Worrell J A, Cullinan J A, Youree C C, Carroll F E, Lorenz C H
Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tennessee 37232-2675, USA.
J Reprod Med. 1996 Sep;41(9):629-32.
To evaluate the reproducibility of radiographic quantification of pulmonary edema on the supine plain chest radiograph and to correlate the radiographic appearance of edema with the clinical assessment and treatment of pulmonary edema.
Retrospective, blind, descriptive study of 24 women with singleton pregnancies in the last trimester selected because of a clinical question of pulmonary edema.
Interobserver variability between radiologists resulted in an average weighted kappa of .71 in grading edema on a 0-3 scale where 0 = no edema and 3 = alveolar flooding. The vascular pedicle (a measure of central circulating volume) was larger among patients who received furosemide (63.4 mm) than those who did not (57.0 mm) (P = .01). The vascular pedicle was also larger among patients receiving tocolytics or steroids (62.8 mm) than those who did not (56.0 mm) (P = .01). The radiographic edema score tended to be lower in patients who received tocolytics and steroids (P = .05). The other correlations were not significant.
Radiographic assessment of pulmonary edema shows fair to good reproducibility, but the clinical correlations are modest. A wider understanding of the wealth of physiologic information available on the plain chest radiograph may prove invaluable in understanding the clinical course and treatment of these patients.
评估仰卧位胸部平片上肺水肿影像学定量的可重复性，并将水肿的影像学表现与肺水肿的临床评估及治疗相关联。
对24例孕晚期单胎妊娠女性进行回顾性、盲法、描述性研究，这些女性因存在肺水肿的临床问题而入选。
放射科医生之间的观察者间变异性导致在0至3级水肿分级中平均加权kappa值为0.71，其中0 =无水肿，3 =肺泡性肺水肿。接受呋塞米治疗的患者血管蒂（中央循环血量的一种测量指标）（63.4毫米）大于未接受治疗的患者（57.0毫米）（P = 0.01）。接受宫缩抑制剂或类固醇治疗的患者血管蒂（62.8毫米）也大于未接受治疗的患者（56.0毫米）（P = 0.01）。接受宫缩抑制剂和类固醇治疗的患者影像学水肿评分往往较低（P = 0.05）。其他相关性不显著。
肺水肿的影像学评估显示出尚可至良好的可重复性，但临床相关性一般。更广泛地理解胸部平片上可用的丰富生理信息可能对理解这些患者的临床病程和治疗具有重要价值。
