职业性尘肺病患者胸部CT与DR影像小阴影形态对比分析  

Comparative analysis of small shadow morphology between chest CT and DR images of patients with occupational pneumoconiosis

作　　者：李忠学[1] 赵夏姿 汤永中 黎乾昌 黄世文[1] 李菲菲 李小萍[1] 丘坤海 LI Zhongxue;ZHAO Xiazi;TANG Yongzhong;LI Qianchang;HUANG Shiwen;LI Feifei;LI Xiaoping;QIU Kunhai(Guangxi Zhuang Autonomous Region Institute of Occupational Disease Prevention and Control,Nanning,Guangxi 530021,China)

机构地区：[1]广西壮族自治区职业病防治研究院,广西南宁530021

出　　处：《中国职业医学》2024年第3期303-307,共5页China Occupational Medicine

基　　金：广西医疗卫生适宜技术开发与推广应用项目(S201912,S2019113)。

摘　　要：目的 比较职业性尘肺病(以下简称“尘肺病”)小阴影形态在计算机断层扫描(CT)与数字化X射线摄影(DR)影像表现的差异。方法 采用判断抽样法,选择1 010例尘肺病患者为研究对象,对其分别进行胸部DR影像和CT影像检查,比较2种影像在小阴影形态表现的差异。结果 研究对象DR和CT影像均检出p、q、r圆形小阴影者分别占76.2%、11.5%和1.3%,均检出不规则小阴影者占1.8%;2种影像学检查对上述4种小阴影形态的检出具有中高度一致性(Kappa值=0.72,P<0.01)。CT影像中,不规则小阴影[包括小叶间隔增厚、磨玻璃影和(或)小叶中心型肺气肿]征像的检出率为54.0%(545/1 010);其中,88.6%(483/545)合并有圆形小阴影。CT影像中不规则小阴影在DR影像中多数被判定为圆形小阴影p影,占88.8%(484/545)。DR和CT影像对于圆形小阴影p/p、p/q、q/p、q/q、q/r、r/q和r/r的判断结果具有中高度一致性(Kappa值=0.52,P<0.01)。结论 CT和DR影像对于尘肺病小阴影的判断具有中高度一致性;CT影像在不规则小阴影判定方面更具优势。CT影像对圆形小阴影形态可沿用DR影像的描述,对不规则小阴影可用小叶间隔增厚、磨玻璃影和(或)小叶中心型肺气肿等描述。Objective To compare the morphology differences in small shadows of occupational pneumoconiosis(hereinafter referred to as"pneumoconiosis")between computed tomography(CT)and digital radiography(DR)imaging.Methods A total of 1010 pneumoconiosis patients were selected as the research subjects using a judgment sampling method.Chest DR imaging and CT imaging were performed on patients,and the differences in small shadow morphology between the two images were compared.Results In both DR and CT images of patients,circular small shadows identified as p,q,and r shapes accounted for 76.2%,11.5%,and 1.3%,respectively,while irregular small shadows were identified in 1.8%of cases.There was medium high consistency between DR and CT in detecting these four types of small shadow morphology(Kappa=0.72,P<0.01).The detection rate of irregular small shadows(including interlobular septal thickening,ground-glass opacity,and/or centrilobular emphysema)by CT images was 54.0%(545/1010),with 88.6%(483/545)of these cases also showing small circular shadows.Irregular small shadows in CT images were mostly identified as p small circular shadows in DR images,accounting for 88.8%(484/545).The results of DR and CT images for p/p,p/q,q/p,q/q,q/r,r/q and r/r in small circular shadows showed medium high consistency(Kappa=0.52,P<0.01).Conclusion The results of CT and DR imaging for pneumoconiosis with small shadow were of medium high consistency,with CT demonstrating advantages in detecting irregular small shadow morphology of pneumoconiosis.CT images can be used to describe the shape of circular small shadow as DR images,and irregular small shadow can be described as interlobular septal thickening,ground-glass opacity,and/or centrilobular emphysema.

关 键 词：尘肺病 小阴影 形态 数字化X射线摄影 计算机断层扫描 一致性 

分 类 号：R135.2[医药卫生—劳动卫生]