摘要
目的探讨尘肺病CT肺区小阴影密集度判定方法及参考片的应用价值。方法回顾性分析2016年1月至2019年12月在安徽省铜陵市立医院接受职业体检的安徽省铜陵市某大型铜业公司244名职工的胸部影像资料。244名受检者同期接受胸部CT扫描及胸部DR摄片。观察并比较CT与DR图像显示小阴影形态和大小(肺区圆形和类圆形结节状影大小以p、q、r表示,不规则形小阴影大小以s、t、u表示)、总体密集度、各肺区小阴影密集度、大阴影、诊断分期的情况。其中CT各肺区小阴影密集度情况采用CT肺区小阴影密集度判定方法及参考片判断,其他观察指标参照GBZ70-2015《职业性尘肺病的诊断》判断。结果CT与DR判断s型小阴影和无小阴影时差异具有统计学意义(P<0.05),判断p、q、r、t、u型小阴影时差异无统计学意义(P>0.05)。CT与DR对小阴影总体密集度判断具有中高度一致性(Kappa=0.692,P=0.001),诊断符合率为82.38%(201/244)。CT与DR在右上、右下、左上、左中、左下肺区显示的小阴影密集度具有中高度一致性(Kappa为0.40~0.75,P<0.05),在右中肺区一致性较差(Kappa=0.381,P=0.001)。DR检出8例11个大阴影,CT检出23例31个大阴影,CT较DR多检出20个(8.20%)大阴影。CT与DR对矽肺诊断分期一致性极好(Kappa=0.843,P=0.001),诊断符合率为91.80%(224/244)。结论应用尘肺病CT肺区小阴影密集度判定方法及参考片,结合GBZ70-2015《职业性尘肺病的诊断》,能对矽肺做出更为准确的诊断。
Objective To explore the application value of the method of judging the density of small shadows in the lung area by using CT and CT reference films for pneumoconiosis.Methods The chest imaging data of 244 employees of a large copper company in Tongling City,Anhui Province who underwent occupational physical examination at Tongling Municipal Hospital in Anhui Province from January 2016 to December 2019 were retrospectively analyzed.Totally 244 cases underwent chest CT scan and chest DR radiography at the same time.The shape and size of the small shadows(the size of the circular and quasi-circular nodules in the lung area were represented by p,q,r,and the size of the irregular small shadows were represented by s,t,u),the overall density,the density of small shadows in each lung area,the large shadows,and the diagnosis stage were observed and compared.The small shadow density of each lung area was judged by the method of judging the small shadow density of CT lung area and the reference film,and other observation indicators were judged according to GBZ70-2015 Diagnosis of Occupational Pneumoconiosis.Results There was a significant difference between CT and DR in judging s-shaped small shadows and no small shadows(P<0.05),and there was no statistically significant difference in judging p,q,r,t,and u-shaped small shadows(P>0.05).CT and DR had medium to high consistency in the judgment of the overall density of small shadows(Kappa=0.692,P=0.001),and the diagnostic coincidence rate was 82.38%(201/244).There was moderate to high agreement between CT and DR in the density of small shadows shown in the right upper,right lower,left upper,left middle,and left lower lung regions(Kappa ranged from 0.40 to 0.75,P<0.05),and the consistency in the right middle lung region was poor(Kappa=0.381,P=0.001).Eleven large shadows were detected in 8 cases by DR,31 large shadows were detected in 23 cases by CT,and 20(8.20%)large shadows were detected more frequently by CT than DR.The agreement between CT and DR for the diagnosis and staging of silicosis was excellent(Kappa=0.843,P=0.001),and the diagnostic coincidence rate was 91.80%(224/244).Conclusion Applying the method of determining the density of small shadows in the lung area of pneumoconiosis and reference films,combined with GBZ70-2015 Diagnosis of Occupational Pneumoconiosis,can make a more accurate diagnosis of silicosis.
作者
胡必锋
朱胜康
翟荣存
李年春
刘晓东
张爱农
童昕
张利霞
马芸
肖本原
Hu Bifeng;Zhu Shengkang;Zhai Rongcun;Li Nianchun;Liu Xiaodong;Zhang Ainong;Tong Xin;Zhang Lixia;Ma Yun;Xiao Benyuan(Department of Radiology,Tongling Municipal Hospital,Tongling 244000,China;Department of Industrial Hygiene,Shicheng Hospital,Tongling Municipal Hospital,Tongling 244000,China)
出处
《中华放射学杂志》
CAS
CSCD
北大核心
2021年第11期1172-1177,共6页
Chinese Journal of Radiology
基金
安徽省重点研究与开发计划项目(1804h08020238)。
关键词
尘肺
体层摄影术
X线计算机
小阴影密集度
参考片
Pneumoconiosis
Tomography,X-ray computed
Small opacity profusion
Reference film
