螺旋CT在支气管扩张症诊断中的应用研究

Spiral CT : Clinical application in diagnosis of bronchiectasis

目的 :评价螺旋 CT在肺段水平诊断支气管扩张症 (支扩 )的价值。 方法 :对 30例临床和 X线疑为支扩的患者共5 40个肺段分别进行 10 m m层厚和薄层 (1～ 3mm )螺旋 CT扫描 ,其中 10例共 180个肺段与支气管造影进行了比较。两位观察者用盲法对不同层厚的螺旋 CT扫描和支气管造影进行评价。 结果 :根据诊断标准并计算 kappa值 ,两位观察者对支扩评价的一致性很好 (к值分别为 0 .96 ,0 .98)。以支气管造影为金标准 ,螺旋 CT 10 m m层厚扫描诊断支扩的敏感性、特异性、准确性分别为 6 4.6 %、10 0 %、90 .1% ;薄层螺旋 CT诊断支扩的敏感性、特异性、准确性分别为 93.8%、10 0 %和 98.3%。 结论 :与HRCT相比 ,薄层螺旋 CT扫描对诊断支扩有更大的优越性 ,对临床疑支扩的患者 ,应首选螺旋 CT检查。

Objective To evaluate the diagnostic value of spiral CT in bronchiectasis at segmental level. Methods Both slice thickness 10mm and 1mm 3mm spiral CT scans were obtained in 30 patients (540segments) with clinical symptoms suggestive of bronchiectasis. Bronchography was performed in 10(180 segments) of 30 patients . Two observers evaluated 30 cases (540 segments) on spiral CT and 10 cases (180 segments) on bronchography independently. Results Bronchiectasis was noted in 90 and 94 segments (10mm section CT scan ) and 108 and 110 segments (thin section CT scan) by two observers in 30 patients (540 segments). Agreements between the two observers were expressed as a к coefficient , к= 0.96 , 0.98 . Compared with bronchography , on thin section spiral CT scans the sensitivity is 93.8% , specificity is 100% ,accuracy is 98.3% ; On the slice thickness 10 mm spiral CT scans the sensitivity is 64.6%, specificity is 100%, accuracy is 90.1%. Conclusion Spiral CT thin section scans can improve CT depiction of bronchiectasis and should be the first choice of the diagnostic methods for the patients with bronchiectasis suspected .