CT和高分辨CT对煤工尘肺小阴影和阴影融合及肺气肿诊断的价值

Exploration of the early detection of lung parenchyma micronodules, nodule coalescence and emphysema by CT and HRCT in coal miners with and without coal-worker＇s pneumoconiosis evidence

目的 探讨CT和高分辨CT（HRCT）早期检测煤工尘肺小阴影、阴影融合与肺气肿的敏感性和准确性.方法 77例煤工尘肺患者、36例无尘肺煤工和37例健康非煤工接受多层螺旋CT机无间隔胸部容积扫描及HRCT扫描,对所获得的CT图像进行煤工尘肺小阴影密集度分级、平均肺密度值和肺气肿指数测定,并与其X线胸片诊断结果对照.结果 对77例煤工尘肺患者CT和HRCT诊断的尘肺小阴影密集度分级与X线胸片尘肺分期一致性较好（Kappa=0.771,P＜0.01）.CT和HRCT诊断尘肺的敏感性达到98.70％,在X线胸片确诊的77例煤工尘肺患者中,CT和HRCT评估76例为煤工尘肺,可疑1例.CT和HRCT从36例X线胸片无尘肺煤工中检出8例（22.22％）达到小阴影密集度1级；从73例Ⅰ～Ⅱ期煤工尘肺患者中,检出26例（35.62％）阴影密集度≥3级,其中3级密集度阴影20例,4级密集度阴影6例；对4例X线胸片Ⅲ期煤工尘肺患者,CT和HRCT与X线胸片诊断结果相同.从113例煤工中,X线胸片检出肺气肿7例（6.19％）,CT检出36例（31.86％）.CT尘肺小阴影密集度1～2级组的CT平均肺密度值最高,明显高于健康对照组、无尘肺组和小阴影密集度4级组,差异有统计学意义（F1=-45.73、F2=-23.00和F3=57.72,P＜0.01或P＜0.05）.结论 从多层螺旋CT获得的CT和HRCT影像,与X线胸片比较,对煤工尘肺小阴影、阴影融合与肺气肿识别的敏感性和准确性均较高,可为煤工尘肺及其并发症的早期诊断提供更先进的手段.

Objective To explore the sensitivity and accuracy of CT and HRCT in early detection of coal-worker＇s pneumoconiosis（CWP）associated micronodules,nodule coalescence and emphysema from coal miners with and without radiographic CWP evidence.Method Continuously Thorax-Vol.CT scanning and High resolution CT scanning were performed on 1 13 coal miners with or without radiographic CWP evidence and 37 health controls by the use of Multi Spiral Computed Tomography（MSCT）.The CT and HRCT images were evaluated for lung parenchyma opacity profusion category,nodule coalescence,emphysema index and mean lung attenuation,and then compared with that on radiographs.Result Good agreement for CWP associated opacity profusion grading was achieved between radiographs and CT scans（Kappa=0.771）.The sensitivity of CT and HRCT were 98.70% for CWP diagnosis when compared with radiographs.8（22.22%）cases out of 36 radiographic CWP negative coal miners were categorized as grade 1 opacity profusion in consistent with CWP on CT and HRCT scans,and 26（35.62%）cases out of 73 radiographic grade 1～2 CWP patients were detected to have at least grade 3 nodular profusion on CT and HRCT scans.Among 113 coal miners,36（31.86%）were recognized as emphysema positive on CT; whereas only 7（6.19%）on radiographs.According to CT opacity profusion grading,mean lung attenuation in coal miners with grade 1～2 opacity profusion classification was significantly increased than that in health control,CWP negative coal miner and grade 4 opacity profusion groups（F1=-45.73,F2=-23.00 and F3=52.72,P〈0.01 and P〈0.05）.Conclusion CT and HRCT acquired from MSCT showed high sensitive and accurate for the early detection of micronodules,nodule coalescence and emphysema in coal miners.It could be used as semi-quantitative and quantitative method in early diagnosis of CWP and its complications. Keywords：Tomography, X-ray computed; Pneumoconiosis; Pulmonary emphysema