无症状非吸烟者肺HRCT定量分析及其与肺功能的相关性研究
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摘要
目的：通过分析不同年龄组无症状非吸烟者吸气相、呼气相HRCT肺密度定量指标，探讨(1)健康成人随年龄的变化，呼吸气相HRCT定量指标的变化及其与肺功能的相关性；(2)年龄对呼气相CT空气潴留的影响以及空气潴留与肺功能的相关性。材料与方法：对经严格选择的63例无症状非吸烟者进行肺吸气末与呼气末HRCT扫描，其中32例进行肺功能测试。将所有受试者按年龄分为5组，评价随年龄增加肺吸气相呼气相定量指标的变化，及其与肺功能的相关性。对呼气相HRCT上空气潴留进行定量分析，并评价其与肺功能的相关性。结果：(1)各年龄组肺呼气相、吸气相CT平均肺密度值(单位HU)分别为：21-30岁组分别为-688.093±29.3875和-881.375±28.9531，31-40岁组-693.805±23.3521和-876.858±26.0755，41-50岁组-706.836±18.3758和-873.663±24.2965，51-60岁组-736.579±21.8974和-876.734±17.3546，61岁以上组-778.672±19.6581和-866.598±20.6975。(2)各年龄组的全肺平均吸呼气相CT肺密度差(单位为HU)分别为：21-30岁组为193.282±53.1184，31-40岁组183.053±64.1520，41-50岁组166.827±44.6268，51-60岁组140.155±39.9931，61岁以上组87.917±34.6236。随着年龄的增高，全肺密度差值呈降低趋势，而且这种降低在统计学上有显著意义(P＜0.01)。(3)FVC、FEV1、TLC与吸气相各个肺野及全肺的平均肺密度均有极显著的相关性(P＜0.01)，此三项指标与吸气相全肺平均密度的相关系数(r)分别为FVC=-0.682、FEV1=-0.694、TLC=-0.768；RV与吸气相中肺野平均肺密度极显著相关(P＜0.01)，与上、下肺野及全肺则为显著相关(P＜0.05)，与全肺的相关系数(r)为-0.565。(4)所有受试者总的空气潴留出现率为39.7％(25／63)，其中Ⅰ型22.2％(14／63)，Ⅱ型17.5％(11／63)，各组均未出现Ⅲ型空气潴留，也就是说没有一例受试者的空气潴留面积超过25％。其中以肺小叶型空气潴留为主的18例，以肺段型为主的9例，未出现肺叶型。(5)空气潴留组与无空气潴留组之间的FVC和FEV1／FVC平均值之间存在显著差异(P＜0.05)；FEV1／FVC更是与空气潴留的分级有明显的相关性(r=-0.529，P＜0.05)。结论：无症状非吸烟者随年龄变化，其吸呼气相HRCT肺密度定量指标，尤其是呼气相平均肺密度和肺密度
中文摘要
差，发生了相应的变化。无症状非吸烟者呼气相HRCT出现的空气储留约
40%，年龄可能为其形成原因之一。无症状非吸烟者的肺功能在正常范围内
时，吸呼气相HRCT仍可能反映某些指标的轻微变化:吸气相平均肺密度较好
的与FVC、FEVI、TLC及RV相关;空气储留的面积分级则与FEVI/F VC呈
明显的相关性。
Objective: To study (1) the changes with aging of inspiratory and expiratory HRCT lung density parameters in asymptomatic nonsmokers, and the correlation with PFT(pulmonary function test) results;(2) the effect on expiratory HRCT air trapping resulted from aging and the correlation between air trapping and PFT results by quantitatively analyzing the inspiratory and expiratory HRCT mean lung density in different groups of asymptomatic nonsmokers. Materials and Methods: Lung HRCT scans were performed at end inspiratory and end expiratory in 63 subjects, and PFT were performed in 32 of them. All the subjects were divided into 5 groups according to the ages. Changes with aging of lung inspiratory and expiratory HRCT quantitative parameters and the correlation with PFT results were assessed. Air trappings in expiratory HRCT were quantitatively analyzed and the correlation between air trapping and PFT results were assessed. Results: (1) In each age group the mean lung density of inspiratory and expiratory lung HRC
T respectively are(HU): 21-30years group respectively are-688.093±29.3875 and -881.375± 28.9531, 31-40 years group -693.805 ±23.3521 and -876.858 + 26.0755, 41-50 years group -706.836± 18.3758 and -873.663±24.2965, 51-60 years group -736.579 ± 21.8974 and -876.734 ± 17.3546 , more than 61 years group -778.672±19.6581 and -866.598 + 20.6975. (2) In each age group the overall mean lung density difference between inspiratory and expiratory HRCT respectively are (HU): 21-30 years group 193.282 ± 53.1184 , 31-40 years group 183.053 + 64.1520, 41-50 years group 166.827±44.6268, 51-60 years group 140.155 + 39.9931, more than 61 years group 87.917 ± 34.6236. With aging, the overall mean lung density difference between inspiratory and expiratory HRCT is on decrease, and the decrease is significantly different (P<0.01).(3)FVC, FEV1, TLC correlate significantly with mean lung density of each lung field and overall lung in inspiratory HRCT(P<0.01), and the correlation parameter (r) between these three results and the me
an lung density of overall lung respectively are : FVC= -0.682, FEV1= -0.694, TLC= -0.768 : RV correlates extremely significantly with the middle lung field in inspiratory HRCT(P<0.01), significantly with the upper, lower lung field
and overall lung(P<0.05), the correlation parameter with the overall lung is -0.565. (4) Air trapping occurred in 39.7% (25/63) subjects, including type I 22.2% (14/63), type II 17.5% (11/63), type III never occurred . In all cases with air trappings ,18 cases predominantly appear as lobular, 9 cases segmental, and none lobar air trapping. (5) The difference of FVC and FEV1/FVC between air trapping group and normal group is significant (P<0.05) : FEV1/FVC significantly correlate with the grade of air trapping especially (r = -0.529, P<0.05). Conclusion: Quantitative parameters of inspiratory and expiratory lung HRCT, especially mean lung density and the density difference changed subsequently with aging in asymptomatic nonsmokers. Air trapping occurred in about 40% asymptomatic nonsmokers and aging maybe one of its causes. Inspiratory and expiratory HRCT may reflect the subtle changes of PFT results within the normal ranges: FVC, FEV1, TLC and RV correlate significantly with inspiratory CT mean lung density
. And there is significant correlation between FEV1/FVC and the area grade of air trapping.
中文摘要
差，发生了相应的变化。无症状非吸烟者呼气相HRCT出现的空气储留约
40%，年龄可能为其形成原因之一。无症状非吸烟者的肺功能在正常范围内
时，吸呼气相HRCT仍可能反映某些指标的轻微变化:吸气相平均肺密度较好
的与FVC、FEVI、TLC及RV相关;空气储留的面积分级则与FEVI/F VC呈
明显的相关性。
Objective: To study (1) the changes with aging of inspiratory and expiratory HRCT lung density parameters in asymptomatic nonsmokers, and the correlation with PFT(pulmonary function test) results;(2) the effect on expiratory HRCT air trapping resulted from aging and the correlation between air trapping and PFT results by quantitatively analyzing the inspiratory and expiratory HRCT mean lung density in different groups of asymptomatic nonsmokers. Materials and Methods: Lung HRCT scans were performed at end inspiratory and end expiratory in 63 subjects, and PFT were performed in 32 of them. All the subjects were divided into 5 groups according to the ages. Changes with aging of lung inspiratory and expiratory HRCT quantitative parameters and the correlation with PFT results were assessed. Air trappings in expiratory HRCT were quantitatively analyzed and the correlation between air trapping and PFT results were assessed. Results: (1) In each age group the mean lung density of inspiratory and expiratory lung HRC
T respectively are(HU): 21-30years group respectively are-688.093±29.3875 and -881.375± 28.9531, 31-40 years group -693.805 ±23.3521 and -876.858 + 26.0755, 41-50 years group -706.836± 18.3758 and -873.663±24.2965, 51-60 years group -736.579 ± 21.8974 and -876.734 ± 17.3546 , more than 61 years group -778.672±19.6581 and -866.598 + 20.6975. (2) In each age group the overall mean lung density difference between inspiratory and expiratory HRCT respectively are (HU): 21-30 years group 193.282 ± 53.1184 , 31-40 years group 183.053 + 64.1520, 41-50 years group 166.827±44.6268, 51-60 years group 140.155 + 39.9931, more than 61 years group 87.917 ± 34.6236. With aging, the overall mean lung density difference between inspiratory and expiratory HRCT is on decrease, and the decrease is significantly different (P<0.01).(3)FVC, FEV1, TLC correlate significantly with mean lung density of each lung field and overall lung in inspiratory HRCT(P<0.01), and the correlation parameter (r) between these three results and the me
an lung density of overall lung respectively are : FVC= -0.682, FEV1= -0.694, TLC= -0.768 : RV correlates extremely significantly with the middle lung field in inspiratory HRCT(P<0.01), significantly with the upper, lower lung field
and overall lung(P<0.05), the correlation parameter with the overall lung is -0.565. (4) Air trapping occurred in 39.7% (25/63) subjects, including type I 22.2% (14/63), type II 17.5% (11/63), type III never occurred . In all cases with air trappings ,18 cases predominantly appear as lobular, 9 cases segmental, and none lobar air trapping. (5) The difference of FVC and FEV1/FVC between air trapping group and normal group is significant (P<0.05) : FEV1/FVC significantly correlate with the grade of air trapping especially (r = -0.529, P<0.05). Conclusion: Quantitative parameters of inspiratory and expiratory lung HRCT, especially mean lung density and the density difference changed subsequently with aging in asymptomatic nonsmokers. Air trapping occurred in about 40% asymptomatic nonsmokers and aging maybe one of its causes. Inspiratory and expiratory HRCT may reflect the subtle changes of PFT results within the normal ranges: FVC, FEV1, TLC and RV correlate significantly with inspiratory CT mean lung density
. And there is significant correlation between FEV1/FVC and the area grade of air trapping.
引文
1 Heremans A, Verschakelen JA, et al. Measurement of lung density by means of quantitative CT scanning. Chest, 1992,102:805-811.
2 Austin JH, Muller NL, Friedman PJ, et al. Glossary of terms for CT of the lungs: recommendations of the Nomenclature Committee of the Fleischner Society. Radiology, 1996,200:327-331.
3 Mastora I, Remy-Jardin M, Sobaszek A et al. Thin-section CT findings in 250 volunteers: Assessment of the relationship of CT findings with smoking history and pulmonary function test results. Radiology,2001,218:695-702.
4 Lee KW, Chung SY, Yang I, Lee Y, Ko EY, Park MJ. Correlation of aging and smoking with air trapping at thin-section CT of the lung in asymptomatic subjects. Radiology,2000,214:831-836.
5 韩江娜．衰老与肺功能．新疆医学，1991，21：41-43．
6 Buist AS, Ross BB. Predicted values for closing volumes using a modified single breath nitrogen test. Am Rev Respir Dis, 1973,107:744-52..
7 Kinsella M, Muller NL, Abboud RT, et al. Quantitation of emphysema by computed tomography using a density mask program and correlation with pulmonary function tests. Chest, 1990,97: 315-321.
8 Levi C, Gray JE, McCullough EC, Hattery RR. The unreliability of CT numbers as absolute values. Am J Roentgenol, 1982,139:443-447
9 Kalender WA, Rienmuller R, Seissler W, Behr J, Welke M, Fichte H.. Measurement of pulmonary parenchymal attenuation: use of spirometric gating with quantitative CT. Radiololgy, 1990,175:265-268.
10 Kohz P, Stabler A, Beinert T, et al. Reproducibility of quantitative, spirometrically controlled CT. Radiology,1995,197:539-542.
11 Kauczor HU, Heussel CP, Fischer B, et al. Assessment of lung Volumes using helical CT at inspiration and expiration: comparison with pulmonary function tests. AJR. 1998,171:1091-1095.
12 Rienmuller RK, Behr J, Kalender WA, et al. Standardized quantitative high resolution CT in lung disease. J Comput Assist Tomogr, 1991,15:742.
13 Bae KT, Slone RM, Gierada DS, et al. Patients with emphysema: quantitative CT analysis before and after lung volume reduction surgery. Radiology, 1997, 203:705-714.
14 韩萍，许景红，杨帆等．螺旋 CT 结合呼吸门控对肺部形态及有关参数与功能关系的研究．临床放射学杂志，1999，18：337-342
15 李铁一 主编．中华影像医学-呼吸系统卷．人民卫生出版社 2002，6：89
16 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，2001，35：923-926．
17 Beinert T, Behr J, Mehnert F, et al. Spirometrically controlled quantitative CT for assessing diffuse parenchymal lung disease. J Comput Assist Tomagr, 1995,19:924-931.
18 谢晟，王仁贵，王仪生 等．肺 HRCT 的吸气相和呼气相的定量研究及其与肺功能关系的初步研究．实用放射学杂志，2002，18：165-167．
19 Hiroaki Arakawa, Webb WR, Marcia Mccowin, et al. Inhomogenous lung attenuation at thin-section CT: Diagnositic value of expiratory scans. Radiology. 1998,206:89-94
20 Stern EJ, Webb WR, Gamsu G. Dynamic quantitative computed tomography: A predictor of pulmonary function in obstructive lung diseases. Invest Radiol, 1994, 29:564-469.
21 Olivier Lucidarma, Emmannel Cohe, Phillipe Cluzel, et al. Expiratory CT scan for chronic airway diseases: correlation with pulmonary test results. A JR, 1998,170:301-307.
22 Webb WR, Stern EJ, Kanth N et al. Dynamic pulmonary CT: findings in healthy adult men. Radiology, 1993,186:117-124.
23 Chen D, Webb WR, Storto ML et al. Assessment of air trapping using postexpiratory high-resolution computed tomography. J Thorac Imaging, 1998,13:135-143.
24 Remy-Jardin M, Remy J, Gosselin B et al. Lung parenchymal changes secondary to cigarette smoking:pathologic CT correlations. Radiology, 1993,186:643-654.
25 Lucidarme O, Coche E, Cluzel P et al. Expiratory CT scans for chronic airway disease: correlation with pulmonary function test results. AJR, 1998,170:301-307.
26 Hansell DM, Wells AU, Padley SP et al. Hypersensitivity pneumonitis: correlation of individual CT patterns with functional abnormalities. Radiology, 1996,199:123-128.
27 Hansell DM, Rubens MB, Padley SP et al. Obliterative bronchiolitis: individual CT signs of small airway disease and functional correlation. Radiology, 1997, 203:721-726.
28 Padley SPG, Adler BD, Hansell DM et al. Bronchiolitis obliterans: highresolution CT findings and correlation with pulmonary function tests. Clin Radiol, 1993,47:236-240.
29 Roberts HR,Wells AU,Milne DG et al.Airflow obstruction in bronchiectasis:correlation between computed tomography features and pulmonary function tests.Thorax,2000,55:198-204．
2 Austin JH, Muller NL, Friedman PJ, et al. Glossary of terms for CT of the lungs: recommendations of the Nomenclature Committee of the Fleischner Society. Radiology, 1996,200:327-331.
3 Mastora I, Remy-Jardin M, Sobaszek A et al. Thin-section CT findings in 250 volunteers: Assessment of the relationship of CT findings with smoking history and pulmonary function test results. Radiology,2001,218:695-702.
4 Lee KW, Chung SY, Yang I, Lee Y, Ko EY, Park MJ. Correlation of aging and smoking with air trapping at thin-section CT of the lung in asymptomatic subjects. Radiology,2000,214:831-836.
5 韩江娜．衰老与肺功能．新疆医学，1991，21：41-43．
6 Buist AS, Ross BB. Predicted values for closing volumes using a modified single breath nitrogen test. Am Rev Respir Dis, 1973,107:744-52..
7 Kinsella M, Muller NL, Abboud RT, et al. Quantitation of emphysema by computed tomography using a density mask program and correlation with pulmonary function tests. Chest, 1990,97: 315-321.
8 Levi C, Gray JE, McCullough EC, Hattery RR. The unreliability of CT numbers as absolute values. Am J Roentgenol, 1982,139:443-447
9 Kalender WA, Rienmuller R, Seissler W, Behr J, Welke M, Fichte H.. Measurement of pulmonary parenchymal attenuation: use of spirometric gating with quantitative CT. Radiololgy, 1990,175:265-268.
10 Kohz P, Stabler A, Beinert T, et al. Reproducibility of quantitative, spirometrically controlled CT. Radiology,1995,197:539-542.
11 Kauczor HU, Heussel CP, Fischer B, et al. Assessment of lung Volumes using helical CT at inspiration and expiration: comparison with pulmonary function tests. AJR. 1998,171:1091-1095.
12 Rienmuller RK, Behr J, Kalender WA, et al. Standardized quantitative high resolution CT in lung disease. J Comput Assist Tomogr, 1991,15:742.
13 Bae KT, Slone RM, Gierada DS, et al. Patients with emphysema: quantitative CT analysis before and after lung volume reduction surgery. Radiology, 1997, 203:705-714.
14 韩萍，许景红，杨帆等．螺旋 CT 结合呼吸门控对肺部形态及有关参数与功能关系的研究．临床放射学杂志，1999，18：337-342
15 李铁一 主编．中华影像医学-呼吸系统卷．人民卫生出版社 2002，6：89
16 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，2001，35：923-926．
17 Beinert T, Behr J, Mehnert F, et al. Spirometrically controlled quantitative CT for assessing diffuse parenchymal lung disease. J Comput Assist Tomagr, 1995,19:924-931.
18 谢晟，王仁贵，王仪生 等．肺 HRCT 的吸气相和呼气相的定量研究及其与肺功能关系的初步研究．实用放射学杂志，2002，18：165-167．
19 Hiroaki Arakawa, Webb WR, Marcia Mccowin, et al. Inhomogenous lung attenuation at thin-section CT: Diagnositic value of expiratory scans. Radiology. 1998,206:89-94
20 Stern EJ, Webb WR, Gamsu G. Dynamic quantitative computed tomography: A predictor of pulmonary function in obstructive lung diseases. Invest Radiol, 1994, 29:564-469.
21 Olivier Lucidarma, Emmannel Cohe, Phillipe Cluzel, et al. Expiratory CT scan for chronic airway diseases: correlation with pulmonary test results. A JR, 1998,170:301-307.
22 Webb WR, Stern EJ, Kanth N et al. Dynamic pulmonary CT: findings in healthy adult men. Radiology, 1993,186:117-124.
23 Chen D, Webb WR, Storto ML et al. Assessment of air trapping using postexpiratory high-resolution computed tomography. J Thorac Imaging, 1998,13:135-143.
24 Remy-Jardin M, Remy J, Gosselin B et al. Lung parenchymal changes secondary to cigarette smoking:pathologic CT correlations. Radiology, 1993,186:643-654.
25 Lucidarme O, Coche E, Cluzel P et al. Expiratory CT scans for chronic airway disease: correlation with pulmonary function test results. AJR, 1998,170:301-307.
26 Hansell DM, Wells AU, Padley SP et al. Hypersensitivity pneumonitis: correlation of individual CT patterns with functional abnormalities. Radiology, 1996,199:123-128.
27 Hansell DM, Rubens MB, Padley SP et al. Obliterative bronchiolitis: individual CT signs of small airway disease and functional correlation. Radiology, 1997, 203:721-726.
28 Padley SPG, Adler BD, Hansell DM et al. Bronchiolitis obliterans: highresolution CT findings and correlation with pulmonary function tests. Clin Radiol, 1993,47:236-240.
29 Roberts HR,Wells AU,Milne DG et al.Airflow obstruction in bronchiectasis:correlation between computed tomography features and pulmonary function tests.Thorax,2000,55:198-204．