多层螺旋CT低剂量扫描对阻塞性肺疾病分级定量测量的初步研究  

Primary study of quantitative measurement in different grades of COPD using low-dose multislice CT

作　　者：李一鸣[1] 尹建忠[2] 杨文杰[3] 谭政帅[1] 

机构地区：[1]扬州市第一人民医院影像科,225001 [2]天津市第一中心医院放射科 [3]天津市第一中心医院呼吸科

出　　处：《国际医学放射学杂志》2012年第5期413-417,429,共6页International Journal of Medical Radiology

摘　　要：目的探讨慢性阻塞性肺疾病(COPD)病人右肺上叶尖段支气管在多层螺旋CT(MSCT)上行气道测量的可行性以及各级别COPD支气管和肺密度的变化。方法随机选取COPD病人15例,采用MSCT行胸部低剂量CT平扫,重组并评价右肺上叶尖段支气管气道壁厚度与直径的比率(TDR)和气道壁面积百分比(WA%),并与每例病人随机选择的内径<2mm支气管的平均TDR和平均WA%进行比较。统计学分析采用t检验和Pearson检验。另外随机选择COPD病人55例,根据肺功能检查按慢性阻塞性肺疾病诊治指南(2007年修订版)标准分为4组,其中COPD 1级16例,2级16例,3级14例,4级9例。同时选取非胸部病变病人15例作为对照组。5组病人均行MSCT低剂量吸气相全肺扫描,测量平均肺密度(MLA)、体素指数(VI)、右肺上叶尖段支气管管腔面积(Ai)、TDR和WA%,并进行比较。统计学分析采用One-Way ANOVA单因素方差分析。结果①右肺上叶尖段支气管所测得的TDR和WA%与小气道测量结果的平均值存在差异,但具有良好的相关性(r分别为0.793和0.784)。②各组病例所测得的MLA随COPD分级的增高呈逐渐减低趋势,VI则逐渐增高;但相邻两级之间差异不具有统计学意义;3、4级病例的Ai减小;除3级与4级外,相邻两级病人所测得的TDR差异不具有统计学意义;各组之间WA%差异均具有统计学意义。结论右肺上叶尖段支气管所测得的TDR和WA%与小气道测量结果的平均值存在良好的相关性。WA%是反映气道重塑、管腔狭窄最敏感的指标。Objective To study the feasibility of airway measurement at the trunk of apical bronchus of right upper lobe in chronic obstructive pulmonary disease （COPD）, and airway dimensions and lung density changes in different COPD stages. Methods 1） Fifteen randomly selected COPD patients underwent low-dose chest multi-slice CT scan. The wall thickness-to-diameter ratio （TDR） and percentage wall area （WA%） at apical bronchus of right upper lobe section, and mean TDR and WA% of small airway （〈2 mm） were calculated. 2） Another fifty-five randomly selected COPD patients were divided into 4 groups on the basis of pulmonary function tests. There were sixteen patients with grade 1, sixteen patients with grade 2, fourteen patients with grade 3, and nine patients with grade 4. Fifteen non-COPD patients were selected as controls. The total lung was scanned with low-dose multi-slice CT during inspiration. The mean lung attenuation （MLA） and voxel index （VI） were measured. Inner area of bronchus （A.~, TDR and WA% of the apical bronchus of right upper lobe were measured. Results 1） The TDR of the apical bronchus of right were smaller than the mean TDR of the small airways; The WA% of the apical bronchus of right were larger than the mean WA% of the small airways; but there were good correlation （r=0.793 and 0.784, respectively）. 2） The MLA values were decreased with increase of COPD stage. The VI values were increased with increase of COPD stage. However, the values did not differ between adjacent stages. The luminal areas of stage 3-4 patients were smaller than that of other stages. There was no statistics difference in TDR between adjacent groups, except between stages 3 and 4. For WA%, the higher stage group had higher WA%. Conclusion There were good correlations for TDR and WA% between the apical bronchus of right upper lobe and small airway. WA% is the most sensitive index for detecting thickened airway.

关 键 词：体层摄影术 X线计算机 低剂量 支气管 阻塞性肺疾病 

分 类 号：R563[医药卫生—呼吸系统]