间质性肺疾病高分辨率CT常见征象的超声特点

Transthoracic ultrasonographic features of typical high-resolution computed tomography signs of interstitial lung diseases

目的探讨床旁经胸超声(TLU)对间质性肺疾病(ILDs)不同胸部高分辨率CT(HRCT)征象鉴别的准确性。方法前瞻性纳入2016年1月至2018年12月北京朝阳医院首次诊断为ILDs的患者50例,其中男21例,女29例,年龄42~73岁,平均年龄(56±14)岁。TLU扫描前外侧胸部和后胸部共计16个扫描点,记录A、B线和胸膜异常;胸部HRCT按照上中下肺野选取3个层面,每个层面需要评估的范围与超声扫描的范围逐一对应,记录胸部HRCT的常见征象;ILDs早期病变定义为胸部HRCT评分≤1分并且没有蜂窝影。计算A、B线和胸膜异常与胸部HRCT征象的关系,Spearman相关系数评估B线和肺HRCT评分的相关性。结果A线诊断CT征象为正常的敏感度和特异度分别为83.9%和84.9%,符合率为84.6%。B线诊断CT征象为异常的敏感度和特异度分别为84.9%和83.9%,符合率为84.6%;小叶中心性结节影较其他HRCT征象B线数量更少、间距更窄,其他的HRCT征象B线无特异性表现;B线发现ILDs早期病变的敏感度和特异度分别为84.3%和83.9%,符合率为84.0%。B线数量(R=0.827,P<0.001)和宽度(R=0.951,P<0.001)与胸部HRCT评分呈明显的正相关关系,B线间距与胸部HRCT评分呈明显的负相关关系(R=-0.831,P<0.001)。肺部超声诊断胸膜病变的敏感度和特异度分别为100.0%和90.0%,符合率为93.6%。结论肺部超声诊断患者是否存在肺部间质性改变具有较高的敏感度和特异度,为临床早期诊断ILDs、评估病变严重程度和随诊治疗效果提供了新的思路,但未能发现肺部超声能够区分不同间质性病变。

Objective To investigate the accuracy of bedside transthoracic lung ultrasonography(TLU)in different typical high resolution computed tomography(HRCT)signs of interstitial lung diseases(ILDs).Methods Fifty patients first diagnosed with ILDs were enrolled from January 2016 to December 2018.There were 21 males and 29 females.The mean age was(56±14)years(rang 42-73 years).TLU was performed in inspiration for the characters of A-lines and B-lines as well as pleural at anterior,lateral and dorsal chest walls,respectively.HRCT was selected at three levels according to the upper,middle,and lower lung fields.The range of each level needing to be evaluated corresponded to the TLU scanning field one by one,and recording the signs of HRCT.Early change of ILDs was definite as the HRCT score was no more than 1 and no honeycomb was present.The correlation between A-lines,B-lines,pleural abnormal and HRCT signs was evaluted.Spearman′s correlation coefficient was used to evaluate the relationship between B-lines and HRCT score.Results The sensitivity and specificity of A-lines for HRCT normality were 83.9%and 84.9%,respectively.Coincidence rate was 84.6%.The sensitivity and specificity of B-lines for HRCT abnormality were 84.9%and 83.9%,respectively.Coincidence rate was 84.6%.Interlobular septal thickening shadow had fewer B-lines and narrower interval than other HRCT signs,while the other HRCT signs had no differences in B-lines.And the sensitivity and specificity of B-lines for detection the early change of HRCT in ILDs were 89.5%and 89.2%,respectively.Coincidence rate was 89.3%.A positive correlation was found between the number of B-lines and HRCT scores(R=0.827,P<0.001),and the width of B-lines and HRCT score(R=0.951,P<0.001).Meanwhile,a negative correlation was found between the interval of B-lines and HRCT score(R=-0.831,P<0.001).The sensitivity and specificity of TLU for HRCT pleural abnormality were 100.0%and 90.0%,respectively.Coincidence rate was 93.6%.Conclusions TLU showed high sensitivity and specificity in finding interstitial changes of the lung.It gives a new view on the diagnostic possibilities of ILDs and may be used to evaluate the severity and the therapeutic effect of treatment.However,TLU could not differentiate HRCT signs of ILDs.