Kazerooni E A, Martinez F J, Flint A, Jamadar D A, Gross B H, Spizarny D L, Cascade P N, Whyte R I, Lynch J P, Toews G
Department of Radiology, University of Michigan Hospitals, Ann Arbor 48109-0326, USA.
AJR Am J Roentgenol. 1997 Oct;169(4):977-83. doi: 10.2214/ajr.169.4.9308447.
The purpose of our study was to determine if three-level thin-section CT depicts idiopathic pulmonary fibrosis (IPF) pathology as accurately as CT obtained at 10-mm increments throughout the entire lungs.
Thin-section (1.0- to 1.5-mm) images at 10-mm increments were obtained and scored prospectively in 25 consecutive patients with newly diagnosed IPF who were participating in a Special Center of Research grant for interstitial lung disease. Each patient's lobe was scored by four thoracic radiologists on a scale of 0-5 for both ground-glass attenuation and fibrosis. The radiologists used three images (limited CT) and also used the entire data set (complete CT). CT scores were compared with pathology scores from 67 open and thoracoscopic biopsies. Limited and complete scores were compared with each other (Pearson correlation coefficient). Interobserver variation in the CT scoring system was assessed using kappa values.
CT fibrosis scores strongly correlated with pathology fibrosis scores for complete (r = .53, p = .0001) and limited (r = .50, p = .0001) CT. CT ground-glass scores correlated with the histologic inflammatory scores for each lobe on complete (r = .27, p = .03) and limited (r = .26, p = .03) CT. The desquamative subcomponent of the pathology inflammatory score had the highest correlation with the CT ground-glass scores (complete: r = .29, p = .01; limited: r = .33, p = .007). Good interobserver agreement existed for both the alveolar and fibrosis components of the CT scoring system (kappa values ranging from .51 to .83) for each lobe of the lung on limited and complete CT.
Limited thin-section CT reveals the pathologic changes associated with IPF as well as CT obtained at 10-mm increments. An added advantage of limited thin-section CT is that it exposes patients to less radiation.
我们研究的目的是确定三级薄层CT描绘特发性肺纤维化（IPF）病理的准确性是否与在整个肺部以10毫米间隔获取的CT一样。
以10毫米间隔获取薄层（1.0至1.5毫米）图像，并对25例连续参与间质性肺病研究特殊中心资助项目的新诊断IPF患者进行前瞻性评分。4名胸部放射科医生对每位患者的肺叶进行评分，磨玻璃影和纤维化均采用0至5分制。放射科医生使用三张图像（有限CT），也使用整个数据集（完整CT）。将CT评分与67例开胸和胸腔镜活检的病理评分进行比较。将有限和完整评分相互比较（Pearson相关系数）。使用kappa值评估CT评分系统中的观察者间差异。
完整CT（r = 0.53，p = 0.0001）和有限CT（r = 0.50，p = 0.0001）的CT纤维化评分与病理纤维化评分密切相关。完整CT（r = 0.27，p = 0.03）和有限CT（r = 0.26，p = 0.03）的CT磨玻璃影评分与每个肺叶的组织学炎症评分相关。病理炎症评分的脱屑亚成分与CT磨玻璃影评分相关性最高（完整：r = 0.29，p = 0.01；有限：r = 0.33，p = 0.007）。对于肺的每个肺叶，在有限和完整CT上，CT评分系统的肺泡和纤维化成分在观察者间一致性良好（kappa值范围为0.51至0.83）。
有限薄层CT显示与IPF相关的病理变化与以10毫米间隔获取的CT一样。有限薄层CT的另一个优点是它使患者接受的辐射更少。
