Quantitative CT parameters of different lung lobe segmentation in assessment of chronic obstructive pulmonary disease
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摘要:
目的:研究肺叶定量CT参数在慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)病情评估中的意义。方法:纳入102例行胸部CT及肺功能检查的稳定期COPD患者。肺功能检测指标包括用力肺活量(forced expiratory volume,FVC)及其占预计值百分比(FVC%pred)、第1秒用力呼气容量(forced expiratory volume in one second,FEV1)及其占预计值的百分比(FEV1%pred)、第1秒率(FEV1/FVC)、最大分钟通气量(maximum ventilatory volume,MVV)及其占预计值百分比(MVV%pred)、最大呼气中期流量(maximum mid expiratory flow,MMEF)。测量CT图像中各肺叶低于-950 HU密度区容积百分比(low attenuation area percentage,LAA%)、分段肺叶主气道直径、分段肺叶主气道壁厚度,并进行统计学分析。结果:定量CT参数与肺通气功能指标呈线性负相关(P<0.001);左肺下叶LAA%取值13.5%时,预测MVV%pred<50%和FEVI%pred<50%的灵敏度分别为66.2%、75.0%,特异度为88.4%、81.0%;左肺下叶气道壁厚度预测FEV1%pred<50%的截点值为3.35 mm,其灵敏度和特异度分别为60.5%、72.9%;LAA%联合气道测量值可以解释42%的FEV1%pred,52%的FEV1/FVC,31%的MMEF和35%的MVV%pred指标的变化。结论:COPD患者不同肺叶的定量CT参数能反映其肺功能的变化,并能预测气流受限的严重程度。
Abstract:
Objective:This study aims to investigate the significance of lung lobe quantitative CT parameters in assessment of chronic obstructive pulmonary disease(COPD). Methods:Total 102 patients with stable COPD were recruited,and performed with chest CT scan and pulmonary function tests. The indexes of pulmonary function include forced expiratory volume(FVC) and predicted value percentage(FVC%pred),forced expiratory volume in one second(FEV1) and predicted value percentage(FEV1% pred),first second rate(FEV1 / FVC),maximum ventilation volume (MVV) and its percentage in the expected value(MVV% pred),maximum mid expiratory flow(MMEF). The percentages of low attenuation area below -950 HU(LAA%)and airway dimensions in each lung lobe segments were measured quantitatively. Results:Parameters of pulmonary ventilation function were linear negatively correlated with airway indicators(P < 0.001). When LAA% of left lower lobe was 13.5%,the sensitivity in prediction of MVV% pred <50% and FEV1%pred <50% was 66.2% and 75.0%,specificity was 88.4% and 81.0%,respectively. Wall thickness of 3.35 mm in left lower lobe had 60.5% sensitivity and 72.9% specificity in the prediction of FEV1 <50%. LAA% combined with airway variables could account for proportional changes in FEV1%pred of 42%,FEV1/FVC of 52%,MMEF of 31%,and MVV%pred of 35%,respectively. Conclusion:Quantitative CT parameters of different lung lobe can reflect deterioration of lung function in patients with COPD,and can be applied to predict the severity of airflow limitation.