粉尘作业者肺部小阴影的高千伏胸片与高分辨率CT对比研究

赵殿辉; 陈达民; 王忠诚; 万卫平

粉尘作业者肺部小阴影的高千伏胸片与高分辨率CT对比研究

A Comparative Study on Small Opacities in High Kilovoltage Plain Chest Film Radiography versus HRCT Scan Taken from Workers Exposed to Occupational Dusts

摘要

摘要:
目的比较高分辨率CT(HRCT)和高千伏胸片对粉尘接触者肺部小阴影的显示能力。

方法对137 例(男性125 例,女性12 例)HRCT 和高千伏胸片资料完整者的影像学资料进行回顾性分析。其中,接触焊尘者56 例,接触矽尘者37 例,接触其他粉尘(包括铝尘、炭黑、水泥等)者44 例。HRCT 采用2 mm层厚、10 mm间隔从肺尖至膈肌扫描,采用-700 HU/1 500 HU的窗位/窗宽进行摄片和观察。HRCT 和高千伏胸片在不知晓职业史的前提下分别进行读片。对胸片和HRCT 评估获得的各肺区小阴影的密集度进行一一比较,并对小阴影总体密集度进行比较。

结果 HRCT 对小阴影总体密集度的评估与胸片评估密切相关(r=0.655,P<0.01),但HRCT 对小阴影的评估分辨率高于胸片(P<0.01)。115例HRCT显示小阴影,其中s影86例,p影5例,p/s影8例,s/p影15例,q影1例。86例胸片显示小阴影,其中s影25例,p 影5 例,p/s 影28 例,s/p 影24 例,q/p 影3 例,q/s 影2 例。86 例胸片显示小阴影的工人中6 例HRCT 显示正常。50 例胸片无小阴影的工人中,34 例(68%)HRCT 显示异常小阴影。HRCT 显示了上肺区及背部小阴影的分布优势。

结论胸部HRCT 在小阴影早期检测方面可弥补胸片的不足,对于准确评估小阴影有一定价值。

Abstract:
Objective To compare the ability to present small opacities on high kilovoltage plain chest film versus high-resolution computed tomography (HRCT).

Methods A retrospective analysis was conducted on HRCT and high kilovoltage plain chest films performed in 137 workers (125 males and 12 females) who were exposed to dust occupationally arc welding fumes, n=56; SiO₂ dust, n=37; other dusts (aluminum, graphite, cement, etc.), n=44. HRCT examination consisted of a series of 2-mm-thick sections with 10-mm intersection spacing from the apex of lungs to the diaphragm. All images were photographed and observed at window widths of 1 500 HU and levels of -700 HU. The profusion of small opacities on chest radiography was compared with that on HRCT. CT and radiographic profusion total scores were also compared.

Results There was a correlation between HRCT and radiography in the profusion scores of small opacities (r=0.655, P<0.01). HRCT showed a higher ability to present small opacities than high kilovoltage plain chest film (P<0.01). The HRCT scans found 115 cases with small opacities (type s=86; type p=5; type p/s=8; type s/p=15; type q=1), while the chest radiography saw 86 cases with small opacities (type s=25; type p=5; type p/s=28; type s/p=24; type q/p=3; type q/s=2). When the chest radiographs showed small opacities (n=86), 6 cases showed no abnormality on HRCT (7%). While the chest radiographs were normal in 50 cases, small opacities were detected on HRCT in 34 cases (68%). The upper and posterior lung predominance of small opacities was obvious on HRCT.

Conclusion The chest HRCT is complementary to plain radiography for better early detection of small opacities, and therefore possesses good diagnostic value for accurately evaluating small opacities.

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