粉尘作业者肺部小阴影的高千伏胸片与高分辨率CT对比研究

A Comparative Study on Small Opacities in High Kilovoltage Plain Chest Film Radiography versus HRCT Scan Taken from Workers Exposed to Occupational Dusts

[目的]比较高分辨率CT(HRCT)和高千伏胸片对粉尘接触者肺部小阴影的显示能力。[方法]对137例(男性125例,女性12例)HRCT和高千伏胸片资料完整者的影像学资料进行回顾性分析。其中,接触焊尘者56例,接触矽尘者37例,接触其他粉尘(包括铝尘、炭黑、水泥等)者44例。HRCT采用2mm层厚、10mm间隔从肺尖至膈肌扫描,采用-700HU/1500HU的窗位/窗宽进行摄片和观察。HRCT和高千伏胸片在不知晓职业史的前提下分别进行读片。对胸片和HRCT评估获得的各肺区小阴影的密集度进行一一比较,并对小阴影总体密集度进行比较。[结果]HRCT对小阴影总体密集度的评估与胸片评估密切相关(r=0.655,P<0.01),但HRCT对小阴影的评估分辨率高于胸片(P<0.01)。115例HRCT显示小阴影,其中s影86例,p影5例,p/s影8例,s/p影15例,q影1例。86例胸片显示小阴影,其中s影25例,p影5例,p/s影28例,s/p影24例,q/p影3例,q/s影2例。86例胸片显示小阴影的工人中6例HRCT显示正常。50例胸片无小阴影的工人中,34例(68%)HRCT显示异常小阴影。HRCT显示了上肺区及背部小阴影的分布优势。[结论]胸部HRCT在小阴影早期检测方面可弥补胸片的不足,对于准确评估小阴影有一定价值。

[Objective] To compare the ability to present small opacities on high kilovoltage plain chest film versus high-resolution computed tomography（HRCT）.[Methods]A retrospective analysis was conducted on HRCT and high kilovoltage plain chest films performed in 137 workers（125 males and 12 females） who were exposed to dust occupationally [arc welding fumes,n=56;SiO2 dust,n=37;other dusts（aluminum,graphite,cement,etc.）,n=44].HRCT examination consisted of a series of 2-mm-thick sections with 10-mm intersection spacing from the apex of lungs to the diaphragm.All images were photographed and observed at window widths of 1 500HU and levels of-700HU.The profusion of small opacities on chest radiography was compared with that on HRCT.CT and radiographic profusion total scores were also compared.[Results] There was a correlation between HRCT and radiography in the profusion scores of small opacities（r=0.655,P0.01）.HRCT showed a higher ability to present small opacities than high kilovoltage plain chest film（P0.01）.The HRCT scans found 115 cases with small opacities（type s=86;type p=5;type p/s=8;type s/p=15;type q=1）,while the chest radiography saw 86 cases with small opacities（type s=25;type p=5;type p/s=28;type s/p=24;type q/p=3;type q/s=2）.When the chest radiographs showed small opacities（n=86）,6 cases showed no abnormality on HRCT（7%）.While the chest radiographs were normal in 50 cases,small opacities were detected on HRCT in 34 cases（68%）.The upper and posterior lung predominance of small opacities was obvious on HRCT.[Conclusion]The chest HRCT is complementary to plain radiography for better early detection of small opacities,and therefore possesses good diagnostic value for accurately evaluating small opacities.