Slone R M, Pilgram T K, Gierada D S, Sagel S S, Glazer H S, Yusen R D, Cooper J D
Mallinckrodt Institute of Radiology, Barnes-Jewish Hospital, Washington University School of Medicine, St Louis, MO 63110, USA.
Radiology. 1997 Sep;204(3):685-93. doi: 10.1148/radiology.204.3.9280244.
To examine the relationship between preoperative radiologic findings and clinical outcome after lung volume reduction surgery.
In 50 consecutive patients, preoperative chest radiographs and computed tomographic (CT) scans were scored by four radiologists for features related to the severity and distribution of emphysema and compared with clinical improvement in forced expiratory volume in 1 second (FEV1), arterial partial pressure of oxygen, and exercise tolerance 6 months after surgery.
In the 47 surviving patients, follow-up data showed greater postoperative improvement in function in patients with a global pattern of predominantly upper-lobe emphysema (P < .05) and in patients with a more heterogeneous distribution of emphysema, compressed lung, and a larger percentage of normal and mildly emphysematous lung (P < .05 for improvement in FEV1). Radiographic scores for individual features were more strongly correlated with outcome than CT scores. The combination of upper-lobe severity and percentage of normal and mildly emphysematous lung at CT were the strongest predictors of improvement in FEV1 (r2 = .49). The three patients who died were older (P = .05) and had more severe, diffuse emphysema compared with other patients.
Imaging studies may help predict the degree of improvement and therefore should be considered an integral part of an objective patient selection process. Radiography alone may be adequate for initial screening.
研究肺减容术前影像学表现与术后临床结局之间的关系。
连续纳入50例患者，由4名放射科医生对其术前胸部X线片和计算机断层扫描（CT）进行评分，评估与肺气肿严重程度及分布相关的特征，并与术后6个月时第1秒用力呼气容积（FEV1）、动脉血氧分压和运动耐量的临床改善情况进行比较。
在47例存活患者中，随访数据显示，以全肺为主的上叶肺气肿患者（P <.05）以及肺气肿分布更不均匀、肺组织受压且正常和轻度肺气肿肺组织所占百分比更高的患者（FEV1改善情况，P <.05）术后功能改善更明显。单个特征的影像学评分与结局的相关性比CT评分更强。上叶严重程度与CT上正常和轻度肺气肿肺组织百分比的组合是FEV1改善的最强预测因素（r2 =.49）。与其他患者相比，3例死亡患者年龄更大（P =.05），肺气肿更严重且弥漫。
影像学检查有助于预测改善程度，因此应被视为客观的患者选择过程的一个组成部分。仅胸部X线检查可能足以进行初步筛查。
