Talini D, Paggiaro P L, Falaschi F, Battolla L, Carrara M, Petrozzino M, Begliomini E, Bartolozzi C, Giuntini C
2nd Institute of Internal Medicine, Respiratory Pathophysiology, University of Pisa, Italy.
Occup Environ Med. 1995 Apr;52(4):262-7. doi: 10.1136/oem.52.4.262.
To compare the usefulness of high resolution computed tomography (HRCT) with chest radiography (CR) in the diagnosis and assessment of severity of silicosis.
27 workers exposed to silica underwent CR, HRCT, and pulmonary function tests. Two experienced readers independently evaluated CR by International Labour Office classification, and grouped the results into four categories. HRCT categories of nodule profusion and the extent of emphysema were graded on a four point scale; in 20 subjects the percentage distribution of lung densities were measured by HRCT.
Concordance between readers was higher for HRCT than for CR (K statistic = 0.49 and 0.29 respectively). There was poor concordance between CR and HRCT in the early stage of silicosis. No significant difference in pulmonary function tests was found among different CR categories, but forced expiratory volume in one second (FEV1), maximal expiratory flow at 50% and 75% of FVC (MEF50, MEF75), and diffusion capacity significantly decreased with increasing HRCT categories. Subjects with simple silicosis detected by HRCT had a lower FEV1 than subjects without silicosis, whereas subjects with conglomerated silicosis showed higher residual volume and functional residual capacity than subjects with simple silicosis. These relations were not affected by smoking or symptoms of chronic bronchitis. Different grades of emphysema detected by HRCT were significantly different in diffusion capacity. Only the HRCTs of the lowest and the highest categories of profusion of parenchymal opacities were significantly different in their distribution of density classes.
HRCT is more reproducible and accurate than CR, as suggested by the higher agreement between readers and the better correlation with pulmonary function tests, irrespective of smoking and chronic bronchitis; however, these data do not support the hypothesis that HRCT is more sensitive than CR in the early detection of silicosis.
比较高分辨率计算机断层扫描（HRCT）与胸部X线摄影（CR）在矽肺诊断及严重程度评估中的效用。
27名接触二氧化硅的工人接受了CR、HRCT及肺功能测试。两名经验丰富的阅片者依据国际劳工组织分类标准对CR进行独立评估，并将结果分为四类。HRCT的结节密集度及肺气肿范围类别按四分制分级；对20名受试者通过HRCT测量肺密度的百分比分布。
阅片者之间对HRCT的一致性高于CR（K统计量分别为0.49和0.29）。矽肺早期CR与HRCT之间的一致性较差。不同CR类别之间肺功能测试无显著差异，但一秒用力呼气容积（FEV1）、用力肺活量50%和75%时的最大呼气流量（MEF50、MEF75）以及弥散能力随HRCT类别增加而显著降低。HRCT检测出的单纯矽肺受试者的FEV1低于未患矽肺的受试者，而融合矽肺受试者的残气量和功能残气量高于单纯矽肺受试者。这些关系不受吸烟或慢性支气管炎症状影响。HRCT检测出的不同等级肺气肿在弥散能力方面存在显著差异。仅实质阴影密集度最低和最高类别的HRCT在密度类别分布上存在显著差异。
如阅片者之间更高的一致性以及与肺功能测试更好的相关性所示，HRCT比CR更具可重复性和准确性，且不受吸烟和慢性支气管炎影响；然而，这些数据并不支持HRCT在矽肺早期检测中比CR更敏感这一假设。
