高分辨率CT与数字摄影胸片在尘肺病筛查中的影像学差异分析

Analysis of imaging differences between high-resolution CT and digital radiography chest films in pneumoconiosis screening

  • 摘要:
    背景 数字摄影(DR)胸片无法明确显示的尘肺病早期病变,在高分辨率CT(HRCT)中能够清晰显示。HRCT能够系统观察尘肺病的演变和进展,为诊断提供可靠的证据。
    目的 通过对HRCT与DR胸片在尘肺病筛查中的影像学差异分析,为尘肺病的早期筛查提供更可靠的依据。
    方法 以某铸锻公司通过职业健康检查筛查出的6名疑似尘肺病早期的铸造作业工人作为研究对象,进行64排螺旋CT薄层扫描并采用高分辨率骨算法重建图像。对尘肺病早期小阴影在DR胸片和HRCT中的影像学表现进行综合分析并作出影像学结论。
    结果 6名受检者在DR胸片检查中均可见肺部多发小结节影和/或不规则影,但小阴影密集度和分布范围均未达到尘肺病的诊断标准。复查HRCT显示,其中4名受检者的肺部可见弥漫分布的微结节影和/或短线状小阴影,其余2名受检者HRCT影像显示为多发局限性胸膜增厚部分钙化和多发结节样胸膜隆起增厚。此外,发现其他病变多例,包括:双肺多发局限性胸膜增厚及钙化3例、肺部多发囊状支气管扩张1例、炎性结节2例、陈旧性病灶2例。通过综合分析,4名患者可见尘肺病早期改变,其中3名从事混砂和清砂作业的患者为矽肺早期改变,1名从事型砂制造作业的患者为铸工尘肺早期改变。
    结论 相比DR胸片,HRCT可以更准确显示病变的形态及分布情况,在识别尘肺病早期小阴影和其他肺部疾患方面具有显著优势。肺部弥漫小结节影并非尘肺病的特征性表现,不能单独作为尘肺病早期的诊断依据。即使有明确的粉尘职业史,也需要排除其他肺部疾病后才能做出尘肺病早期的诊断。粉尘作业,特别是矽尘作业工人X线胸片异常,即使小阴影分布情况未达到尘肺病的诊断标准也应建议复查HRCT,以便于早期发现尘肺病患者和高危人群并早期实施临床干预,从而达到疾病预防的目的。

     

    Abstract:
    Background  The early lesions of pneumoconiosis that cannot be clearly shown by digital radiography (DR) chest films can be clearly displayed in high-resolution CT (HRCT). HRCT enables systematic observation of the evolution and progression of pneumoconiosis, providing reliable evidence for diagnosis.
    Objective To provide reliable evidences for the early screening of pneumoconiosis, By analyzing the imaging difference between HRCT and DR chestfilms in pneumoconiosis screening.
    Methods Six casting workers in a casting forging company suspected of early stage of pneumoconiosis through regular occupational health examination screening were recruited , and 64 rows of spiral CT thin layer were scanned and reconstructed by high-resolution bone algorithm. Compare the imaging findings of early stage of pneumoconiosis small shadow on DR chest film and HRCT and make diagnostic conclusion.
    Results All six subjects had Multiple small nodules and/or irregular shadows in the lungs were found in all six patients’ DR chest films, but the density and distribution of small shadows did not meet the diagnostic criteria of pneumoconiosis. The HRCT review showed that, dispersively distributed micro nodule shadows and/or short-thread shape thin shadows in the lung in four patients, the rest two patients' HRCT images showed multiple localized pleural thickening and partial calcification and multiple nodules like pleural uplift thickening. Other lesions were also identified, including lung multiple localized pleural thickening and calcification in 3 cases, lung multiple cystic bronchiectasis in 1 case, inflammatory nodules in 2 cases, of chronic lesions in 2 case. Through comprehensive analysis, early stage of pneumoconiosis were seen in 4 patients, among which 3 patients engaged in sand mixing and sand clearing presenting early stage of silicosis; 1 patient engaged in moulding sand manufacturing presenting early stage of foundry worker pneumoconiosis.
    Conclusion Compared with DR chest film, HRCT can more accurately show the morphology and distribution of lesions, and has significant advantages in identifying small shadows in early stage of pneumoconiosis and other lung diseases. The diffuse small nodules in the lung is not a characteristic manifestation of pneumoconiosis, and cannot be used as the basis for the diagnosis of early stage of pneumoconiosis alone. Even with a clear occupational dust exposure history, an early stage of pneumoconiosis diagnosis can be made after excluding other lung diseases. After dust work, especially silicon dust work workers showing abnormal changes in X-ray chest film, review of the HRCT should be conducted even if the small shadow distribution does not meet the diagnostic criteria of pneumoconiosis, so as to early detection of pneumoconiosis patients and high-risk groups.

     

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