Baumstark A, Swensson R G, Hessel S J, Levin D C, Grossman W, Mann J T, Abrams H L
AJR Am J Roentgenol. 1984 May;142(5):877-84. doi: 10.2214/ajr.142.5.877.
This study evaluated how accurately the chest film could be used to determine pulmonary capillary wedge pressure (PCW) in patients with chronic heart disease. Six experienced readers interpreted the erect posteroanterior chest radiographs of 50 patients whose measured PCWs ranged from 6 to 38 mm Hg. Direct numeric estimates of PCW from the films were closely related to measured levels of PCW (r = 0.675). This linear correlation increased to 0.81 when individual-reader variations were reduced by taking a "consensus" (mean) of the six readers' estimates for each case. A combination of the judged degree of pulmonary blood flow redistribution (PFR) and three particular signs of pulmonary venous hypertension (PVH), basal and perihilar vascular blurring and alveolar edema, adequately summarized the radiographic information about PCW. These combined judgments of PFR/PVH identified films from patients with higher and lower PCW levels as accurately as readers' numeric estimates of PCW. Other radiographic signs (enlargement of the heart and central pulmonary vessels and the presence of Kerley lines or pleural effusion) were also positively related to increases in PCW, but added little to the information provided by the PFR/PVH criteria.
本研究评估了胸部X线片用于确定慢性心脏病患者肺毛细血管楔压（PCW）的准确性。六位经验丰富的阅片者解读了50例患者的立位后前位胸部X线片，这些患者测量的PCW范围为6至38 mmHg。根据X线片对PCW进行的直接数值估计与测量的PCW水平密切相关（r = 0.675）。当通过对每个病例采用六位阅片者估计值的“共识”（均值）来减少个体阅片者差异时，这种线性相关性提高到了0.81。肺血流再分布（PFR）的判断程度与肺静脉高压（PVH）的三个特定征象（肺底部和肺门周围血管模糊以及肺泡水肿）相结合，充分总结了有关PCW的X线信息。这些PFR/PVH的综合判断对PCW水平较高和较低患者的X线片识别，与阅片者对PCW的数值估计一样准确。其他X线征象（心脏和肺中央血管增大以及存在Kerley线或胸腔积液）也与PCW升高呈正相关，但对PFR/PVH标准提供的信息补充不多。
