慢性阻塞性肺疾病肺气肿表型的CT肺功能研究

目的 :采用CT肺功能检查探讨慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)肺气肿表型患者的临床特征。方法:选取2014年1月至2015年12月在我院就诊的稳定期COPD患者66例。行CT肺功能检查,计算深吸气末低衰减区(low attenuation area,LAA)占全肺体积百分比,即肺气肿指数(LAA%),LAA%≥15%者为肺气肿表型组,LAA%15%者为非肺气肿表型组。采用慢性阻塞性肺病评价量表(CAT)评价生活质量,记录既往急性加重次数;行常规肺功能检查记录1 s用力呼气容积(FEV1)、用力肺活量(FVC)、FEV1/FVC、RV/TLC;采用Pearson线性相关性分析检验各项指标之间的相关性。结果:66例平均CAT评分(14.83±7.56)分,平均COPD急性加重次数(2.14±1.42)次,平均FEV1(44.94±21.61)%,平均LAA%(15.25±10.52)%。LAA%与FEV1、FEV1/FVC呈负相关(r=-0.473,-0.469;P0.05),与RV/TLC、CAT评分、急性加重次数呈正相关(r=0.512,0.483,0.421;P0.05);肺气肿表型组和非肺气肿表型组患者在年龄、CAT评分、急性加重频率、气流受限方面差异均有统计学意义(均P0.05)。结论:LAA%与常规肺功能指标存在明显相关性,对无法配合常规肺功能检查者能提供较为客观的临床参考依据;COPD肺气肿表型患者在年龄、急性加重频率、气流阻力、影像学表现及生活质量方面具有其独特性。     

CT双相扫描三维定量分析慢性阻塞性肺疾病CT肺功能与常规肺功能的关系

目的 应用64层螺旋CT双相扫描三维定量分析慢性阻塞性肺疾病(COPD)患者CT定量肺功能与常规肺功能(PFT)之间的关系,并评估CT定量分析肺功能在COPD患者中的应用价值.方法 收集84例COPD患者,采用64层螺旋CT扫描机,于深吸气末和深呼气末分别对患者行全肺扫描.采用全自动后处理软件,三维定量分析CT肺气肿参数和空气潴留评估参数.应用Spearman相关系数和多元线性回归分析CT肺功能参数与PFT之间的关系.结果 CT肺气肿评估参数最低1％衰减值[Perc1,(-984.28±17.93)HU]、最低15％衰减值[Perc15,(-948.35±22.26) HU]与片力呼气容积实测值与预计值百分比(FEV1％,48.69±23,47),第1秒用力呼气容积与用力肺活量比[FEV1/FVC,(45.89±15.36)％呈正相关(r=0.45 ～0.67,P＜O.01),与残气比[RV/TLC,(61.32±14.48)％]呈负相关(r=-0.33～-0.42,P＜0.01).CT评估肺气肿指数(EI)和空气潴留评估参数:-860～-950 HU范围内呼气相、吸气相衰减区占全肺容积百分比的差值[RVC-860～-950,(17.66±22.36)％]、呼气相与吸气相CT平均肺密度比值(MLDex/in,0.93 ±0.06)、呼气相与吸气相CT全肺容积比(LVeex/im,0.71 ±0.14)与FEV1％、FEV1/FVC呈负相关(r=-0.48～-0.69,P＜0.01);CT评估肺气肿参数[EI,(18.43±13.60)％]和空气潴留评估参数(RVC-860 ～-950、MLDex/in、LVeex/in)与RV/TLC呈正相关(r=0.41 ～0.66,P＜0.01).随后一元线性回归分析表明,CT肺气肿评估参数(EI 、Perc1、Perc15)和CT空气潴留评估参数(RVC-860～-950、MLDeex/in、LVeex/in)的变化与常规PFT参数间具有关联性(R2值0.27 ～O.66,P＜0.01);进一步将CT肺气肿与空气潴留参数两两结合成CT肺功能模型,进行多元线性回归分析(R2=0.66～0.85,P＜0.01),较单独分析时明显提高.结论 COPD患者CT肺气肿和空气潴留参数二者分别与PFT具有线性相关性,能够有效反映患者肺功能变化.CT肺气肿参数和空气潴留参数组成相关模型联合分析,与PFT相关性更好,更精确地反映了COPD患者肺功能的变化.     

基于定量CT分析COPD患者肺血管改变与肺气肿严重程度的一致性

目的 基于定量电子计算机断层扫描(CT)分析慢性阻塞性肺疾病(COPD)患者肺血管改变、肺气肿、气道受限三者相关性,在体内证实COPD患者肺血管与肺气肿异常的相关性。方法 回顾性分析“数字肺”平台2015年3月至2016年11月慢性阻塞性肺疾病患者(COPD)共计113例。计算吸气相CT图像上肺低衰减区百分比(LAA%),全肺以及各个肺叶肺血管体积百分比(IPVV%)。采用单因素方差分析(正态分布)或Kruskal Wallis H秩和检验(非正态分布)比较不同严重程度肺气肿的肺血管参数的差异。Spearman相关分析IPVV%与LAA%和一秒用力呼气容积(FEV1)/用力肺活量(FVC)、FEV1%的相关性。结果 全肺以及各个肺叶IPVV%与LAA%呈显著强负相关(P值均<0.001),最强相关系数r=-0.735,在右肺上叶和左肺上叶相关性最强。全肺以及各个肺叶IPVV%与FEV1%和FEV1/FVC均呈显著正相关(P值均<0.001),最强相关系数分别为r=0.441和r=0.498。IPVV%与LAA%的相关性显著强于IPVV%与FEV1%和FEV1/FVC的相关性...     

多层螺旋CT肺气肿指数评估慢性阻塞性肺疾病的肺叶功能

目的 探讨多层螺旋CT (MSCT)肺气肿指数(EI)评估慢性阻塞性肺疾病(COPD)患者肺叶功能的价值.资料与方法 30例临床确诊的COPD患者(研究组)和34例CT胸部体检且肺功能正常者(对照组)均行MSCT及临床肺功能检查.测量肺容积、肺气肿容积(EV)、EI,分析全肺及肺叶EI与第1秒用力肺活量实测值与预测值百分比(FEV1％)、第1秒用力肺活量/用力肺活量(FEV1/FVC)的相关性,比较两组各肺叶EI总和与全肺EI之间的差异.结果 研究组呼吸两相各肺叶及全肺EI均显著高于对照组(P＜0.05);研究组深吸气相右肺上叶EI值与FEV1/FVC呈正相关(r=0.400,P＜0.05),其他肺叶及全肺EI值与FEV1％(r=-0.693～-0.498,P＜0.05)、FEV1/FVC(r=-0.765 ～-0.353,P＜0.05)呈负相关;深呼气相各肺叶及全肺EI值与FEV1％(r=-0.729～-0.473,P＜0.05)、FEV1/FVC(r=-0.769～-0.353,P＜0.05)均呈负相关.结论 MSCT测量全肺及各肺叶EI值与肺功能指标有一定的相关性,采用EI值能够判断COPD患者全肺及肺叶的损伤程度及功能.     

皮肌炎/多发性肌炎并发间质性肺病的CT定量分析与肺功能的相关性研究

目的:探讨CT定量分析对皮肌炎/多发性肌炎并发间质性肺病(DM/PM-ILD)的评估价值。方法:回顾性分析2017年1月至2020年10月我院确诊的61例DM/PM-ILD患者同一时期的胸部HRCT及肺功能检查资料，同时选取60例性别、年龄及BMI相匹配且胸部HRCT无异常的健康人作为对照。使用3D Slicer软件根据阈值分割法获得CT定量指标，包括正常肺区域百分比(NL%)、磨玻璃影区域百分比(GGO%)、纤维化区域百分比(F%)及总的异常病变区域百分比(AA%)。肺功能参数包括肺总量占预计值的百分比(TLC%)、用力肺活量占预计值的百分比(FVC%)、第一秒用力呼气量占预计值的百分比(FEV1%)、一秒率(FEV1/FVC)、肺一氧化碳弥散量占预计值的百分比(DLCO%)。采用Spearman或Pearson相关分析及多元逐步线性回归分析各组数据之间的关系，使用ROC曲线确定鉴别DM/PM-ILD组与对照组的最佳CT定量指标。结果:ROC曲线分析结果显示，GGO%鉴别DM/PM-ILD患者组与对照组具有最大的AUC为0.91(95%CI:0.85～0.96),以GGO%=7.1%...     

COPD患者双相MSCT气道成像与肺功能相关性的初步探讨

目的探讨慢性阻塞性肺疾病(COPD)患者双相(吸气相和呼气相)多层螺旋CT(MSCT)气道成像与肺功能的关系,旨在为COPD提供简便、易行的诊断方法。方法 42例COPD患者行肺功能检查后行双相MSCT气道成像,使用自编气道分析软件获得第3～5级支气管双相管腔面积及其比值。采用Spearman相关分析双相管腔面积及其比值与肺功能的相关性。结果 (1)呼气相管腔面积与肺功能的相关性高于吸气相管腔面积与肺功能的相关性,且相关系数随管腔面积减小而增大,第5级支气管呼气相管腔面积与第1秒用力呼气容量占预计值的百分比(FEV1%预计值)及第1秒用力呼气容量占用力呼气肺活量的百分比[FEV1/FVC(%)]呈明显正相关(r分别为0.725与0.711,P值均<0.001)。(2)双相管腔面积比值与肺功能具有程度不一的正相关,且相关系数随着管腔面积变小而增加,第5级支气管双相管腔面积比值与FEV1%预计值及FEV1/FVC(%)呈明显正相关(r分别为0.672与0.596,P值均<0.001)。结论双相MSCT气道成像能通过评价气道大小及其变化较好地评价COPD患者的肺功能状态。     

CT肺功能成像技术研究

目的探讨CT肺功能成像技术的可行性,着重研究CT肺功能参数与肺功能检查(pulmonary functional test, PFT)参数的相关性.方法共69例,包括PFT正常者21例,阻塞性通气功能障碍者37例,限制性通气功能障碍者9例,混合性功能障碍者2例,均在1周内完成PFT和胸部CT检查.采用最大吸气末和呼气末屏气螺旋CT扫描.扫描参数120 kV,175 mA,每层螺旋扫描时间1 s,床速20 mm/s,螺距2∶1.将CT图像经医学数字影像与通讯(DICOM)协议接口接到计算机上.利用自行研制的CT肺功能定量软件进行数据分析.结果通过吸气末CT测得的肺体积(Vin)与PFT的最大肺总量(TLC)存在明显相关性(r=0.866,P<0.001),呼气末CT测得的肺体积(Vex)与残气量(RV)有相关性 (r=0.833,P<0.001),呼吸比(Vex/Vin)与RV/TLC有相关性(r=0.590,P<0.001).吸气像平均CT值与第1秒量占预计值的百分比(FEV1%),第1秒用力呼吸量(FEV1)/用力肺活量(FVC)存在相关性(r=0.382, P<0.05 ; r=0.682, P<0.01).像素指数(PI)=-910～-950 HU与FEV1、FEV1%、 FVC%、FEV1/FVC均存在相关性,其中与FEV1/FVC的相关性最好(r=0.747～0.772,P<0.01).呼气像平均CT值与FEV1、FEV1%、FVC%、FEV1/FVC存在相关性(r=0.624, P<0.01; r=0.654, P<0.01; r=0.452, P<0.01 ; r=0.758, P<0.01).呼气像CT各阈值与PFT参数均存在相关性.结论最大吸气末和最大呼气末行螺旋CT扫描,可获得肺部解剖和肺功能情况的参数,与PFT结果相关性好,因此本法是行之有效的CT肺功能定量成像技术.     

低剂量CT扫描及肺功能检查对COPD小气道参数的研究

目的探讨低剂量CT扫描和肺功能检查在评价COPD患者气道重塑方面的作用和关系。方法选取COPD患者60例为观察组,同时选择与观察组患者年龄匹配的健康体检者30例为对照组。应用低剂量CT扫描并观察患者肺部影像学表现,运用后处理软件测量COPD患者气道壁厚度(T)、气道壁面积(WA)及气道外径(D)等参数,评估气道重塑的程度。结果1)实验组支气管管壁厚度与外径比值的2倍(2T/D)和管壁横断面积占支气管总面积的百分比(WA%)显著高于对照组(P<0.01),差异有统计学意义;2)对照组肺功能指标(FEV1/预计值)%、(FEV1/FVC)%显著大于观察组(P<0.01),差异具有统计学意义;3)经直线相关分析,观察组患者FEV1%与(2T/D)成负相关(P<0.01);与WA%成负相关(P<0.01)。结论低剂量CT扫描在评估COPD气道重塑方面具有非常高的准确性,肺功能指标(FEV1/预计值)%、(FEV1/FVC)%与COPD患者气道重塑关系密切。     

肺泡蛋白沉着症X线胸片及高分辨率CT表现与肺功能的关系

目的 探讨肺泡蛋白沉着症X线胸片及胸部高分辨率CT(HRCT)影像表现及其与肺功能检查的相关性.方法 回顾性分析19例肺泡蛋白沉着症患者的X线胸片、胸部HRCT及肺功能检查[肺总量、一氧化碳弥散量(DLCO)、第一秒用力肺活量(FEV1)及一秒率(FEV1/FVC)],根据肺部阴影的程度、范围、严重程度及网格阴影范围进行影像学评分,将X线胸片及HRCT的影像评分与肺功能指标进行相关性分析.结果 X线胸片以双侧对称的自肺门向外放射的"蝶翼征"表现为主,胸部HRCT特征性的表现为两肺弥漫性分布的斑片状磨玻璃样气腔实变影,伴小叶间隔增厚及网格影,这种"铺路石"样病变呈地图样分布.19例患者的肺功能结果 为DLCO占预计值百分比:(54.49±16.78)%;FEV1/FVC:(86.00±6.70)%.X线胸片的范围评分及严重度评分与DLCO占预计值百分比呈负相关(r=-0.661,P＜0.01;r=-0.475,P＜0.05).HRCT严重度评分为(16.47±5.26)分,在HRCT的各项评分中严重度评分与限制性通气功能障碍(FEV1/FVC升高)及弥散功能障碍(DLCO占预计值百分比下降)的相关性最好(DLCO占预计值百分比r=-0.809,P＜0.01;FEV1/FVC r=0.573,P＜0.05);HRCT的范围评分比程度评分与肺功能的相关性更好,而HRCT的网格范围评分只与弥散功能障碍相关.结论 肺泡蛋白沉着症X线胸片、胸部HRCT与肺功能相关性良好,HRCT比X线胸片更能准确反映肺功能受损情况.     

慢性阻塞性肺疾病肺功能与CT扫描容积定量参数指标的相关性分析

目的探讨有慢性阻塞性肺疾病(COPD)高危因素的肺功能正常者肺部CT征象及CT容积定量参数与肺功能指标的相关性。方法分析本院80例存在COPD高危因素的肺功能正常者的临床资料,均行薄层CT扫描和肺功能检查。结果 80例受检者肺部CT征象以小叶中小型肺气肿、线样肺不张和间隔旁型肺气肿为多见,分别占28.75%、35.00%、46.25%,而其余CT征象的构成比均低于18%。按照受检者肺气肿指数(EI)的不同,37例出现肺气肿(EI≥3%),43例无肺气肿(EI3%)。相比无肺气肿者,伴有肺气肿者第1s用力呼气容积(FEV1)占用力肺活量(FVC)百分比(FEV1/FVC)显著降低,双肺总容积明显增加(P0.01);而二者BMI、FEV1/预计值和肺总量比较,均无明显差异(P0.05)。经Pearson相关性分析发现,双肺总容积与肺总量存在正相关关系(r=0.52,P0.01),阈值低于-950HU肺气肿容积(EV-950)与肺总量具有正相关关系(r=0.45,P0.01)。结论伴有COPD高危因素的肺功能正常者CT形态学存在一定特点,CT征象主要表现在小叶中小型肺气肿、线样肺不张和间隔旁型肺气肿,并且CT容积定量参数与肺功能指标存在一定相关性。     

脂肪肝的CT定量定性分析与中医证型相关性研究

目的:通过CT对非酒精性脂肪肝(NAFL)进行定性定量诊断分析,探讨NAFL的CT诊断与中医证型之间的相关性。方法:选取NAFL 229例,分为肝郁脾虚、痰湿内阻、痰瘀互结、肝肾不足、湿热内蕴5个中医证型,均行肝脏螺旋CT扫描,测量肝、脾CT值,将不同中医证型NAFL的轻中重CT分级及肝、脾CT比值进行统计分析。结果:中医证型之间CT定量诊断的轻、中、重分级差异有统计学意义(P<0.01);5个证型之间肝、脾CT比值差异有统计学意义(P<0.01),肝、脾CT比值按照秩次排列为肝郁脾虚证>湿热内蕴证>痰湿内阻证>痰瘀互结证>肝肾不足证。结论:NAFL的CT定量诊断与中医证型密切相关,各中医证型脂肪浸润程度的变化,与NAFL中医病因病机、证型演变相吻合,提示肝、脾CT比值可作为区分NAFL中医证型的客观性指标之一。     

吸烟人群肺部MDCT形态和容积量化评估及与肺功能的相关性研究

目的 分析吸烟人群肺部多排螺旋CT(MDCT)形态学特点,测量CT肺容积量化参数,研究二者与肺功能检查(PFT)指标的相关性.方法 选取59例吸烟者,其中14例为慢性阻塞性肺疾病(COPD)患者,另纳入39例不吸烟者作为对照组.所有受试者接受MDCT双气相扫描及PFT.分析并比较3组人群中与吸烟相关的11种肺部CT征象.测量肺气肿指数(EI)和平均肺密度(MLD).分析上述参数与PFT指标的相关性.结果 ①小叶中心型肺气肿、间隔旁型肺气肿、支气管扩张或管壁增厚的评分及发生率在3组间存在统计学差异(P均＜0.01).②吸烟COPD患者间隔旁型肺气肿与一氧化碳弥散量(DLCO)/肺泡容积(VA),支气管扩张或管壁增厚与DLCO实测值与预计值比值[DLCO SB(％P)]、DLCO与VA比值的实测值与预计值之比[DLCO/VA(％P)],EI与25％最大呼气量实测值与预计值的比值[MEF25％(％P)]、DLCO SB(％ p)、DLCO/VA(％P)均呈负相关.吸烟非COPD者小叶中心型肺气肿与第1秒用力呼气量与用力肺活量的比值(FEV1/FVC)、MEF25％(％P)、50％最大呼气量实测值与预计值的比值[MEF5％(％P)]、DLCO SB(％P)及DLCO/VA(％P),间隔旁型肺气肿与DLCO SB(％P)、DLCO/VA(％P),支气管扩张或管壁增厚与DLCO/VA(％P),EI与FEV1/FVC、MEF5％(％P)均呈负相关,MLD与FEV1(％P)、MEF25％ (％P)呈正相关.结论 MDCT可用于分析吸烟人群的肺部形态异常,其形态学特点及容积量化参数对肺功能有很好的预测价值.     

Quantitatively assessed dynamic contrast-enhanced magnetic resonance imaging in patients with chronic obstructive pulmonary disease: correlation of perfusion parameters with pulmonary function test and quantitative computed tomography

OBJECTIVES: The purpose of this study is to evaluate the correlation of the perfusion parameters of 3-dimensional, contrast-enhanced magnetic resonance (MR) imaging (3D CEMRI) with pulmonary function test (PFT) and quantitative computed tomography (CT) parameters in patients with chronic obstructive pulmonary disease (COPD). MATERIALS AND METHODS: In 14 patients with COPD, 3D CEMRI was performed. From the signal intensity-time curves, pulmonary blood flow (PBF), pulmonary blood volume (PBV), and mean transit time of each pixel was calculated. From the volumetric CT data, the quantitative parameters including the volume fraction of the lung below -950 Housefield Units (V(-950)) and mean lung density were assessed. The correlation between the MR perfusion parameters and the parameters from quantitative CT and PFT was assessed using Spearman correlation analysis. The correspondence of the regional impairment of perfusion on MR perfusion maps to the areas of emphysema on quantitative CT maps in each patient was assessed qualitatively using a 4-class visual scoring method by 2 readers. RESULTS: All 3D CEMRI examinations were successfully completed and MR perfusion parameters were obtained in all patients. The Spearman correlation test showed that PBF positively correlated with forced expiratory volume in 1 second (FEV(1))/forced vital capacity (FVC) (R = 0.49, P = 0.044), PBV positively correlated with FEV(1)/FVC (R = 0.69, P = 0.006) and negatively correlated with V-950 (R = -0.61, P = 0.020), and mean transit time positively correlated with FEV(1) (R = 0.63, P = 0.017) and FEV(1)/FVC (R = 0.76, P = 0.002). The areas of perfusion impairment on PBF and PBV maps were relatively well correlated with the areas of emphysema on CT maps [very good or good: PBF 71.5% (reader 1) and 64.3% (reader 2) of the patients, kappa = 0.47 (P < 0.001); PBV 78.6% (reader 1) and 78.6% (reader 2) of the patients, kappa = 0.89 (P < 0.001)]. CONCLUSIONS: This study shows that the deterioration of perfusion parameters measured on MR in patients with COPD, correlates with worsening of airflow limitation on PFT and emphysema index on CT. Regional heterogeneity of emphysema on CT matches with the decreased perfusion on MR.     

Detection of emphysema with computed tomography. Correlation with pulmonary function tests and chest radiography

We studied 60 male patients who had concurrent chest films (CXR), computed tomography scans (CT) and pulmonary function tests (PFT) to assess the sensitivity of CT and conventional films in detecting emphysema compared with PFT. We also sought to determine whether emphysema could be diagnosed by CT in patients with normal pulmonary function. Using a method similar to that proposed by Bergin, we scored the severity of emphysema depicted by CT, and using arterial deficiency and bullae as criteria, we estimated the degree of emphysema on CXR. There was a significant inverse correlation between CT scores for emphysema and percentage predicted values of DLco/VA (r = -0.650), FEV1 (r = -0.552), and FVC (r = -0.409), (P less than 0.001). A significant but smaller correlation also was noted with the CXR scores and percentage predicted: DLco/VA (r = -0.564), FEV1 (r = -0.454), and FVC (r = -0.355), (P less than 0.005). When decreased diffusion capacity and airway obstruction were used as functional criteria of emphysema, CT was as sensitive as PFT and more sensitive than CXR in detecting emphysema (96% vs. 68%). There was CT evidence of emphysema in 69% (24/35) of patients who did not have functional findings of emphysema. In 12 pathologic specimens available for review, 11 had emphysema by CT and pathologic examination; one patient had centrilobular emphysema undetected by CT. We conclude that CT is as sensitive as PFT in detecting emphysema and more sensitive than conventional radiography. CT may be more sensitive than PFT in detecting mild emphysema.(ABSTRACT TRUNCATED AT 250 WORDS)     

超声、CT定量诊断脂肪肝与中医证型相关性的比较

目的:通过超声、CT对非酒精性脂肪肝的定量诊断,分析两者诊断的脂肪肝严重程度与中医证型的相关性。方法:选取非酒精性脂肪肝229例,分为肝郁脾虚、痰湿内阻、痰瘀互结、肝肾不足、湿热内蕴5个中医证型,同时进行轻、中、重度分级。应用超声与CT检查对脂肪肝进行定量诊断,分析脂肪肝程度与中医各证型的关系。结果:①各中医证型在2种检查方法定量诊断脂肪肝分级的分布结果,均显示肝郁脾虚证以轻度脂肪肝为主,肝肾不足证以重度脂肪肝为主,经χ2检验,各中医证型间的脂肪肝程度差异均有统计学意义(P0.01);②2种影像学方法诊断的轻中重度脂肪肝进行中医证型间的两两比较,其中肝郁脾虚证与痰瘀互结证、肝郁脾虚证与痰湿内阻证、肝郁脾虚证与肝肾不足证、肝郁脾虚证与湿热内蕴证、痰湿内阻证与肝肾不足证、肝肾不足证与湿热内蕴证的脂肪肝程度分级比较差异均有统计学意义(P0.001)。结果显示2种影像学方法的统计结果基本一致。结论:中医辨证分型与脂肪肝严重程度密切相关,对判断各证型脂肪浸润程度具有参考价值;提示超声、CT检查均可作为规范脂肪肝中医证型的可行方法。     

慢性阻塞性肺疾病气道病变的64层MSCT与肺功能的相关性研究

目的：探讨64层螺旋CT对慢性阻塞性肺疾病（COPD）气道病变的影像学改变与常规肺功能检查（PFT）的相关性。方法：选取COPD患者（男29例,女10例）及正常对照组（男34例,女11例）进行高分辨率CT（HRCT）和常规肺功能检查。CT扫描分别于深吸气末和深呼气末进行。观察COPD小气道异常的主要HRCT征象：马赛克灌注、呼气末空气潴留征、小叶中心型肺气肿、支气管扩张、支气管壁增厚。分析气道异常与PFT检查参数值的相关性。结果：①HRCT所见COPD与对照组的气道异常的发生率有显著性差异（P〈0.05）;②COPD患者HRCT显示小气道异常与PFT检查结果有相关性,主要表现为：支气管壁增厚、马赛克灌注、呼气末空气潴留征与残气容积/肺总量（RV/TLC）和最大呼气流率（MEF）相关（P值均〈0.05）,支气管扩张与一秒用力呼气容积（FEV1）、残气容积/肺总量（RV/TLC）相关（P〈0.05）,小叶中心型肺气肿与残气容积相关（P〈0.05）。结论：64层螺旋CT获取HRCT可用于COPD气道病变的诊断,HRCT显示COPD的气道异常征象与PFT指标相关。     

Texture-based quantification of pulmonary emphysema on high-resolution computed tomography: comparison with density-based quantification and correlation with pulmonary function test

PURPOSE: To develop a system for texture-based quantification of emphysema on high-resolution computed tomography (HRCT) and to compare it with density-based quantification in correlation with pulmonary function test (PFT). MATERIALS AND METHODS: Two hundred sixty-one circular regions of interest (ROI) with 16-pixel diameter [66 ROIs representing typical area of normal lung; 69 representing bronchiolitis obliterans (BO); 64, mild emphysema (ME); and 62, severe emphysema (SE)] were used to train the automated classification system based on the Support Vector Machine classifier and on variable texture and shape features. An automated quantification system was developed with a moving ROI in the lung area, which classified each pixel into 4 categories. To validate the system, the HRCT and standard-kernel-reconstructed volumetric CT data of 39 consecutive patients with emphysema were included. Using this system, the whole lung area was evaluated, and the area fractions of each class were calculated (normal lung%, BO%, ME%, SE%, respectively). The emphysema index (EI) of texture-based quantification was defined as follows: (0.3 x ME% + SE%) (TEI). EIs from density-based quantification with a threshold of -950 Hounsfield Units, were measured on both HRCT (DEI_HR_2D) and on volumetric CT (DEI_standard_3D). The agreement between TEI, DEI_HR_2D, and DEI_standard_3D was assessed using interclass correlation coefficients (ICC). Correlation of the results on the TEI with the PFT results was compared with the results of the DEI_standard_3D and the DEI_HR_2D with Spearman's correlation test. To evaluate the contribution of each texture-based quantification lesion (BO%, ME%, SE%) on PFT, multiple linear regression analysis was performed. RESULTS: The calculated TEI (19.71% +/- 17.98%) was well correlated with the DEI_standard_3D (19.42% +/- 14.30%) (ICC = 0.95), whereas the ICC with DEI_HR_2D (37.22% +/- 9.42%) was 0.43. TEI showed better correlation with PFT than DEI_standard_3D or DEI_HR_2D did [R = 0.71 vs. 0.67 vs. 0.61 for forced expiratory volume in 1 second (FEV(1))/forced vital capacity (FVC); 0.54 vs. 0.50 vs. 0.43 for diffusing capacity (DLco), respectively]. Multiple linear regression analysis revealed that the BO% and SE% areas were independent determinants of FEV(1)/FVC, whereas the ME% and the SE% were determinants of DLco. CONCLUSION: Texture-based quantification of emphysema using an automated system showed better correlation with the PFT results than density-based quantification. Separate quantification of the BO, ME, and SE areas showed a different contribution of each component to the FEV(1)/FVC and the DLco. The proposed system can be successfully used for detailed regional and global evaluation of lung lesions on HRCT scanning for emphysema.     

Assessment of lung volumes in pulmonary emphysema using multidetector helical CT: comparison with pulmonary function tests.

The purpose of this study is to evaluate the usefulness of multidetector helical CT (MDCT) with three-dimensional (3D) postprocessing for assessing the lung volume at inspiration and expiration of the pulmonary emphysema and for comparing it with pulmonary function tests. Percentage lung volume at the threshold of -930, -900, -810, -790, and -770 at expiration showed good correlation with FEV1, FEV1/FVC, and DLCO/Va. Excellent correlation was observed between percentage lung volume at the threshold of -900 and FEV1/FVC. CT densitometry at expiration showed better correlation than that at inspiration with pulmonary function tests. MDCT with 3D technique is useful for assessing the severity of pulmonary emphysema.     

COPD患者肺气肿程度对气道径线与肺功能相关性的影响

目的：定量分析肺气肿程度对气道径线及其与肺功能相关性的影响。方法对73例慢性阻塞性肺疾病(COPD)患者行呼气相 CT 扫描,测量肺气肿指数(LAA%)以及右肺上叶尖段(RB1)、右肺下叶后基底段(RB10)、左肺上叶尖后段(LB1)、左肺下叶后基底段(LB10)亚段支气管的气道径线,包括管壁厚度(WT),管壁厚度/气道直径(WT/AD),管壁面积比值(WA%);以 LAA%=15%为界限,将 COPD 患者分为2组,即轻度肺气肿组(34例)和重度肺气肿组(39例)。分别比较不同亚段支气管的轻度、重度肺气肿组 WA%、WT/AD、WT 与 FEV1%的相关性。结果除外 RB10亚段支气管的轻度肺气肿组中 WT 及重度肺气肿组的气道径线与 FEV1%无明显相关(P >0.05),其余各亚段支气管(RB1,LB1,LB10)的轻度肺气肿组气道径线指标与 FEV1%均呈负相关(r=-0.382~-0.799,P <0.05),均优于重度肺气肿组(r =-0.371~-0.687,P <0.05)。RB1、LB1、LB10气道径线均与FEV1%呈负相关,其中 RB1的气道径线与 FEV1%相关性最好;各亚段支气管中轻度肺气肿组气道径线与 FEV1%的相关性均优于重度肺气肿组。结论肺气肿的严重程度会影响气道径线与气流受限的相关性,在 COPD 患者的 CT 定量研究中,需将这一相互影响的过程考虑入内。     

64层螺旋CT肺容积成像在慢性阻塞性肺疾病中的诊断价值

目的 探讨64层螺旋CT肺容积扫描诊断慢性阻塞性肺疾病(COPD)的临床价值.资料与方法 COPD组87例,对照组29例,进行64层螺旋CT肺容积扫描和常规肺功能检查,两次检查时间间隔小于30d,研究CT肺容积参数与肺功能实验室指标之间的相关性,并采用ROC曲线分析CT肺容积参数对COPD诊断和分级的临床价值.结果 CT容积扫描获取的肺气肿容积比例与肺功能分级、RV(实际/预计％)、TLC(实际/预计％)、RV/TLC(％)、FEV1(实际/预测％)和FEV1/VC MAX(％)之间均存在显著相关(r分别为0.560,0.309,0.246,0.280,-0.522,-0.599,P均＜0.01):ROC曲线分析结果显示,全肺肺气肿容积比例、右肺肺气肿容积比例和左肺肺气肿容积比例诊断COPD的曲线下面积分别为0.863、0.822和0.917(P均＜0.01),差异有统计学意义.结论 CT测量的肺气肿容积与肺总容积之比和肺功能分级相关,对诊断COPD有预测意义.