多模态影像学在职业性尘肺病诊断中的应用价值  

Value of multimodal imaging in diagnosis of occupational pneumoconiosis

作　　者：王子辰 胡茂能[1] WANG Zichen;HU Maoneng(Imaging Center,the Third Clinical College of Anhui Medical University,the Third People’s Hospital of Hefei,Hefei,Anhui 230022,China)

机构地区：[1]安徽医科大学合肥第三临床学院(合肥市第三人民医院)影像中心,安徽合肥230022

出　　处：《职业卫生与应急救援》2022年第3期323-326,共4页Occupational Health and Emergency Rescue

基　　金：安徽省重点研究与开发计划项目(1704f0804041);合肥市自主创新政策“借转补”资金项目(J2019Y06);合肥市学术技术带头人及后备人选科研项目(20211013-11)。

摘　　要：目的探讨多模态影像学在职业性尘肺病诊断中的应用价值。方法选取2018年6月—2021年3月就诊的160例职业性尘肺病患者为研究对象,所有对象均进行高千伏X线摄影(HKV)、数字化X线摄影(DR)、数字X线摄影联合双能量减影(DES)、高分辨率CT(HRCT)检查,比较4种检查方法对尘肺病患者诊断分期结果的一致性以及肺部合并症检出率,评估4种检查方法在尘肺病诊断中的诊断效能。结果HKV对尘肺病诊断具有中等一致性,HKV的Kappa=0.562(95%CI:0.471-0.652);DR、DES对尘肺病诊断结果均具有较高一致性,DR的Kappa=0.669(95%CI:0.584-0.753);DES的Kappa=0.750(95%CI:0.677-0.823);而HRCT对尘肺病诊断具有高度一致性,HRCT的Kappa=0.882(95%CI:0.829-0.935)(P均<0.01)。该4种检查方法对肺气肿、肺大泡、胸膜增厚、胸腔积液检出率不同(P<0.05),而对于肺结核的检出率差异无统计学意义(P>0.05)。HRCT对肺气肿、肺大泡、胸膜增厚、胸腔积液检出率高于其他3种方法(P<0.05)。结论4种检查方法在职业性尘肺病及其合并症诊断中均有一定的诊断效能,可联合应用以提高尘肺病诊断分期准确率。Objective To explore the value of multimodal imaging in the diagnosis of occupational pneumoconiosis.Methods A total of 160 patients with occupational pneumoconiosis who were hospitalized from June 2018 to March 2021were studied.All the subjects underwent high kilovolt radiography(HKV),digital radiography(DR),digital radiography combined with dual energy subtraction(DES)and high-resolution CT(HRCT).The consistency of the diagnostic staging results of these four examination methods for pneumoconiosis patients and the detection rates of pulmonary complications were compared,to evaluate the diagnostic efficacy of four methods in the diagnosis of pneumoconiosis.Results HKV had medium consistency in the diagnosis of pneumoconiosis with kappa of 0.562(95%CI:0.471-0.652);The diagnostic results of DR and DES for pneumoconiosis were highly consistent with kappa of 0.669(95%CI:0.584-0.753)and0.750(95%CI:0.677-0.823),respectively;HRCT was highly consistent in the diagnosis of pneumoconiosis with kappa of 0.882(95%CI:0.829-0.935)(P<0.01).The detection rates of emphysema,bullae,pleural thickening and pleural effusion by these 4 methods were different(P<0.05),while there was no significant difference in the detection rates of pulmonary tuberculosis(P>0.05).The detection rates of emphysema,bullae,pleural thickening and pleural effusion by HRCT were higher than that by the other three methods(P<0.05).Conclusions These four methods have certain diagnostic efficacy in the diagnosis of occupational pneumoconiosis and its complications,and can be combined used to improve the accuracy of diagnosis and staging of pneumoconiosis.

关 键 词：职业性尘肺病 诊断 影像学 高千伏X线摄影 数字化X线摄影 数字X线摄影联合双能量减影 高分辨率CT 一致性 

分 类 号：R135.2[医药卫生—劳动卫生]