Miniati M, Filippi E, Falaschi F, Carrozzi L, Milne E N, Sostman H D, Pistolesi M
Istituto di Fisiologia Clinica del CNR, Istituto di Clinica Medica II, Pisa, Italy.
Am J Respir Crit Care Med. 1995 May;151(5):1359-67. doi: 10.1164/ajrccm.151.5.7735585.
To objectively reappraise the role of the chest radiograph (CXR) in the clinical assessment of emphysema, we compared a standardized reading of CXR with both a visual scoring and a quantitative analysis of high resolution computed tomography (HRCT) of the chest in 46 consecutive patients with chronic obstructive pulmonary disease (COPD) and fixed expiratory airflow limitation. CXR were scored for signs of overinflation and pulmonary vascular deficiency by three independent observers. HRCT scans were independently scored for extent of emphysema and for both severity and extent of emphysema. In 28 of 46 patients, inspiratory and expiratory HRCT scans were analyzed quantitatively by measuring the mean CT number in Hounsfield Units (HU) and the percentage of lung area with CT numbers < -900 HU. Quantitative CT data were compared with reference values obtained in seven normal nonsmokers. The CXR score of emphysema showed a highly significant interobserver reproducibility and correlated linearly (p < 0.001) with HRCT visual scores and quantitative data from both inspiratory and expiratory CT scan. CXR score correlated with functional indices of airflow obstruction, overinflation, and impaired lung diffusing capacity in a way comparable to that obtained by using qualitative and quantitative CT data. Patients with no signs of emphysema on CXR had mean expiratory CT numbers within normal range and a fraction of lung area with CT numbers < -900 HU on expiratory scan not exceeding 15% of total cross-sectional area. The latter value was consistently greater than 15% in patients with CXR score > 0.(ABSTRACT TRUNCATED AT 250 WORDS)
为了客观地重新评估胸部X线片（CXR）在肺气肿临床评估中的作用，我们将46例连续性慢性阻塞性肺疾病（COPD）且存在固定性呼气气流受限的患者的CXR标准化解读结果，与胸部高分辨率计算机断层扫描（HRCT）的视觉评分及定量分析结果进行了比较。由三名独立观察者对CXR的过度充气和肺血管减少征象进行评分。HRCT扫描则独立地对肺气肿范围以及肺气肿的严重程度和范围进行评分。在46例患者中的28例，通过测量亨氏单位（HU）的平均CT值以及CT值＜-900 HU的肺面积百分比，对吸气和呼气HRCT扫描进行定量分析。将定量CT数据与7名正常非吸烟者获得的参考值进行比较。肺气肿的CXR评分显示出观察者间高度显著的可重复性，并且与HRCT视觉评分以及吸气和呼气CT扫描的定量数据呈线性相关（p＜0.001）。CXR评分与气流阻塞、过度充气以及肺弥散功能受损的功能指标之间的相关性，与使用定性和定量CT数据所获得的相关性相当。CXR上无肺气肿征象的患者，其呼气CT平均数值在正常范围内，呼气扫描时CT值＜-900 HU的肺面积占总横截面积的比例不超过15%。在CXR评分＞0的患者中，后一数值始终大于15%。（摘要截短于250字）
