Nishimura K, Izumi T, Kitaichi M, Nagai S, Itoh H
Chest Disease Research Institute, Kyoto University, Japan.
Chest. 1993 Oct;104(4):1149-55. doi: 10.1378/chest.104.4.1149.
The purpose of this study was to evaluate the role of high-resolution computed tomography (HRCT) in the clinical diagnosis of diffuse infiltrative lung disease (DILD). Diagnostic accuracy was compared using both chest radiography and HRCT. One hundred thirty-four cases of DILD, representing 21 different diseases, were selected for study, and the disease state was confirmed either histologically or microbiologically. The HRCT images and chest radiographs, available in all cases, were reviewed separately and in random order by 20 physicians who were provided only with information on each patient's age and sex. Overall, a correct first-choice diagnosis was made in 38 percent using radiographs and in 46 percent using HRCT images (p < 0.01). The correct diagnosis was among the top three choices in 49 percent when chest radiographs were used, and in 59 percent when HRCT images were viewed (p < 0.01). The correct first-choice diagnosis increased remarkably when the HRCT was used in usual interstitial pneumonia, sarcoidosis, alveolar proteinosis, bronchiolitis obliterans organizing pneumonia, hypersensitivity pneumonitis, and pulmonary lymphangiomyomatosis. High-resolution computed tomography was confirmed to be superior to conventional radiography in the accurate diagnosis of DILD in clinical practice.
本研究的目的是评估高分辨率计算机断层扫描（HRCT）在弥漫性浸润性肺疾病（DILD）临床诊断中的作用。使用胸部X线摄影和HRCT比较诊断准确性。选择了代表21种不同疾病的134例DILD病例进行研究，疾病状态通过组织学或微生物学确诊。所有病例均有的HRCT图像和胸部X线片由20名医生分别以随机顺序进行回顾，这些医生仅获得了每位患者的年龄和性别信息。总体而言，使用X线片时38%做出了正确的首选诊断，使用HRCT图像时为46%（p<0.01）。使用胸部X线片时，正确诊断在前三选择中的比例为49%，查看HRCT图像时为59%（p<0.01）。在寻常型间质性肺炎、结节病、肺泡蛋白沉积症、闭塞性细支气管炎伴机化性肺炎、过敏性肺炎和肺淋巴管平滑肌瘤病中使用HRCT时，正确的首选诊断显著增加。在临床实践中，高分辨率计算机断层扫描在DILD的准确诊断方面被证实优于传统X线摄影。
