24 male New Zealand rabbits through insufflation of room air (5, 10 and 15, and 25 and 40 mL/kg, respectively) into their pleural cavities. intercostal LUS and subcostal DUS M-mode images were acquired using a point-of-care system for estimating ShanEn and DE.
ShanEn and DE as functions of air insufflation volumes exhibited U-shaped curves and were exponentially decreasing, respectively. Either ShanEn or DE had areas under the receiver operating characteristic curves [95% confidence interval (CI)] of 1.0000 (95% CI: 1.0000-1.0000), 0.9833 (95% CI: 0.9214-1.0000), and 0.9407 (95% CI: 0.8511-1.0000) for differentiating between normal and mild pneumothorax, mild and moderate pneumothoraces, and moderate and severe pneumothoraces, respectively.
Our findings imply that the combination of ShanEn and DE give the promising potential for pneumothorax quantitative diagnosis.
对于气胸稳定的患者，肺超声（LUS）和膈肌超声（DUS）是进行保守观察的合适方式，并且由于其便携、实时、成本相对较低，以及最重要的是无辐射暴露，它们还可用于及时检测任何部位危及生命的气胸。LUS M 模式图像上肺滑动消失和 DUS M 模式图像上膈肌移动（DE）异常分别是气胸最常见和最新的诊断标准。然而，对 M 模式图像的目视检查仍然具有主观性，需要对 LUS 和 DUS M 模式图像进行定量分析。
本研究采用 LUS M 模式图像的香农熵（ShanEn）和基于自动测量的 DE 进行气胸的客观诊断和严重程度量化。通过向 24 只雄性新西兰兔胸腔内分别注入室内空气（5、10 和 15 以及 25 和 40 mL/kg）诱导轻度、中度和重度气胸。使用床旁系统采集肋间 LUS 和肋下 DUS M 模式图像以估计 ShanEn 和 DE。
ShanEn 和 DE 作为注入空气量的函数分别呈现 U 形曲线和指数下降。对于区分正常与轻度气胸、轻度与中度气胸以及中度与重度气胸，ShanEn 或 DE 的受试者操作特征曲线下面积[95%置信区间（CI）]分别为 1.0000（95%CI：1.0000 - 1.0000）、0.9833（95%CI：0.9214 - 1.0000）和 0.9407（95%CI：0.8511 - 1.0000）。
我们的研究结果表明，ShanEn 和 DE 的联合应用在气胸定量诊断方面具有广阔的前景。
