CAJ | 학술논문

目的探讨不同体位呼气相薄层MSCT对异基因造血干细胞移植(allo-HSCT)后肺部气体潴留诊断的价值.方法对31例allo-HSCT后患者行低剂量呼气相仰卧位、俯卧位肺部MSCT扫描,检查患者肺部有无气体潴留病灶,利用GE 工作站测定气体潴留区域(呼气相肺部CT值≤-700 HU)占全肺体积百分比,并进行评分,得出体积分数.对不同体位病灶检出率用McNemar检验,对测得的体积分数进行秩和检验.结果仰卧位扫描发现8例气体潴留阳性(25.8％)；俯卧位扫描阳性15例(48.4％),其中双体位均示阳性7例,仰、俯2种体位的阳性检出率差异有统计学意义(x2 =4.00,P=0.039)；2种体位测得体积分数仰卧位得分13分,俯卧位得分21分,差异有统计学意义(Z=-3.37,P=0.001),俯卧位对气体潴留敏感度较高.结论 allo-HSCT后临床上出现慢性排异反应患者进行呼气相薄层MSCT肺部检查,应加扫俯卧位,不仅可以更敏感地发现双肺下叶前段气体潴留病灶,并且可以初步评估气体潴留的严重程度,为临床早期诊断和早期治疗提供依据.
목적 탐토불동체위호기상박층MSCT대이기인조혈간세포이식(allo-HSCT)후폐부기체저류진단적개치.방법 대31례allo-HSCT후환자행저제량호기상앙와위、부와위폐부MSCT소묘,검사환자폐부유무기체저류병조,이용GE 공작참측정기체저류구역(호기상폐부CT치≤-700 HU)점전폐체적백분비,병진행평분,득출체적분수.대불동체위병조검출솔용McNemar검험,대측득적체적분수진행질화검험.결과 앙와위소묘발현8례기체저류양성(25.8％)；부와위소묘양성15례(48.4％),기중쌍체위균시양성7례,앙、부2충체위적양성검출솔차이유통계학의의(x2 =4.00,P=0.039)；2충체위측득체적분수앙와위득분13분,부와위득분21분,차이유통계학의의(Z=-3.37,P=0.001),부와위대기체저류민감도교고.결론 allo-HSCT후림상상출현만성배이반응환자진행호기상박층MSCT폐부검사,응가소부와위,불부가이경민감지발현쌍폐하협전단기체저류병조,병차가이초보평고기체저류적엄중정도,위림상조기진단화조기치료제공의거.
Objective To explore the effects of different body positions at the expiratory phase thinsection multi-slice spiral CT on the diagnosis of pulmonary air trapping after allogeneic hematopoietic stem cell transplantation(allo-HSCT).Methods Thirty-one allo-HSCT patients underwent the expiratory phase low-dose MSCT lung scanning at supine and prone positions to detect whether they have air trapping lesion,the volume percent of air trapping region (CT value ≤-700 HU at expiratory phase) against the whole lung was measured by using GE workstation after grading.Statistical analysis on lesion detection rate was performed with McNemar test and volume percent with rank sum test.Results Air trapping regions were observed in 8 patients (25.8％,8/31) who performed CT scan at the supine position,while 15 cases (48.4％,15/31)were positive for prone position CT scan.Seven cases showed positive results at both body positions.Statistical significance in the positive detection rate at supine and prone positions was found (x2 =4.00,P =0.039).The volume fraction of the two positions was 13 for supine position and 21 for prone position with statistical significance (Z =-3.37,P =0.001).Sensitivity at prone position CT scan to detect air trapping was much higher than that at supine position CT scan.Conclusion For allo-HSCT patients with chronic rejection reaction,performing expiratory phase thin-section CT scan and prone position scan can not only improve the detection rate of lung forepart lesions,but also preliminarily evaluate the severity of the air trapping,which can provide a basis for the early diagnosis and treatment in clinics.