呼气相薄层CT诊断异基因造血干细胞移植术后气体潴留及预测闭塞性细支气管炎综合征

Expiratory thin-section CT in evaluation of air-trapping and predicting bronchiolitis obliterans syndrome for patients afterallogeneic hematopoietic stem cell transplantation

目的探讨造血干细胞移植术后闭塞性细支气管炎综合征(BOS)最佳呼气相薄层CT气体潴留评估方法。方法采用三层五分法及视觉评估法两种阅片方法回顾性分析29例造血干细胞移植术后BOS患者呼气相薄层CT表现,对比呼气相薄层CT气体潴留影像学评分对于气体潴留的诊断价值和视觉评估法、三层五分法及肺功能检查(PFTs)3种方法对于BOS的早期预测价值。结果 PTTs分级:17例BOS0,7例BOS-p,2例BOS1,1例BOS2,2例BOS3,PFTs预测BOS发生的敏感度为41.38%(12/29)。三层五分法ROC曲线下面积(0.566)大于视觉评估法(0.485)。三层五分法评估的敏感度为25.00%(3/12),特异度为82.35%(14/17),阳性预测值(PPV)为50.00%(3/6),阴性预测值(NPV)为60.87%(14/23),预测BOS的敏感度为55.17%(16/29);视觉评估法敏感度为41.67%(5/12),特异度为58.82%(10/17),PPV为41.67%(5/12),NPV为58.82%(10/17),预测BOS的敏感度为79.31%(22/29)。结论对于诊断气体潴留,三层五分法的价值大于视觉评估法;对早期预测BOS,视觉评估法的预测价值最高,三层五分法次之,PFTs最小。

Objective To explore the optimal assessment method of expiratory thin-section CT in assessment of air-trapping and predicting bronchiolitis obliterans syndrome （BOS） in patients after hematopoietic stem cell transplantation （HSCT）. Methods Five-point scale method and visual method were retrospectively used to analyze expiratory thin-section CT radiological findings in 29 patients after HSCT and diagnosed as BOS. These two methods were evaluated according to air trapping, and the predictive value of 5-point scale method, visual method and pulmonary function tests （PFTs） were compared. Results PFTs showed BOS0 in 17, BOS-p in 7, BOS1 in 2, BOS2 in 1 and BOS3 in 2 patients, with the long-term BOS predictive sensitivity of 41.38% （12/29）. The area under the ROC curve of five-points scale method （0.566） was larger than that of visual method （0.485）. When 5-point scale method was used, the sensitivity was 25.00% （3/12）, specificity was 82.35% （14/17）, PPV was 50.00% （3/6） and NPV was 60.87% （14/23）, while the sensitivity of prediction to BOS was 55.17% （16/29）. When the visual evaluation method was used, the sensitivity was 41.67% （5/12）, specificity was 58.82% （10/17）, PPV was 41.67% （5/12） and NPV was 58.82% （10/17）, while the sensitivity of prediction to BOS was 79.31% （22/29）. Conclusion Five-point scale method has a higher diagnosis value than visual method. While visual evaluation method has the strongest prediction ability, visual method medium and PFTs have weak prediction ability for early BOS.