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.
