64层SCT低剂量双相扫描在COPD患者肺功能评价中的应用研究
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摘要
目的
通过对COPD患者行64层SCT低剂量深吸气末、深呼气末扫描,利用pulmo软件,并与临床肺功能检查(PFT)对照,探讨64层SCT低剂量双相扫描获得的密度、体积及像素指数各指标在COPD患者肺功能评价方面的应用价值。
资料与方法
对长治医学院附属和平医院及中南大学湘雅二医院2010年3月-2010年9月期间,部分住院及门诊的经临床肺功能检查确诊的COPD患者36例,男性19例,女性17例,年龄范围51岁-84岁,平均年龄65.5士12.3岁,进行64层SCT低剂量双相扫描。另对30例健康体检者(无任何心肺疾患且胸部CT检查正常),男18例,女12例,年龄范围50岁-75岁,平均年龄60.5±10.5岁,进行同样方法的CT扫描。两组研究对象均采用德国Siemens SOMATOM Sensation 64层SCT机进行深吸气末、深呼气末的全肺低剂量扫描。利用pulmo软件,按扫描层数将全肺等分为上、中、下三个肺区,分别测量和计算出COPD组与正常对照组的：(1)深吸气末、深呼气末上、中、下肺区及全肺的密度指标与体积指标：其中密度指标纳入研究的有：深吸气末密度(Din)、深呼气末密度(Dex)、密度差(Dex-Din)、密度比(Dex/Din)、密度变化百分比(Din-Dex)/Din,体积指标有：深吸气末体积(Vin)、深呼气末体积(Vex)、体积差(Vin-Vex)、体积比(Vex/Vin)、体积变化百分比(Vin-Vex)/Vin。(2)将深吸气末、深呼气末像素指数(PI)分为-1024～-960,-960～-910,-910～-800,-800～-700,-700～-400,5个阈值区域,计算出深吸气末、深呼气末各阂值区域的像素指数：深吸气末像素指数(Plin)、深呼气末像素指数(Plex)。(3)深吸气末、深呼气末上、中、下肺区及全肺的小于-910HU的像素指数各指标：PIin-910、PIex-9100、PIin-910-PIex-910、PIex-910/PIin-910、(PIin-910-PIex-910/PIin-910。所有COPD患者均在CT检查前后3天内完成PFT检查,PFT检查采用德国耶格公司的体积描记仪Master Lab(Jaeger, Gemrnay)测定肺通气功能,指标为第1秒用力肺活量的实测值与预计值的比值(FEV1%)及第1秒用力肺活量与用力肺活量的比值(FEV1/FVC)。另对其中的40例被检查者(包括20例COPD组及20例正常对照组)加做100mAs吸气末CT扫描,所有扫描结束后,由CT扫描机自动计算出每次扫描(包括50m As呼吸双相与100mAs单相)的容积CT剂量指数(computed tomography dose index, CTDIvol)和剂量长度乘积(dose-length product, DLP),计算并比较不同管电流及呼吸状态下的CT扫描辐射剂量,并由有经验的医师及技师各一人,对每幅图像进行阅片,评价不同扫描条件下每幅横断面影像的质量。应用SPSS17.0统计软件包进行数据统计,不同扫描条件下的的CTDIvol DLP的比较采用配对样本的t检验,不同扫描条件下的CT图像质量评价应用四格表的X2检验(Fisher确切概率法),CT各指标的两独立样本之间采用t检验,比较COPD组与正常组之间的差异性,利用Pearson相关分析来检验各CT指标与肺功能FEV1%、FEV1/FVC指标的相关性。
结果
1.50mAs呼吸双相扫描的CTDIVol之和、DLP之和与100mAs条件下单相扫描的相应指标比较,它们之间的差异均无统计学意义(p>0.05)；管电流使用100mAs吸气末、50mAs深吸气末、深呼气末的图像优良率分别为100%、97.5%、92.5%,它们之间的差异没有统计学意义(p>0.05)。
2.COPD组与正常组比较,各肺区及全肺区的密度各指标差异均有统计意义(p<0.05或p<0.01)；各肺区的Vin差异无统计学意义(p>0.05),各肺区及全肺区的其余体积指标差异均有统计意义(p<0.05或p<0.01)；除PIin.910-PIex.910外,各肺区及全肺区的PI-910指标差异均有显著统计学意义(p<0.01)。
3.正常组与COPD组比较,Plin在-960～-1024,-910～-960,-800～-910三个分区差异有显著统计意义(p<0.01),而Plex在各个分区差别均有显著统计意义(p<0.01)。
4.PI-960～1024,PI-910～1024与FEVl%、FEV1/FVC有显著相关性(p<0.01),以PI-910～-1024相关性较佳。
5.各CT指标中,所有呼气相指标与反映气流阻塞的FEV1%、FEV1/FVC均有良好的相关性,双相密度差值及各指标比值、变化百分比也与FEVl%、FEV1/FVC有良好的相关性(p<0.01)。
结论
1.应用64层SCT低剂量双相扫描所获得的容积数据与图像质量能够满足正常人及COPD患者肺功能评价的要求,可取代常规剂量下的64层SCT双相扫描肺功能检查。
2.64层SCT低剂量双相扫描可用于评价正常人及COPD患者的肺功能状况,其中Dex.Vex.PI-910指标及Dex-Din及呼气末与吸气末各项指标比值、变化百分比为肺功能评价的有用指标(与FEVl%.FEVl/FVC两项指标均有较好的相关性),而PIex-910. PIex-910/PIin-910指标更有临床价值(与FEVl%.FEVl/FVC相关系数均达0.64以上)。
Objective
The patients with COPD were selected and underwent chest 64 slices SCT Low-dose scanning at full inspiration and full expiration, respectively.The total lung was measured by CT pulmo software and the indexes were contrasted with the PFT results.To explore the clinical value of the density,volume and pixel index from 64 slices SCT images in evaluation of pulmonary function of patients with COPD.
Materials and Methods
Between March 2010 and September 2010,36 COPD patients (COPD group) who are partial out-patient clinic and partial hospitalization from the heping Hospital of Changzhi medical college and the second xiangya Hospital of central south University were enrolled in this study.All the patients were underwent PFT and were essentially verified COPD. The patients included 19 males and 17 females ranging in age from 51 to 84,with an mean age of 65.5±12.3 years.All the patients were underwent PFT and 64 slices SCT within 3 days.30 healthy people (control group) were selected and 64 slices SCT chest scanning results were normal.The group included 18 males and 12 females ranging in age from 50 to 75,with an mean age of 60.5±10.5 years.The two groups were underwent chest 64 slices SCT (Siemens,Germanny) low-dose scanning at full inspiration and full expiration.After the scanning,the total lung was measured by CT pulmo software. The lung was divided into three equal regions. Measure and calculate the results of each region (include upper,middle,lower field and the total lung) respectively:(1)lung density at full inspiration and full expiration (Din,Dex), density difference (Dex-Din), density ratio (Dex/Din), density variation percentage (Din-Dex)/Din;lung volume at full inspiration and full expiration (Vin,Vex),volume difference (Vin-Vex), volume ratio (Vex/Vin), volume variation percentage (Vin-Vex)/Vin; (2)pixels indexes with five groups of-1024～-960,-960～-910,-910～-800,-800～-700,-700～-400.Ca-lculate the pixels indexes at full inspiration and full expiration (the PI value is the sum of the Pixels under-910HU), (PIin-910,Plex-910),PI-910 difference (PIin-910-PIex-910), PI-910ratio (PIex-910/PIin-910),PI-910 variation percentage (PIin-910-PIex-910)/PIin-910.Their pulmonary function were tested by Master Lab (Jaeger,Germany).The indexes were forced expiratory volume at the first second%pre (FEV1%) and ratio of the first second forced expiratory volume to forced vital capacity (FEV1/FVC). We selected 20 patients with COPD and 20 healthy people.All subjects were underwent 64 slices SCT scanning of the total lung at routine-dose with inspiration,extrally.When the scanning was finished,CT machine calculated computed tomography dose index(CTDIvol) and dose-length product(DLP) automatically. We compared radiation dose at different tube currents and different breath condition and invited a salty doctor and a salty technician to observe every image and evaluate the section image quality. The results were analyzed statistically by the SPSS 17.0. CTDI Vol and DLP at different scanning condition were tested by paired t-test.Image quality evaluation at different scanning condition was tested by X2 test. Compared with the CT indexes between the COPD group and the normal group by t-test and the CT indexes were analyzed the correlation with the FEVI%and FEV1/FVC by pearson correlation analysis..
Results
1. Compared with CTDIVol in single phase of 100 mAs and the sum of CTDIvoLin two phases at low-dose of 50mAs, the difference between them was not statistically significant (p>0.05).DLP was the same result. Section image fineness ration at 100mAs at inspiration，50mAs at full inspiration,50 mAs at full expiration was 100%、97.5%、92.5%,the difference between them was not statistically significant (p>0.05)
2.Compared with density indexes of each region and the total lung in normal group and the case group,the difference between them was statistically significant (p<0.05 or p<0.01); the difference of lung volume at full inspiration at each region was not statistically significant(p>0.05); the difference of the other lung volume indexes at each region and the total lung was statistically significant (p<0.05或p0.01); the difference of the all PI-910 indexes except the PIin-910-PIex.910 was statistically significant (p<0.01).
3.Compared with Plin indexes of the total lung that were in-960～1024,-910～-960,-800～-910, three regions in normal group and all the case groups, the difference between them was statistically significant (p<0.01);but the difference of the all PIex indexes was statistically significant (p<0.01)
4.There was statistical significance between the correlation with PI-960～-1024, PI-910～-1024 and FEV1%, FEV1/FVC (p<0.01), the PI-910～-1024 is Better.
5.Excellent correlation was found between all the expiratory indexes with FEV1% and FEV1/FVC (p<0.01). There was statistical significance between the correlation with density difference,each indexes ratio, indexes variation percentage and FEV1%, FEV1/FVC (p<0.01),
Conclusions
1. The data and image quality obtained from 64 slices SCT chest scanning at low-dose in full inspiration and full expiration meets the requirements of pulmonary function assessment of patients with COPD and healthy people. It can replace the scanning of two phases at routine-dose to evaluate pulmonary function.
2.64 slices SCT chest scanning at low-dose at full inspiration and full expiration can be used to evaluate pulmonary function of COPD and healthy people.Among all the indexes, Dex,Vex,PL-910, Dex-Din,the ration and the variation percentage were all the useful indexes to evaluate pulmonary function. (There was statistical significance between the correlation with all the indexes, FEV1%and FEVl/FVC.But PIex-910 and PIex-910/PIin-910were better.(The correlation coefficients were larger than 0.64)
通过对COPD患者行64层SCT低剂量深吸气末、深呼气末扫描,利用pulmo软件,并与临床肺功能检查(PFT)对照,探讨64层SCT低剂量双相扫描获得的密度、体积及像素指数各指标在COPD患者肺功能评价方面的应用价值。
资料与方法
对长治医学院附属和平医院及中南大学湘雅二医院2010年3月-2010年9月期间,部分住院及门诊的经临床肺功能检查确诊的COPD患者36例,男性19例,女性17例,年龄范围51岁-84岁,平均年龄65.5士12.3岁,进行64层SCT低剂量双相扫描。另对30例健康体检者(无任何心肺疾患且胸部CT检查正常),男18例,女12例,年龄范围50岁-75岁,平均年龄60.5±10.5岁,进行同样方法的CT扫描。两组研究对象均采用德国Siemens SOMATOM Sensation 64层SCT机进行深吸气末、深呼气末的全肺低剂量扫描。利用pulmo软件,按扫描层数将全肺等分为上、中、下三个肺区,分别测量和计算出COPD组与正常对照组的：(1)深吸气末、深呼气末上、中、下肺区及全肺的密度指标与体积指标：其中密度指标纳入研究的有：深吸气末密度(Din)、深呼气末密度(Dex)、密度差(Dex-Din)、密度比(Dex/Din)、密度变化百分比(Din-Dex)/Din,体积指标有：深吸气末体积(Vin)、深呼气末体积(Vex)、体积差(Vin-Vex)、体积比(Vex/Vin)、体积变化百分比(Vin-Vex)/Vin。(2)将深吸气末、深呼气末像素指数(PI)分为-1024～-960,-960～-910,-910～-800,-800～-700,-700～-400,5个阈值区域,计算出深吸气末、深呼气末各阂值区域的像素指数：深吸气末像素指数(Plin)、深呼气末像素指数(Plex)。(3)深吸气末、深呼气末上、中、下肺区及全肺的小于-910HU的像素指数各指标：PIin-910、PIex-9100、PIin-910-PIex-910、PIex-910/PIin-910、(PIin-910-PIex-910/PIin-910。所有COPD患者均在CT检查前后3天内完成PFT检查,PFT检查采用德国耶格公司的体积描记仪Master Lab(Jaeger, Gemrnay)测定肺通气功能,指标为第1秒用力肺活量的实测值与预计值的比值(FEV1%)及第1秒用力肺活量与用力肺活量的比值(FEV1/FVC)。另对其中的40例被检查者(包括20例COPD组及20例正常对照组)加做100mAs吸气末CT扫描,所有扫描结束后,由CT扫描机自动计算出每次扫描(包括50m As呼吸双相与100mAs单相)的容积CT剂量指数(computed tomography dose index, CTDIvol)和剂量长度乘积(dose-length product, DLP),计算并比较不同管电流及呼吸状态下的CT扫描辐射剂量,并由有经验的医师及技师各一人,对每幅图像进行阅片,评价不同扫描条件下每幅横断面影像的质量。应用SPSS17.0统计软件包进行数据统计,不同扫描条件下的的CTDIvol DLP的比较采用配对样本的t检验,不同扫描条件下的CT图像质量评价应用四格表的X2检验(Fisher确切概率法),CT各指标的两独立样本之间采用t检验,比较COPD组与正常组之间的差异性,利用Pearson相关分析来检验各CT指标与肺功能FEV1%、FEV1/FVC指标的相关性。
结果
1.50mAs呼吸双相扫描的CTDIVol之和、DLP之和与100mAs条件下单相扫描的相应指标比较,它们之间的差异均无统计学意义(p>0.05)；管电流使用100mAs吸气末、50mAs深吸气末、深呼气末的图像优良率分别为100%、97.5%、92.5%,它们之间的差异没有统计学意义(p>0.05)。
2.COPD组与正常组比较,各肺区及全肺区的密度各指标差异均有统计意义(p<0.05或p<0.01)；各肺区的Vin差异无统计学意义(p>0.05),各肺区及全肺区的其余体积指标差异均有统计意义(p<0.05或p<0.01)；除PIin.910-PIex.910外,各肺区及全肺区的PI-910指标差异均有显著统计学意义(p<0.01)。
3.正常组与COPD组比较,Plin在-960～-1024,-910～-960,-800～-910三个分区差异有显著统计意义(p<0.01),而Plex在各个分区差别均有显著统计意义(p<0.01)。
4.PI-960～1024,PI-910～1024与FEVl%、FEV1/FVC有显著相关性(p<0.01),以PI-910～-1024相关性较佳。
5.各CT指标中,所有呼气相指标与反映气流阻塞的FEV1%、FEV1/FVC均有良好的相关性,双相密度差值及各指标比值、变化百分比也与FEVl%、FEV1/FVC有良好的相关性(p<0.01)。
结论
1.应用64层SCT低剂量双相扫描所获得的容积数据与图像质量能够满足正常人及COPD患者肺功能评价的要求,可取代常规剂量下的64层SCT双相扫描肺功能检查。
2.64层SCT低剂量双相扫描可用于评价正常人及COPD患者的肺功能状况,其中Dex.Vex.PI-910指标及Dex-Din及呼气末与吸气末各项指标比值、变化百分比为肺功能评价的有用指标(与FEVl%.FEVl/FVC两项指标均有较好的相关性),而PIex-910. PIex-910/PIin-910指标更有临床价值(与FEVl%.FEVl/FVC相关系数均达0.64以上)。
Objective
The patients with COPD were selected and underwent chest 64 slices SCT Low-dose scanning at full inspiration and full expiration, respectively.The total lung was measured by CT pulmo software and the indexes were contrasted with the PFT results.To explore the clinical value of the density,volume and pixel index from 64 slices SCT images in evaluation of pulmonary function of patients with COPD.
Materials and Methods
Between March 2010 and September 2010,36 COPD patients (COPD group) who are partial out-patient clinic and partial hospitalization from the heping Hospital of Changzhi medical college and the second xiangya Hospital of central south University were enrolled in this study.All the patients were underwent PFT and were essentially verified COPD. The patients included 19 males and 17 females ranging in age from 51 to 84,with an mean age of 65.5±12.3 years.All the patients were underwent PFT and 64 slices SCT within 3 days.30 healthy people (control group) were selected and 64 slices SCT chest scanning results were normal.The group included 18 males and 12 females ranging in age from 50 to 75,with an mean age of 60.5±10.5 years.The two groups were underwent chest 64 slices SCT (Siemens,Germanny) low-dose scanning at full inspiration and full expiration.After the scanning,the total lung was measured by CT pulmo software. The lung was divided into three equal regions. Measure and calculate the results of each region (include upper,middle,lower field and the total lung) respectively:(1)lung density at full inspiration and full expiration (Din,Dex), density difference (Dex-Din), density ratio (Dex/Din), density variation percentage (Din-Dex)/Din;lung volume at full inspiration and full expiration (Vin,Vex),volume difference (Vin-Vex), volume ratio (Vex/Vin), volume variation percentage (Vin-Vex)/Vin; (2)pixels indexes with five groups of-1024～-960,-960～-910,-910～-800,-800～-700,-700～-400.Ca-lculate the pixels indexes at full inspiration and full expiration (the PI value is the sum of the Pixels under-910HU), (PIin-910,Plex-910),PI-910 difference (PIin-910-PIex-910), PI-910ratio (PIex-910/PIin-910),PI-910 variation percentage (PIin-910-PIex-910)/PIin-910.Their pulmonary function were tested by Master Lab (Jaeger,Germany).The indexes were forced expiratory volume at the first second%pre (FEV1%) and ratio of the first second forced expiratory volume to forced vital capacity (FEV1/FVC). We selected 20 patients with COPD and 20 healthy people.All subjects were underwent 64 slices SCT scanning of the total lung at routine-dose with inspiration,extrally.When the scanning was finished,CT machine calculated computed tomography dose index(CTDIvol) and dose-length product(DLP) automatically. We compared radiation dose at different tube currents and different breath condition and invited a salty doctor and a salty technician to observe every image and evaluate the section image quality. The results were analyzed statistically by the SPSS 17.0. CTDI Vol and DLP at different scanning condition were tested by paired t-test.Image quality evaluation at different scanning condition was tested by X2 test. Compared with the CT indexes between the COPD group and the normal group by t-test and the CT indexes were analyzed the correlation with the FEVI%and FEV1/FVC by pearson correlation analysis..
Results
1. Compared with CTDIVol in single phase of 100 mAs and the sum of CTDIvoLin two phases at low-dose of 50mAs, the difference between them was not statistically significant (p>0.05).DLP was the same result. Section image fineness ration at 100mAs at inspiration，50mAs at full inspiration,50 mAs at full expiration was 100%、97.5%、92.5%,the difference between them was not statistically significant (p>0.05)
2.Compared with density indexes of each region and the total lung in normal group and the case group,the difference between them was statistically significant (p<0.05 or p<0.01); the difference of lung volume at full inspiration at each region was not statistically significant(p>0.05); the difference of the other lung volume indexes at each region and the total lung was statistically significant (p<0.05或p0.01); the difference of the all PI-910 indexes except the PIin-910-PIex.910 was statistically significant (p<0.01).
3.Compared with Plin indexes of the total lung that were in-960～1024,-910～-960,-800～-910, three regions in normal group and all the case groups, the difference between them was statistically significant (p<0.01);but the difference of the all PIex indexes was statistically significant (p<0.01)
4.There was statistical significance between the correlation with PI-960～-1024, PI-910～-1024 and FEV1%, FEV1/FVC (p<0.01), the PI-910～-1024 is Better.
5.Excellent correlation was found between all the expiratory indexes with FEV1% and FEV1/FVC (p<0.01). There was statistical significance between the correlation with density difference,each indexes ratio, indexes variation percentage and FEV1%, FEV1/FVC (p<0.01),
Conclusions
1. The data and image quality obtained from 64 slices SCT chest scanning at low-dose in full inspiration and full expiration meets the requirements of pulmonary function assessment of patients with COPD and healthy people. It can replace the scanning of two phases at routine-dose to evaluate pulmonary function.
2.64 slices SCT chest scanning at low-dose at full inspiration and full expiration can be used to evaluate pulmonary function of COPD and healthy people.Among all the indexes, Dex,Vex,PL-910, Dex-Din,the ration and the variation percentage were all the useful indexes to evaluate pulmonary function. (There was statistical significance between the correlation with all the indexes, FEV1%and FEVl/FVC.But PIex-910 and PIex-910/PIin-910were better.(The correlation coefficients were larger than 0.64)
引文
[1]中华医学会呼吸病学分会慢性阻塞性肺疾病学组.慢性阻塞性肺疾病诊治指南(2007年修订版),2007,21(2)：31-41.
[2]Lopez AD,Murray CC.The global burden of disease,1990-2020.Nat Med 1998;(4):1241-1243.
[3]Global strategy for the management and prevention of Chronic Obstructive Lung Disease. Global Initiative for Chronic Obstructive Lung Disease.UPDATED 2006 (Based on an April 1998 NHLBI/WHO Workshop).
[4]李惠民,肖湘生.实验性呼吸窘迫综合征的CT研究[J].中国医学计算机成像杂志,1998,4(2)：267-271。
[5]Arakawa H,Webb WR,Air trapping on expiratory high-resolution CT scans in the absence of inspiratory scan abnormalities:correlation with pulmonary function tests and differential diagnosis.AJR Am J Roentgenol.1998 May; 170(5):1349-53.
[6]Knudson RJ, Standen JR, Kaltenbon WT, etal.Expiratory computed tomography for assessment of suspected pulmonary emphysema.Chest,1991,99(6): 1357-66.
[7]徐茂盛,彭顺秀,周永生,等.双相高分辨率CT对慢阻肺的定量诊断价值分析[J].中国误诊学杂志,2005,5(9)：1606-1608.
[8]徐茂盛,谢晟,王仁贵,等.慢性阻塞性肺疾病的肺高分辨率CT呼气相研究[J].实用放射学杂志,2004,20(6)：493-495.
[9]Hiroaki Arakawa,Webb WR,Marcia Mccowin,et al.In homgeneous lung at tenuation at thin section CT:diagnostic value of expira toryscans[J]. Radiology, 1998,206(1):89-94.
[10]金利芳,缪兢陶,李征宇,等.多层螺旋CT体素指数评估慢性阻塞性肺病空气储留的研究.中国医学影像技术.2007,23(7)：1033-1036.
[12]Kauczor HU,Heussel CP,Fischer B,et al.Assessment of Lung Volumes Using Helical CT at Inspiration and Expiration:Comparison with Pulmonary Function Tests[J].AJR,1998,171(4):1091-1095.
[12]Shin Matsuoka,Yasuyuki Kurihara,Kunihiro Yagihashi,et al.Quantitative Assessment of Air Trapping in Chronic Obstructive Pulmonary Disease Using Inspiratory and Expiratory Volumetric MDCT[J].AJR 2008,190(3):762-769.
[13]Zaporozhan J, Ley S,Eberhardt R,et al.Paired Inspiratory/Expiratory Volumetric Thin-Slice CT Scan for Emphysema Analysis:Comparison of Different Quantitative Evaluations and Pulmonary Function Test[J].CHEST,2005,128(5): 3212-3220.
[14]张伟宏,牟文斌,齐冰,等.阻塞性通气障碍的CT肺功能成像参数[J].中国医学影像技术,2005,21(6)：906-909.
[15]张伟宏,刘玉清,牟文斌,等.CT肺功能成像技术研究[J].中华放射学杂志,2001,35(11)：832-836
[16]Zaporozhan J,Ley S,Eberhardt R,et al.Paired Inspiratory/Expiratory Volumetric Thin-Slice CT Scan for Emphysema Analysis:Comparison of Different Quantitative Evaluations and Pulmonary FunctionTest[J].Chest,2005,128(5):3212-3220.
[17]BeinertT, Behr J, MehnertF,et al. Spirometrically controlled quantitative CT for assessing diffuse parenchymal lung disease-J ComputAssistTomogr,1995,19(6): 924-931.
[18]Kalender WA,Rienmuller R, Seisslwe W, etal.Measurement of Pulmonary parenchymal attenuation:use of spirometric gating with quantitative CT.Radiology 1990;175(1):265-268.
[19]Kauczor HU, Heussel CP, Fischer B, et al. Assessment of lung volumes usinghelical CTat inspiration and expiration:comparison with pulmonary function tests. AJR,1998,171(4):1091-1095.
[20]潘纪戊,吴国庚,陈起航.肺气肿的诊断：CT和肺功能检查的比较.中华放射学杂志,1995,29(4),680-683.
[21]谢晟,王仁贵,王仪生,等.正常成人肺高分辨率CT的吸气相和呼气相的定量研究.China JM IT,2002,18(9)：902-904.
[22]Stern EJ, Webb WR. Dynamic imaging of lung morphology with ultrafast high-resolution computed tomograph. J Thorac Imaging,1993,8(4):273-282.
[23]Webb WR,Stern EJ,Kanth N,et al. Dynamic pulmonary CT:Findings in normal adult men[J]. Radiology,1993,186(1):117-124.。
[24]Masanori Akira,Kazushige Toyokawa,Yoshikazu Inoue,et al.Quantitative CT in Chronic Obstructive Pulmonary Disease:Inspiratory and Expiratory assessment [J].AJR,2009,192(1):267-272.
[25]Gevenois PA,De Vuyst P,Sy M, et al.Pulmonary emphysema.quantitative CT during expiration. Radiology,1996,199(3):825-829.
[26]Muller NL, Staples CA, Miller RR, et al."Density mask":an objective method to quantitate emphysema using computed tomography. Chest,1988,94(4): 782-787.
[27]Adams H, Bernard MS, McConnochie K. An appraisal of CT pulmonary density mapping in normal subjects. Clin Radiol,1991,43(4):238-242.
[28]Gevenois PA,Scillia P,de Maertelaer V, et al.The effects of age,sex,lung size and hyperinflation on CT lung densitometry. AJR,1996,167(5):1169-1173.
[29]Genereux GP. Computed tomography and the lung:review of anatomic and densitometric features with their clinical application. J Can Assoc Radiol,1985,36(2): 88-102.
[30]Knudson RJ,Standen JR,Kaltenborn WT,et al. Expiration computed tomography for assessment of suspected pulmonary emphysema. Chest,1991, 99(6):1357-1366.
[1]中华医学会呼吸病学分会慢性阻塞性肺疾病学组.慢性阻塞性肺疾病诊治指南(2007年修订版),2007,21(2)：31-41.
[2]Global strategy for the management,and prevention of Chronic Obstructive Lung Disease.Global Initiative for Chronic Obstructive Lung Disease.UPDATED 2006 (Based on an April 1998 NHLBI/WHO Workshop).
[3]潘纪戌,李果珍,施发表,等.慢性阻塞性肺病中X线和肺功能的关系.临床放射学杂志,1992,11(4)：171-174.
[4]Petroll WM,Knight H,Rochester DF.A model approach to assess diaphragmatic volume displacement[J].JAppl Physiol,1990,69(6):2175-2182.
[5]Bellemare F,Couture J,Cordeau MP,et al.A natomic landmarks to estimate the length of the diaphragm from chest radiographs:effects of emphysema and lung volume reduction surgery[J].Chest,2001,120(2):444-452.
[6]Singh B,Panizza JA,Finucane KE.Breath-by-breath measurement of the volume displaced by diaphragm motion[J]. JAppl Physiol,2003,94(3):1084-1091.
[7]Webb WR,Muller NL,Naidich DP.High-resolution CT of the Lung parenchymaiRadiol Clin North Am,1989,27(6):1085-97.
[8]Philippe A,Grenier,Catherine Beigelman-Aubry,Catalin Fetita,et al. New frontiers in CT imaging of airway disease.Eur Radiol 2002,12(5):1022-1044.
[9]Marom EM,Goodman PC,Mc Adams HP. Diffuse abnormalities of the trachea and main bronchi.AJR 2001,176(3):713-717.
[10]Ambrosetti M,Ageno W,Spanevello A,et al. Prevalence and prevention or venous thromboe-Mbolism in patients with acute exacerbations or COPD[J]. Thromb Res,2003,112(4):203-207.
[11]Park KJ, Bergin CJ,Clausen JL.Quantitation of emphysema with three-dimensional CT densitometry.comparison with two-dimensional analysis,visual emphysema scores and pulmonary function test results.Radiology,1999,211(2): 541-547.
[12]张伟宏,蔡柏蔷,王京岚等.肺气肿的CT肺功能成像：CT技术与肺功能检查的对照研究[J].中华结核和呼吸杂志,2002,25(3)：150-153.
[13]Wakayama K,Kurihara N,Fujimoto S,et al.Relationship between exercise capacity and the severity of emphysema as determined by high-resolution CT[J].Eur Respir J,1993,6(9):1362-1367.
[14]Lamer RJ,Thelissen GR,Kessels AG,et al.Chronic obstructive pulmonary disease:evaluation with spirometrically controlled CT lung densitometry[J].Radiology, 1994,193(1):109-113.
[15]Shiro Satoh,Shinichi Ohdama,Hitoshi Shibuya,et al.Sliding thin slab,minimum intensity projection imaging frobjective analysis of emphysema.Radiat Med,2006,24(6):415-421.
[16]Stern EJ, Webb WR. Dynamic imaging of lung morphology with ultrafast high-resolution computed tomograph. J Thorac Imaging,1993,8(4):273-282.o
[17]Stern EJ, Webb WR, Gamsu G..Dynamic quantitative computed tomography: apredictor of pulmonary function in obstructive lung disease.Invest Radiol, 1994,29(5):564-569,
[18]张国桢,朱砚萍,单琳等.多层螺旋CT评价肺气肿患者肺功能的可行性.中华放射学杂,2007,41(3)：243-247.
[19]韩萍,张帆,刘芳等.螺旋CT结合呼吸门控对矽肺形态与功能变化的研究.中华放射学杂志,2002,36(7)：597-600.
[20]Akahaka A, Yomashita Y, Nakayama Y, et a.l Assessment of lung volumes in pulmonary emphysema using multidetector helical CT:comparison with pulmonary function tests. Comput Med Imaging Grap,2001,25(5):399-404.
[21]Chen D,Webb WR,Storto ML,et al.Assessment of air trapping using post expiratory high-resolution computed tomography[J]. J Thorac Imaging,1998, 13(2):135-143.
[22]沈慧聪,伍建林,郎志谨,等.动态CT扫描在慢性阻塞性肺病中的应用研究[J].中国医学计算机成像杂志,2003,9(4)：263-266.
[23]伍建林,沈慧聪,宋清伟,等.健康成人肺脏在动态螺旋CT扫描中正常表现的定量研究[J].中国临床医学影像杂志,2001,12(4)：246-247.
[24]薛雁山,许建英,纪智.阻塞性肺气肿定量CT与肺功能检查相关性的实验研究[J].中国医学影像技术,2002,18(5)：406-408.
[25]刘芳,韩萍,冯敢生,等.呼吸门控定量CT对慢性阻塞性肺疾病的诊断价值.中华放射学杂志,2001,35(12)：923-926。
[26]Lucidarme O, Coche E, Cluzel P, et al.Expirtory CT Scans for chronic airway disease:correlation with pulmonary function tests results.AJR,1998,170(2): 301-307。
[27]伍建林,沈慧聪,宋清伟,等。健康成人肺脏在动态螺旋CT扫描中正常表现的定量研究.中国临床医学影像杂志,2001,12(4)：246-249。。
[28]Gurney JW,Jones KK,Robbins RA,et al.Regional distribution of emphysema: correlation of high resolution CT with pulmonary function tests in unselected smokers[J].Radiology,1992,183(2):457-463.
[29]John HM,Austin MD.Pulmonary emphysema:imaging assessment of lung volume reduction surgery[J]. Radiology,1999,212(1):1-3.
[30]杨明,潘纪戍,陈起航,等.慢性阻塞性肺部疾病的电子束CT动态扫描[J].中华放射学杂志,1998,32(2)：76-81.
[31]]Mamadou Hawa H.D,Herveo G,et al.Distribution of Lung Density and Mass in Patients With Emphysema as Assessed by Quantitative Analysis of CT[J].CHEST,2000,118(6):1566-1575.
[32]Kauczor HU,Heussel CP,Fischer B,et al.Assessment of plung volume using helical CT at inspiration and expiration:comparison with pulmonary function tests.ARJ,1998,171(4):1091-1095.
[33]张伟宏,刘玉清,牟文斌,等.CT肺功能成像技术研究[J].中华放射学杂志,,2001,35(11)：832-836.
[34]葛虓俊,张国祯,滑炎卿,等·多层螺旋CT肺容积测定与肺功能的对照研究[J].中国CT和MRI杂志,2005,3(1)：30-32.
[35]李凯,龙莉玲,黄仲奎.多层螺旋CT肺容积测定在慢性阻塞性肺疾病预测诊断的应用价值[J].实用放射学杂志,2008,24(9)：1179-1183.
[36]Akira M, Toyokawa K, Inoue Y, et al. Quantitative CT in chronic obstructive pulmonary disease:inspiratory and expiratory ssessment [J]. AJR,2009,192 (7): 267-272.
[37]许景红,韩萍,等.呼吸门控下肺功能成像的研究.中华医学杂志,英文版.2002,115(10)：1545-1547.
[38]葛虓俊,张国桢,毛定飚,等.多层螺旋CT肺像素指数与肺功能的相关性[J].中国医学科学院学报,2006,28(1)：61-63.
[39]张国桢,朱砚萍,单琳等.多层螺旋CT评价肺气肿患者肺功能的可行性.中华放射学杂,2007,41(3)：243-247.
[40]Muller NL, Staples CA, Miller RR, et al."Density mask":an objective method to quantitate emphysema using computed tomography. Chest,1988, 94(4):782-787.
[41]张伟宏,蔡柏蔷,王京岚,林耀广,等.肺气肿的CT肺功能成像：CT技术与肺功能检查的对照研究.中华结核和呼吸杂志,2002,25(3)：150-153.
[2]Lopez AD,Murray CC.The global burden of disease,1990-2020.Nat Med 1998;(4):1241-1243.
[3]Global strategy for the management and prevention of Chronic Obstructive Lung Disease. Global Initiative for Chronic Obstructive Lung Disease.UPDATED 2006 (Based on an April 1998 NHLBI/WHO Workshop).
[4]李惠民,肖湘生.实验性呼吸窘迫综合征的CT研究[J].中国医学计算机成像杂志,1998,4(2)：267-271。
[5]Arakawa H,Webb WR,Air trapping on expiratory high-resolution CT scans in the absence of inspiratory scan abnormalities:correlation with pulmonary function tests and differential diagnosis.AJR Am J Roentgenol.1998 May; 170(5):1349-53.
[6]Knudson RJ, Standen JR, Kaltenbon WT, etal.Expiratory computed tomography for assessment of suspected pulmonary emphysema.Chest,1991,99(6): 1357-66.
[7]徐茂盛,彭顺秀,周永生,等.双相高分辨率CT对慢阻肺的定量诊断价值分析[J].中国误诊学杂志,2005,5(9)：1606-1608.
[8]徐茂盛,谢晟,王仁贵,等.慢性阻塞性肺疾病的肺高分辨率CT呼气相研究[J].实用放射学杂志,2004,20(6)：493-495.
[9]Hiroaki Arakawa,Webb WR,Marcia Mccowin,et al.In homgeneous lung at tenuation at thin section CT:diagnostic value of expira toryscans[J]. Radiology, 1998,206(1):89-94.
[10]金利芳,缪兢陶,李征宇,等.多层螺旋CT体素指数评估慢性阻塞性肺病空气储留的研究.中国医学影像技术.2007,23(7)：1033-1036.
[12]Kauczor HU,Heussel CP,Fischer B,et al.Assessment of Lung Volumes Using Helical CT at Inspiration and Expiration:Comparison with Pulmonary Function Tests[J].AJR,1998,171(4):1091-1095.
[12]Shin Matsuoka,Yasuyuki Kurihara,Kunihiro Yagihashi,et al.Quantitative Assessment of Air Trapping in Chronic Obstructive Pulmonary Disease Using Inspiratory and Expiratory Volumetric MDCT[J].AJR 2008,190(3):762-769.
[13]Zaporozhan J, Ley S,Eberhardt R,et al.Paired Inspiratory/Expiratory Volumetric Thin-Slice CT Scan for Emphysema Analysis:Comparison of Different Quantitative Evaluations and Pulmonary Function Test[J].CHEST,2005,128(5): 3212-3220.
[14]张伟宏,牟文斌,齐冰,等.阻塞性通气障碍的CT肺功能成像参数[J].中国医学影像技术,2005,21(6)：906-909.
[15]张伟宏,刘玉清,牟文斌,等.CT肺功能成像技术研究[J].中华放射学杂志,2001,35(11)：832-836
[16]Zaporozhan J,Ley S,Eberhardt R,et al.Paired Inspiratory/Expiratory Volumetric Thin-Slice CT Scan for Emphysema Analysis:Comparison of Different Quantitative Evaluations and Pulmonary FunctionTest[J].Chest,2005,128(5):3212-3220.
[17]BeinertT, Behr J, MehnertF,et al. Spirometrically controlled quantitative CT for assessing diffuse parenchymal lung disease-J ComputAssistTomogr,1995,19(6): 924-931.
[18]Kalender WA,Rienmuller R, Seisslwe W, etal.Measurement of Pulmonary parenchymal attenuation:use of spirometric gating with quantitative CT.Radiology 1990;175(1):265-268.
[19]Kauczor HU, Heussel CP, Fischer B, et al. Assessment of lung volumes usinghelical CTat inspiration and expiration:comparison with pulmonary function tests. AJR,1998,171(4):1091-1095.
[20]潘纪戊,吴国庚,陈起航.肺气肿的诊断：CT和肺功能检查的比较.中华放射学杂志,1995,29(4),680-683.
[21]谢晟,王仁贵,王仪生,等.正常成人肺高分辨率CT的吸气相和呼气相的定量研究.China JM IT,2002,18(9)：902-904.
[22]Stern EJ, Webb WR. Dynamic imaging of lung morphology with ultrafast high-resolution computed tomograph. J Thorac Imaging,1993,8(4):273-282.
[23]Webb WR,Stern EJ,Kanth N,et al. Dynamic pulmonary CT:Findings in normal adult men[J]. Radiology,1993,186(1):117-124.。
[24]Masanori Akira,Kazushige Toyokawa,Yoshikazu Inoue,et al.Quantitative CT in Chronic Obstructive Pulmonary Disease:Inspiratory and Expiratory assessment [J].AJR,2009,192(1):267-272.
[25]Gevenois PA,De Vuyst P,Sy M, et al.Pulmonary emphysema.quantitative CT during expiration. Radiology,1996,199(3):825-829.
[26]Muller NL, Staples CA, Miller RR, et al."Density mask":an objective method to quantitate emphysema using computed tomography. Chest,1988,94(4): 782-787.
[27]Adams H, Bernard MS, McConnochie K. An appraisal of CT pulmonary density mapping in normal subjects. Clin Radiol,1991,43(4):238-242.
[28]Gevenois PA,Scillia P,de Maertelaer V, et al.The effects of age,sex,lung size and hyperinflation on CT lung densitometry. AJR,1996,167(5):1169-1173.
[29]Genereux GP. Computed tomography and the lung:review of anatomic and densitometric features with their clinical application. J Can Assoc Radiol,1985,36(2): 88-102.
[30]Knudson RJ,Standen JR,Kaltenborn WT,et al. Expiration computed tomography for assessment of suspected pulmonary emphysema. Chest,1991, 99(6):1357-1366.
[1]中华医学会呼吸病学分会慢性阻塞性肺疾病学组.慢性阻塞性肺疾病诊治指南(2007年修订版),2007,21(2)：31-41.
[2]Global strategy for the management,and prevention of Chronic Obstructive Lung Disease.Global Initiative for Chronic Obstructive Lung Disease.UPDATED 2006 (Based on an April 1998 NHLBI/WHO Workshop).
[3]潘纪戌,李果珍,施发表,等.慢性阻塞性肺病中X线和肺功能的关系.临床放射学杂志,1992,11(4)：171-174.
[4]Petroll WM,Knight H,Rochester DF.A model approach to assess diaphragmatic volume displacement[J].JAppl Physiol,1990,69(6):2175-2182.
[5]Bellemare F,Couture J,Cordeau MP,et al.A natomic landmarks to estimate the length of the diaphragm from chest radiographs:effects of emphysema and lung volume reduction surgery[J].Chest,2001,120(2):444-452.
[6]Singh B,Panizza JA,Finucane KE.Breath-by-breath measurement of the volume displaced by diaphragm motion[J]. JAppl Physiol,2003,94(3):1084-1091.
[7]Webb WR,Muller NL,Naidich DP.High-resolution CT of the Lung parenchymaiRadiol Clin North Am,1989,27(6):1085-97.
[8]Philippe A,Grenier,Catherine Beigelman-Aubry,Catalin Fetita,et al. New frontiers in CT imaging of airway disease.Eur Radiol 2002,12(5):1022-1044.
[9]Marom EM,Goodman PC,Mc Adams HP. Diffuse abnormalities of the trachea and main bronchi.AJR 2001,176(3):713-717.
[10]Ambrosetti M,Ageno W,Spanevello A,et al. Prevalence and prevention or venous thromboe-Mbolism in patients with acute exacerbations or COPD[J]. Thromb Res,2003,112(4):203-207.
[11]Park KJ, Bergin CJ,Clausen JL.Quantitation of emphysema with three-dimensional CT densitometry.comparison with two-dimensional analysis,visual emphysema scores and pulmonary function test results.Radiology,1999,211(2): 541-547.
[12]张伟宏,蔡柏蔷,王京岚等.肺气肿的CT肺功能成像：CT技术与肺功能检查的对照研究[J].中华结核和呼吸杂志,2002,25(3)：150-153.
[13]Wakayama K,Kurihara N,Fujimoto S,et al.Relationship between exercise capacity and the severity of emphysema as determined by high-resolution CT[J].Eur Respir J,1993,6(9):1362-1367.
[14]Lamer RJ,Thelissen GR,Kessels AG,et al.Chronic obstructive pulmonary disease:evaluation with spirometrically controlled CT lung densitometry[J].Radiology, 1994,193(1):109-113.
[15]Shiro Satoh,Shinichi Ohdama,Hitoshi Shibuya,et al.Sliding thin slab,minimum intensity projection imaging frobjective analysis of emphysema.Radiat Med,2006,24(6):415-421.
[16]Stern EJ, Webb WR. Dynamic imaging of lung morphology with ultrafast high-resolution computed tomograph. J Thorac Imaging,1993,8(4):273-282.o
[17]Stern EJ, Webb WR, Gamsu G..Dynamic quantitative computed tomography: apredictor of pulmonary function in obstructive lung disease.Invest Radiol, 1994,29(5):564-569,
[18]张国桢,朱砚萍,单琳等.多层螺旋CT评价肺气肿患者肺功能的可行性.中华放射学杂,2007,41(3)：243-247.
[19]韩萍,张帆,刘芳等.螺旋CT结合呼吸门控对矽肺形态与功能变化的研究.中华放射学杂志,2002,36(7)：597-600.
[20]Akahaka A, Yomashita Y, Nakayama Y, et a.l Assessment of lung volumes in pulmonary emphysema using multidetector helical CT:comparison with pulmonary function tests. Comput Med Imaging Grap,2001,25(5):399-404.
[21]Chen D,Webb WR,Storto ML,et al.Assessment of air trapping using post expiratory high-resolution computed tomography[J]. J Thorac Imaging,1998, 13(2):135-143.
[22]沈慧聪,伍建林,郎志谨,等.动态CT扫描在慢性阻塞性肺病中的应用研究[J].中国医学计算机成像杂志,2003,9(4)：263-266.
[23]伍建林,沈慧聪,宋清伟,等.健康成人肺脏在动态螺旋CT扫描中正常表现的定量研究[J].中国临床医学影像杂志,2001,12(4)：246-247.
[24]薛雁山,许建英,纪智.阻塞性肺气肿定量CT与肺功能检查相关性的实验研究[J].中国医学影像技术,2002,18(5)：406-408.
[25]刘芳,韩萍,冯敢生,等.呼吸门控定量CT对慢性阻塞性肺疾病的诊断价值.中华放射学杂志,2001,35(12)：923-926。
[26]Lucidarme O, Coche E, Cluzel P, et al.Expirtory CT Scans for chronic airway disease:correlation with pulmonary function tests results.AJR,1998,170(2): 301-307。
[27]伍建林,沈慧聪,宋清伟,等。健康成人肺脏在动态螺旋CT扫描中正常表现的定量研究.中国临床医学影像杂志,2001,12(4)：246-249。。
[28]Gurney JW,Jones KK,Robbins RA,et al.Regional distribution of emphysema: correlation of high resolution CT with pulmonary function tests in unselected smokers[J].Radiology,1992,183(2):457-463.
[29]John HM,Austin MD.Pulmonary emphysema:imaging assessment of lung volume reduction surgery[J]. Radiology,1999,212(1):1-3.
[30]杨明,潘纪戍,陈起航,等.慢性阻塞性肺部疾病的电子束CT动态扫描[J].中华放射学杂志,1998,32(2)：76-81.
[31]]Mamadou Hawa H.D,Herveo G,et al.Distribution of Lung Density and Mass in Patients With Emphysema as Assessed by Quantitative Analysis of CT[J].CHEST,2000,118(6):1566-1575.
[32]Kauczor HU,Heussel CP,Fischer B,et al.Assessment of plung volume using helical CT at inspiration and expiration:comparison with pulmonary function tests.ARJ,1998,171(4):1091-1095.
[33]张伟宏,刘玉清,牟文斌,等.CT肺功能成像技术研究[J].中华放射学杂志,,2001,35(11)：832-836.
[34]葛虓俊,张国祯,滑炎卿,等·多层螺旋CT肺容积测定与肺功能的对照研究[J].中国CT和MRI杂志,2005,3(1)：30-32.
[35]李凯,龙莉玲,黄仲奎.多层螺旋CT肺容积测定在慢性阻塞性肺疾病预测诊断的应用价值[J].实用放射学杂志,2008,24(9)：1179-1183.
[36]Akira M, Toyokawa K, Inoue Y, et al. Quantitative CT in chronic obstructive pulmonary disease:inspiratory and expiratory ssessment [J]. AJR,2009,192 (7): 267-272.
[37]许景红,韩萍,等.呼吸门控下肺功能成像的研究.中华医学杂志,英文版.2002,115(10)：1545-1547.
[38]葛虓俊,张国桢,毛定飚,等.多层螺旋CT肺像素指数与肺功能的相关性[J].中国医学科学院学报,2006,28(1)：61-63.
[39]张国桢,朱砚萍,单琳等.多层螺旋CT评价肺气肿患者肺功能的可行性.中华放射学杂,2007,41(3)：243-247.
[40]Muller NL, Staples CA, Miller RR, et al."Density mask":an objective method to quantitate emphysema using computed tomography. Chest,1988, 94(4):782-787.
[41]张伟宏,蔡柏蔷,王京岚,林耀广,等.肺气肿的CT肺功能成像：CT技术与肺功能检查的对照研究.中华结核和呼吸杂志,2002,25(3)：150-153.