高分辨率CT视觉评分及定量分析评估成人肺朗格汉斯细胞组织细胞增生症的价值

The value of high-resolution CT visual scoring and quantitative analysis for the assessment of pulmonary Langerhans cell histiocytosis in adults

目的探讨胸部高分辨率CT(HRCT)视觉评分及定量分析评估成人肺朗格汉斯细胞组织细胞增生症(PLCH)的价值。方法回顾性分析2014年8月至2021年12月北京协和医院经病理组织学证实的51例成人PLCH患者的胸部HRCT及肺功能检查资料。由2名影像医师采用主观视觉评分法评估患者HRCT图像中结节、囊腔病变累及范围,并根据不同评分将结节病变分为3组,囊腔病变分为4组。应用全自动后处理软件,三维定量分析肺部低衰减区容积占全肺总容积比例(LAA%)。肺功能的评估指标包括第1秒用力呼气容积(FEV_(1))、用力肺活量(FVC)、FEV_(1)/FVC、肺一氧化碳弥散量(D_(L)CO)、肺泡通气量(V_(A))、D_(L)CO/V_(A)、校正后肺一氧化碳弥散量(D_(L)COc)、D_(L)COc/V_(A);除FEV_(1)/FVC为实测值外,其他指标均采用实测值占预计值百分比(%pred)表示。采用Spearman秩相关性分析病变主观视觉评分、LAA%与肺功能检查各指标的相关性。采用Kruskal-Wallis非参数检验对结节和囊腔病变不同评分组的肺功能指标进行分析。结果51例患者HRCT图像均可见结节和囊腔病变。HRCT结节病变视觉评分与肺功能指标无相关性(P>0.05),不同结节评分组间比较肺功能指标差异均无统计学意义(P>0.05)。囊腔病变视觉评分与FEV_(1)/FVC、D_(L)CO%pred、D_(L)CO/V_(A)%pred、D_(L)COc%pred、D_(L)COc/V_(A)%pred呈负相关(r=-0.491、-0.347、-0.330、-0.373、-0.346,P<0.05),且不同囊腔病变组肺功能指标差异均有统计学意义(P<0.05)。LAA%与FEV_(1)/FVC、D_(L)CO%pred、D_(L)CO/V_(A)%pred、D_(L)COc%pred、D_(L)COc/V_(A)%pred呈负相关(r=-0.278、-0.378、-0.418、-0.395、-0.451,P<0.05)。结论PLCH患者HRCT结节病变视觉评分与肺功能无相关性,囊腔病变视觉评分及定量分析可一定程度评估患者肺通气及弥散功能的损害程度。

Objective To explore the value of high-resolution CT(HRCT)visual scores and quantitative analysis in assessing pulmonary Langerhans cell histiocytosis(PLCH)in adults.Methods In total 51 adult patients with PLCH confirmed by pathology in Peking Union Medical College Hospital from August 2014 to December 2021 were retrospectively analyzed.All patients underwent HRCT and pulmonary function tests(PFT).The involvement of the nodular and cystic lesions were evaluated by two experienced radiologists using CT visual scores.The cases were divided into three groups based on the nodular scores,and into four groups based on the cystic scores,respectively.Ratio of low attenuation areas(LAA%)was measured by an automatic post-processing software.Pulmonary function indices including forced expiratory volume in the first second(FEV_(1)),forced vital capacity(FVC),FEV_(1)/FVC,diffusion capacity for carbon monoxide of lung(D_(L)CO),alveolar ventilation(V_(A)),D_(L)CO/V_(A),D_(L)CO corrected for hemoglobin(D_(L)COc),D_(L)COc/V_(A)were collected.FEV_(1)/FVC was expressed as measured values and other indices were expressed as percent predicted(%pred).Spearman correlation analysis was used to evaluate the correlation between HRCT visual scores,LAA%and PFT.The lung function indices among different nodular groups as well as among different cystic groups were compared using the Kruskal‐Wallis test.Results Both nodular and cystic lesions were found on HRCT images of all 51 patients.There were no correlation between the visual scores of nodular lesions and lung function indices(all P>0.05).There were no significant differences in lung function indices among different nodular groups(all P>0.05).The visual scores of cystic lesions were negatively correlated with FEV_(1)/FVC,D_(L)CO%pred,D_(L)CO/V_(A)%pred,D_(L)COc%pred,D_(L)COc/V_(A)%pred(r=-0.491,-0.347,-0.330,-0.373,-0.346,respectively,all P<0.05);the pulmonary function indices among different cystic groups had significant difference(all P<0.05).LAA%were negatively correlated with FEV_(1)/FVC,D_(L)CO%pred,D_(L)CO/V_(A)%pred,D_(L)COc%pred,D_(L)COc/V_(A)%pred(r=-0.278,-0.378,-0.418,-0.395,-0.451,respectively,all P<0.05).Conclusion HRCT visual scores of nodular lesions do not correlate with lung function in patients with PLCH.Visual scores and quantitative analysis of the cystic lesions can reflect the impairment degree of pulmonary ventilation and diffusion function to a certain extent,and may be used in assessment of patients with PLCH.