CT及高分辨率CT对煤工尘肺大阴影的诊断价值及临床应用

Diagnostic value and clinical application of CT/HRCT for coal workers' pneumoconiosis with large opacities

目的探讨CT/高分辨率CT(CT/HRCT)对煤工尘肺(CWP)大阴影的诊断价值。方法对62例CWP作胸部CT/HRCT扫描,并与X线胸片进行比较。结果62例CWP X线胸片检出大阴影19例,检出率为30.6%,共检出大阴影30个;CT/HRCT检出大阴影者43例,检出率为69.4%,共检出大阴影123个。CT/HRCT较X线胸片多检出大阴影93个(4.1倍)。2种检查方法的大阴影检出率比较,差异有统计学意义(x^2=18.58,P<0.01)。无一例X线胸片上显示大阴影而CT/HRCT未能显示者。62例CWP X线胸片检出Ⅲ期大阴影(≥1.0 cm×2.0 cm)者17例,检出率为27.4%,共检出Ⅲ期大阴影27个;CT/HRCT检出Ⅲ期大阴影34例,检出率为54.8%,共检出Ⅲ期大阴影67个,CT/HRCT比X线胸片多检出Ⅲ期大阴影40个,2种检查方法的大阴影检出率比较,差异有统计学意义(x^2=9.63,P<0.01)。CT/HRCT对大阴影的形态、内部结构、边缘特征、尘肺微细病变及特殊位置的大阴影均具有良好的显示能力。结论CT/HRCT在复杂性尘肺的诊断能力明显优于X线胸片,可检出X线胸片所不能发现的大阴影,可作为尘肺的一种重要而有实用价值的辅助检查手段。

Objective To study the diagnostic value of CT/HRCT for the coal workers＇pneumoconiosis （CWP） with large opacities. Methods Sixty-two patients with CWP were examined with both chest radiograph and CT/HRCT scan. Comparison was done. Results Large opacities were found in 19 patients in the chest radiograph of 62 patients with CWP. The detection rate was 30.6%. Thirty large opacities were found using chest radiograph. Forty-three patients with large opacities were found using the CT/HRCT. The detection rate was 69.4%. One hundred and twenty-three large opacities were found using CT/HRCT. Ninety-three more large opacities were found by CT/HRCT than by chest radiograph. The total detection rate of large opacities by CT was 4.1 times than by chest radiograph. Both differences were statistically significant （Χ^2=18.58, P〈0.01）. CT/HRCT found all patients with large opacities detected in the chest radiograph. Seventeen patients with Stage Ⅱ large opacities （≥1.0 cm×2.0 cm） were found by the chest radiograph. The detection rate was 27.4% （17/62）. Twenty-seven large opacities were found using chest radiograph. Thirty-four patients with Stage Ⅱ large opacities were found using the CT/HRCT. The detection rate was 54.8%. The found Stage Ⅱ large opacities added up to 67. The found Stage Ⅱ large opacities by CT/HRCT were 40 more than using chest radiograph. Both differences were statistically significant （Χ^2=9.63, P〈0.01）. CT/HRCT was reliable to show the morphology, the inside structure, the tiny lesion and the special location of the large opacities of CWP. It could provide more important information for differential diagnosis. Conclusion CT/HRCT is significantly better than the chest radiograph in the diagnosis of complicated CWP. It can find the large opacities that the chest radiograph can not. It has a great diagnostic and practical value as an assistant examination method. CT/HRCT could be considered as the reference and evidence for staging progression in diagnosis of pneumoconiosis.