The Research Value of Biphasic Registration Quantitative Computed Tomography Emphysema Index in the Evaluation of Mild to Moderate COPD
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摘要:
目的：通过配准的双气相定量CT对轻中度慢性阻塞性肺疾病（COPD）患者肺气肿定量指标的对比分析，寻找最优肺气肿定量指标。方法：回顾性收集健康体检对照组55例和慢性阻塞性肺疾病全球倡议（GOLD）1级21例，GOLD 2级31例。将CT原始DICOM数据导入“数字肺”分析平台，测定深吸气末LAA％-950和深呼气末 LAA％-910。将呼气相与吸气相CT图像配准，根据阈值法计算出肺气肿区域百分比（PRMEmph％）、功能性小气道病变区域百分比（PRMfSAD％）和正常区域百分比（PRMNormal％）。肺功能指标包括FVC、FEV1％、FEV1/FVC。组间一般资料、CT定量指标和肺功能差异采用独立样本t检验、Mann-Whitney U检验或卡方检验，相关性采用Spearman相关分析。绘制受试者工作特征（ROC）曲线分析CT定量参数对轻中度COPD患者肺气肿的诊断效能。结果：轻中度COPD患者与正常对照组间性别、吸烟指数、FEV1％、FEV1/FVC、吸气相LAA％-950、呼气相LAA％-910、PRMEmph％、PRMfSAD％及 PRMNormal％差异均有统计学意义。吸气相LAA％-950与FEV1/FVC呈负相关，呼气相LAA％-910、PRMEmph％与FVC、FEV1％、FEV1/FVC均呈负相关。ROC曲线分析结果显示吸气相LAA％-950、呼气相LAA％-910及PRMEmph％曲线下面积分别为 0.742、0.861、0.876，其中PRMEmph％指标的曲线下面积最大，对应临界值为9.84％，敏感度76.90％，特异度94.50％。结论：定量CT肺气肿指标吸气相LAA％-950、呼气相LAA％-910及双气相 PRMEmph％都能够客观评估轻中度COPD患者的肺气肿情况，其中PRMEmph％是最优评估指标。
Abstract:Objective: To find the optimal quantitative index of emphysema by comparing and analyzing the quantitative indexes of emphysema in patients with mild to moderate chronic obstruction pulmonary disease (COPD) via registered biphasic quantitative computed tomography (QCT). Methods: We retrospectively collected 55 healthy controls, 21 Global Initiative for Chronic Obstructive Pulmonary Disease (GOLD) 1 case, and 31 GOLD 2 cases in our hospital. We imported the CT raw DICOM data into the "Digital Lung" analysis platform and measured the LAA-950% at the end of deep inspiration and the LAA-910% at the end of deep expiration. The expiratory and inspiratory CT images were registered. Then, the percentage of emphysema area (PRMEmph%), the percentage of functional small airway disease area (PRMfSAD%), and the percentage of the normal area (PRMNormal%) were calculated according to the threshold method. Pulmonary function indicators included FVC, FEV1%, and FEV1/FVC. Differences in general data, CT quantitative indexes, and pulmonary function between groups were assessed using the independent sample t-test, Mann–Whitney U test, or chi-square test, and the correlation was analyzed using Spearman correlation. The receiver operating characteristic (ROC) curve was drawn to analyze the diagnostic performance of CT quantitative parameters for emphysema in patients with mild to moderate COPD. Results: There were significant differences in sex, smoking index, FEV1%, FEV1/FVC, inspiratory phase LAA%-950, expiratory phase LAA%-910, PRMEmph%, PRMfSAD%, and PRMNormal% between the mild to moderate COPD patients and normal control groups. The inspiratory phase LAA%-950 was negatively correlated with FEV1/FVC, the expiratory phase LAA%-910 and PRMEmph% were negatively correlated with FVC, FEV1%, and FEV1/FVC. ROC curve analysis results showed that the areas under the curve of inspiration phase LAA%-950, expiratory phase LAA%-910, and PRMEmph% were 0.742, 0.861, and 0.876, respectively. Among them, the area under the curve of the PRMEmph% index was the largest, with a corresponding critical value of 9.84%, a sensitivity of 76.90%, and a specificity of 94.50%. Conclusion: Quantitative CT emphysema index LAA%-950 in the inspiratory phase, LAA%-910 in the expiratory phase, and PRMEmph% in biphasic can objectively evaluate emphysema in patients with mild to moderate COPD, among which PRMEmph% is the best evaluation index.
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图 3 男，63岁，GOLD 2级。正常对照受试者与轻中度COPD患者PRMEmph％（红色区域）存在差异，轻中度COPD患者病变明显加重
Figure 3. Male, 63 years old, GOLD grade 2. There was a difference in PRMEmph％ (red area) between normal controls and patients with mild to moderate COPD, and the lesions of patients with mild to moderate COPD were significantly aggravated
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图 4 CT定量参数区分轻中度COPD患者肺气肿的ROC
Figure 4. ROC of CT quantitative parameters to differentiate emphysema in patients with mild to moderate COPD
表 1 一般资料结果比较
Table 1 Comparison of general information and results
项目 正常对照组（n=55） 轻中度COPD患者（n=52） 统计检验 $t/ {\chi }^{2}/Z $ P 年龄/岁 58.130±8.228 58.700±9.622 -0.735 0.464 性别（男/女） 53/2 40/12 8.883 0.003 BMI/（kg/m2） 24.573±2.975 23.380±2.507 1.684 0.096 吸烟指数 400.000（392.000） 655.000（800.000） -3.327 0.001 FVC/L 3.461±0.769 3.270±1.052 1.248 0.215 FEV1％/％ 81.570±14.395 69.640±13.654 3.008 0.003 FEV1/FVC/％ 81.030±10.000 58.880±9.771 12.236 ＜0.001 注：正态资料用$\bar{x}$±s表示，偏态资料用M(Q)表示。 
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表 2 正常对照与轻中度COPD组间CT定量指标比较
Table 2 Comparison of CT quantitative indexes between the normal control and mild to moderate COPD groups
项目 正常对照组（n=55） 轻中度COPD患者（n=52） 统计检验 Z P 吸气相LAA％-950/％ 19.210（7.890） 28.160（12.080） -4.323 ＜0.001 呼气相LAA％-910/％ 10.380（10.360） 26.210（26.680） -6.439 ＜0.001 PRMEmph％/％ 4.055（3.570） 15.610（18.590） -6.697 ＜0.001 PRMfSAD％/％ 14.685（11.640） 27.810（15.280） -4.806 ＜0.001 PRMNormal％/％ 59.615（15.120） 37.340（37.490） -5.273 ＜0.001 注：偏态资料用M(Q)表示。
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表 3 CT定量参数与肺功能的相关性
Table 3 Correlations between CT quantitative parameters and pulmonary function
CT定量参数 相关系数及其检验rS（P） FVC/L FEV1％/％ FEV1/FVC/％ 吸气相LAA％-950/％ 0.044（0.655） -0.150（<0.122） -0.512（<0.001） 呼气相LAA％-910/％ -0.301（0.002） -0.394（<0.001） -0.668（<0.001） PRMEmph％/％ -0.269（0.005） -0.361（<0.001） -0.696（<0.001）
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