Hunsaker A, Ingenito E, Topal U, Pugatch R, Reilly J
Department of Radiology, Brigham and Women's Hospital, Boston, MA 02115, USA.
AJR Am J Roentgenol. 1998 Feb;170(2):309-14. doi: 10.2214/ajr.170.2.9456934.
This study was performed to assess the usefulness of preoperative thin-section CT alone and in combination with physiologic measurements in emphysema patients being evaluated for lung volume reduction surgery.
Six 1-mm collimation sections through the chest were obtained in 20 patients being evaluated for lung volume reduction surgery. Extent and severity of emphysema were assessed by visually scoring the images. CT scores ranged from 0 to 144. Inspiratory resistance was measured in 12 of 20 patients and was also used to discriminate between responders (change in forced expiratory volume in 1 sec, > or = 150 ml after surgery) and nonresponders (change in forced expiratory volume in 1 sec, < 150 ml after surgery).
Four of 20 patients with mild emphysema as revealed by thin-section CT (scores of < 50) did not improve lung function after lung volume reduction surgery. Eight of the remaining 16 patients with moderate to severe emphysema as revealed by thin-section CT (scores of > 50) underwent inspiratory resistance measurement. Those seven patients whose inspiratory resistance measurement exceeded 8.5 cm H2O/l per second did not respond favorably to lung volume reduction surgery (change in forced expiratory volume in 1 sec, < 150 ml). The remaining five patients whose inspiratory resistance measurement was less than 8.5 cm H2O/l per second responded favorably to lung volume reduction surgery. Thus, only five of the 20 patients showed improvement in forced expiratory volume in 1 sec after surgery.
Our data suggest that among patients with moderate to severe emphysema who are being examined for lung volume reduction surgery, the combination of radiologic and physiologic assessment is more accurate for predicting a favorable response to lung volume reduction surgery than radiologic assessment alone. However, in patients with chronic obstructive pulmonary disease by the American Thoracic Society criteria, mild emphysema as revealed on thin-section CT virtually precludes further workup because these patients are unlikely to respond favorably to lung volume reduction surgery.
本研究旨在评估术前薄层CT单独应用以及联合生理测量在接受肺减容手术评估的肺气肿患者中的应用价值。
对20例接受肺减容手术评估的患者获取6层1毫米准直的胸部CT图像。通过对图像进行视觉评分来评估肺气肿的范围和严重程度。CT评分范围为0至144。在20例患者中的12例测量了吸气阻力，并用于区分反应者（术后第1秒用力呼气量变化≥150毫升）和无反应者（术后第1秒用力呼气量变化<150毫升）。
薄层CT显示为轻度肺气肿（评分<50）的20例患者中有4例在肺减容手术后肺功能未改善。薄层CT显示为中度至重度肺气肿（评分>50）的其余16例患者中有8例进行了吸气阻力测量。吸气阻力测量超过8.5厘米水柱/升·秒的7例患者对肺减容手术反应不佳（术后第1秒用力呼气量变化<150毫升）。吸气阻力测量小于8.5厘米水柱/升·秒的其余5例患者对肺减容手术反应良好。因此，20例患者中只有5例术后第1秒用力呼气量有所改善。
我们的数据表明，在接受肺减容手术检查的中度至重度肺气肿患者中，放射学和生理学评估相结合比单独的放射学评估更准确地预测对肺减容手术的良好反应。然而，按照美国胸科学会标准诊断为慢性阻塞性肺疾病的患者中，薄层CT显示为轻度肺气肿实际上无需进一步检查，因为这些患者对肺减容手术不太可能有良好反应。
