尘肺病胸部CT重建图像圆形小阴影密集度评价方法的研究

Study on evaluation method of circular small shadow profusion in chest CT reconstruction images of pneumoconiosis

目的遴选尘肺病诊断用胸部CT图像模式,建立尘肺病胸部CT圆形小阴影密集度判定方法。方法于2021年4月,选择以圆形小阴影为主要表现的、具有同期数字化X线摄影技术(DR)胸片和胸部CT影像学资料的66例职业性尘肺病患者作为研究对象。采用1.5 mm、5 mm胸部CT轴位图像,1 mm、5 mm胸部CT冠状位多平面重组(MPR)图像,5 mm胸部CT冠状位最大密度投影(MIP)图像,观察尘肺病患者不同影像特征,并同DR胸片进行影像学比较分析,建立实验用胸部CT标准。对实验用胸部CT标准与GBZ 70-2015《职业性尘肺病的诊断》的密集度判定结果进行一致性验证。结果66例研究对象均为男性,尘肺壹期33例、尘肺贰期17例、尘肺叁期16例。观察66例研究对象五种胸部CT图像发现,不同模式胸部CT图像均能清晰显示和辨识圆形小阴影、大阴影、小阴影聚集、蜂窝状磨玻璃影、片状磨玻璃影、全肺均匀性低密度磨玻璃影、网格状磨玻璃影、索条状影、线状影、胸膜下棘突状影、胸膜下结节、各种肺气肿及肺纹理扭曲断裂等异常影像;小阴影聚集多伴有大阴影的出现;5 mm CT图像血管影延展性好,小结节影较易区分;5 mm胸部CT冠状位MIP图像使用了边缘增强技术,容易出现小阴影融合和纤维化影融合现象;5 mm胸部CT冠状位MPR图像在阅片的整体性上与DR胸片存在高度一致性。用GBZ 70-2015标准,对66例研究对象DR胸片与5 mm胸部CT冠状位MPR图像总体密集度进行比较,一致性检验Kappa值=0.64。用GBZ 70-2015标准和实验用胸部CT标准,分别对66例研究对象DR胸片和5 mm胸部CT冠状位MPR图像总体密集度判定结果进行比较,一致性检验Kappa值=0.80,具有高度一致性。结论5 mm冠状位MPR图像作为尘肺病诊断的胸部CT图像模式是适宜的;沿用GBZ 70-2015密集度判断标准片遴选路径和方法,建立的实验用胸部CT标准对尘肺病5 mm胸部CT冠状位MPR图像圆形小阴影总体密集度判定结果与GBZ 70-2015标准具有高度一致性。

ObjectiveTo select chest CT image patterns for the diagnosis of pneumoconiosis and establish a method for determining the profusion of circular small shadows in chest CT.MethodsIn April 2021,66 cases of occupational pneumoconiosis patients with digital radiography(DR)chest radiographs and chest CT imaging data with circular small shadow as the main manifestations were selected as the study objects.1.5 mm and 5 mm chest CT axial images,1 mm and 5 mm chest CT coronal multi-plane recombination(MPR)images,and 5 mm chest CT coronal maximum intensity projection(MIP)images were used to observe the different characteristics of pneumoconiosis patients,and were compared and analyzed with DR chest radiographs to establish the experimental chest CT standards.The consistency of the profusion results between the experimental chest CT standards and GBZ 70-2015 Diagnosis of Occupational Pneumoconiosis was verified.ResultsAll the 66 objects were male,including 33 cases of stageⅠpneumoconiosis,17 cases of stageⅡpneumoconiosis and 16 cases of stageⅢpneumoconiosis.By observing five chest CT images of 66 objects,we found that chest CT images of different modes could clearly display and identify abnormal images such as small circular shadow,large shadow,small shadow aggregation,honeycomb glass shadow,flake glass shadow,uniform low-profusion glass shadow,mesh glass shadow,cable shadow,linear shadow,subpleural spinous shadow,subpleural nodules,various kinds of emphysema and lung texture distortion and fracture.Small shadow aggregation was usually accompanied by the appearance of large shadow.The vascular shadows in 5 mm CT images had good ductility,and small nodules were easy to distinguish.The coronal MIP image of 5 mm chest CT used edge enhancement technology,which was prone to small shadow fusion and fibrotic shadow fusion.The coronal MPR image of 5 mm chest CT was highly consistent with the DR chest radiographs in terms of the integrity of film reading.GBZ 70-2015 standard was used to compare the profusion of DR chest radiographs and 5 mm chest CT coronal MPR images of 66 objects,and the consistency test Kappa=0.64.GBZ 70-2015 standard and experimental chest CT standard were used to compare the profusion results of DR chest radiographs and 5 mm chest CT coronal MPR images of 66 objects,respectively,and the consistency test Kappa=0.80,with high consistency.Conclusion5 mm coronal MPR image is suitable for chest CT imaging in the diagnosis of pneumoconiosis.Following the selection path and method of GBZ 70-2015 profusion criterion,the established experimental chest CT standard in determining the profusion of small circular shadows in 5 mm coronal MPR images of chest CT with pneumoconiosis has a high consistency with GBZ 70-2015 standard.