Thurlbeck W M, Simon G
AJR Am J Roentgenol. 1978 Mar;130(3):429-40. doi: 10.2214/ajr.130.3.429.
Accuracy of the radiologic diagnosis of emphysema was assessed in 696 patients from whose lungs paper-mounted whole-lung sections had been made. Emphysema was diagnosed radiographically primarily on the basis of arterial deficiency. In addition, lung length, lung width, size of the retrosternal space, heart size, and diaphragm position were recorded from the chest films. Recognition of emphysema was poor when radiographs of inadequate quality were included (anteroposterior films or films from patients with acute or chronic lung disease). When these films were excluded, only occasional radiographs from patients without emphysema or with mild emphysema were thought to have emphysema radiologically. Of the patients with moderately severe and severe emphysema, 41% were diagnosed as having emphysema, as were two-thirds of those with the most severe grade of emphysema. For a given grade of emphysema, the radiologic diagnosis of emphysema was made more frequently when patients had severe chronic airflow obstruction. Emphysema was usually most severe in the zones of the lung in which emphysema was radiologically apparent. Centrilobular emphysema was usually present when emphysema was diagnosed radiologically in the upper zones of the lung, and panacinar emphysema was usually present when emphysema was diagnosed in the lower zones. Lung length and the size of the retrosternal space increased, the level of the diaphragm lowered, heart size decreased, and lung width was unchanged as emphysema became more severe. Lung length and diaphragm level were the most discriminating measurements, followed by size of the retrosternal space. No combination of radiologic variables was found that recognized emphysema better than the subjective diagnosis of emphysema based on arterial deficiency. Radiologic lung dimensions are related to stature; for given stature these measurements are larger in men and women.
对696例制作了纸质全肺切片的患者进行了肺气肿放射学诊断准确性的评估。肺气肿的放射学诊断主要基于动脉缺损。此外，从胸部X光片中记录肺长度、肺宽度、胸骨后间隙大小、心脏大小和膈肌位置。当纳入质量不佳的X光片（前后位片或急慢性肺部疾病患者的片子）时，肺气肿的识别效果较差。排除这些片子后，只有偶尔来自无肺气肿或轻度肺气肿患者的X光片在放射学上被认为有肺气肿。在中度严重和重度肺气肿患者中，41%被诊断为有肺气肿，最严重等级的肺气肿患者中有三分之二被诊断为有肺气肿。对于给定等级的肺气肿，当患者有严重的慢性气流阻塞时，肺气肿的放射学诊断更频繁。肺气肿通常在放射学上明显的肺区域最为严重。当在肺上部区域放射学诊断为肺气肿时，通常存在小叶中心型肺气肿，而在肺下部区域诊断为肺气肿时，通常存在全小叶型肺气肿。随着肺气肿加重，肺长度和胸骨后间隙大小增加，膈肌水平降低，心脏大小减小，肺宽度不变。肺长度和膈肌水平是最具鉴别力的测量指标，其次是胸骨后间隙大小。未发现任何放射学变量组合在识别肺气肿方面比基于动脉缺损的肺气肿主观诊断更好。放射学肺尺寸与身高有关；对于给定身高，这些测量值在男性和女性中更大。
