Lee P H, Carr D H, Rubens M B, Cole P, Hansell D M
Department of Radiology, Royal Brompton National Heart and Lung Hospital, London, UK.
Clin Radiol. 1995 Dec;50(12):839-41. doi: 10.1016/s0009-9260(05)83104-6.
There are many reports that state that the distribution and pattern of bronchiectasis may be sufficiently characteristic for a specific cause to be suggested. The aim of this study was to determine whether experienced chest radiologists could confidently and accurately diagnose various aetiologies of bronchiectasis from the computed tomography (CT) pattern of disease alone. CT scans of 108 patients with bronchiectasis of various causes (67 with idiopathic bronchiectasis, 10 with allergic bronchopulmonary aspergillosis, 12 with syndromes of impaired mucociliary clearance, 12 with hypogammaglobulinaemia and seven with adult cystic fibrosis) were assessed by three chest radiologists without knowledge of clinical data. Each observer listed the three most likely diagnoses in order of probability. In addition, a level of confidence on a 3-point scale was assigned to the first choice diagnosis. A correct first-choice diagnosis was made in 45% of readings. A high confidence level was given in only 9% of the first choice readings. Of these, a correct diagnosis was reached in 35%. There was poor interobserver agreement (mean kappa = 0.20). In conclusion, we found that the causes of bronchiectasis cannot be reliably diagnosed on the basis of CT appearances alone.
有许多报告指出，支气管扩张的分布和模式可能具有足够的特征，从而提示特定病因。本研究的目的是确定经验丰富的胸部放射科医生能否仅根据疾病的计算机断层扫描（CT）模式自信且准确地诊断支气管扩张的各种病因。108例不同病因支气管扩张患者（67例特发性支气管扩张、10例变应性支气管肺曲霉病、12例黏液纤毛清除功能障碍综合征、12例低丙种球蛋白血症和7例成人囊性纤维化）的CT扫描由三位胸部放射科医生在不了解临床资料的情况下进行评估。每位观察者按可能性顺序列出三种最可能的诊断。此外，对首选诊断给予3分制的置信度。在45%的读片中做出了正确的首选诊断。仅9%的首选读片给出了高置信度。其中，35%得出了正确诊断。观察者间一致性较差（平均kappa = 0.20）。总之，我们发现仅根据CT表现无法可靠地诊断支气管扩张的病因。
