Kantitatif Bilgisayarli Tomografinin Kronik Obstrüktif Akciğer Hastaliği Fenotipi Belirlemedeki Rolü

Yıl 2021, , 97 - 103, 31.12.2021

Sümeyye Alparslan Bekir , Gökçe Kaan Ataç Evrim Akpınar , Esra Büyük , Sinem Güngör , Eylem Tunçay , Meral Gülhan

https://doi.org/10.35514/mtd.2021.56

Öz

Amaç: Kronik obstrüktif akciğer hastalığı tanısı konmuş hastalarda, kantitatif toraks BT’nin KOAH fenotiplerinin belirlenmesindeki rolünü araştırmak.
Materyal ve Metod: Ocak 2007- Eylül 2013 tarihleri arasında Ufuk Üniversitesi Dr. Rıdvan Ege Hastanesi Göğüs Hastalıkları polikliniği/servisinde değerlendirilen 104 hasta ve 20 kontrol olgusu çalışmaya alındı. Hastaların spirometrik parametrelerine SFT kayıtlarından, toraks BT verilerine ise Radyoloji arşivinden ulaşıldı. Tüm toraks BT’lerin kantitatif incelemesi Radyoloji Anabilim Dalında belirlenen tek bir Radyoloji Uzmanı tarafından yapıldı. Görüntü Arşivleme ve İletişim sisteminden elde edilen toraks BT incelemeleri Radyoloji servisinde kullanılan iş istasyonuna yüklendi. Bu amaçla Adwanced Workstation 4.2 Sun Workstation kullanıldı.
Bulgular: Çalışmamızda sağ ve sol akciğer amfizem hacimleri ortalama değerleri sırasıyla 205,8 ± 303,3 ml ve 210,3 ± 363,8 ml olup kontrol grupları ile aralarında anlamlı bir fark bulundu (p<0,001). Olguların ROC analizinden elde edilen amfizem hacmi eşik değeri % 2,1 olarak alındığında, FEV1/FVC <%70’in altında olma durumunu tahmin etmedeki duyarlılığı %62,3, seçiciliği %94,4, pozitif prediktif değeri ise %98,5 olarak bulundu. Kronik bronşit ise direk bronş duvar kalınlığı ölçümleriyle bir cut-off belirlenemedi. Katılımcıların spirometri değerleri incelendiğinde kronik bronşitlilerin (n=39) FEV1, FEV1/FVC ve FEF 25-75 değerleri amfizemli olgularınkinden (n=65) anlamlı olarak yüksek bulunmuştur (p<0,05). Spirometri değerlerinden, YÇBT’deki amfizem yüzdesi ile en yüksek negatif korelasyon gösteren parametre FEV1/FVC idi (r=-0,539) (p<0,001). Diğer spirometri değerlerinin aksine FEV1/FVC ( % ) değeri ile bronş duvar kalınlığı arasında negatif korelasyon izlendi (r=-0,214) (p<0,05).
Sonuç: Kantitatif BT’de amfizem ve kronik bronşit varlığının fonksiyonel değerlendirme sonuçlarını öngördüğü ancak, yıllık atak sayısı ve semptom skorları açısından belirleyici olmadığı izlenmiştir. Ayrıca kantitatif BT’de amfizem hacmi eşik değeri %2,1 olarak bulundu. Radyolojik bulguların klinikle korelasyonu değerlendirilip fenotip belirlenmesi için ileri araştırmalara ihtiyaç vardır.
Anahtar kelimeler: Bilgisayarlı tomografi, KOAH, fenotip, spirometri

Anahtar Kelimeler

Bilgisayarlı tomografi, KOAH, fenotip, spirometri

Destekleyen Kurum

Yok

The role of quantitative computed tomography in determining the phenotype of chronic obstructive pulmonary disease

Öz

Backround: To assess the role of quantitative thorax computerized tomography (CT) in determining phenotypes of chronic obstructuve pulmonary disease (COPD).
Material and Methods: 104 patients admitted /consulted to Chest Diseases outpatient clinic/ ward in University Hospital and 20 healthy controls were enrolled in this study between January 2007 and September 2013. The spirometry values were obtained from Spirometry Lung Function Test registry and thorax CT scans were obtained from archive of Radiology department. The quantitative evaluation of CTs were performed by the same radiologist. The torax CT imagings obtained from the Picture archiving and Communication System were loaded to the work station of Radiology. Advanced Workstation 4.2 Sun Workstation was applied.
Results: The emphysema mean volumes of the right and the left lung - evaluated were 205,8 ± 303,3 ml and 210,3 ± 363,8 ml, and significant difference was determined between the groups (p<0,001). The threshold for emphysema volume was detected as 2,1%; sensitivity, specifity anpositive predictive value to predict FEV1/FVC ≤ 70 was 62,3%, 94,4% 98,5% respectively. No cut-off value was determined for chronic bronchitis with bronchial diameter measurements. Besides, FEV1, FEV1/FVC and FEF 25-75 values of the patients with chronic bronchitis were significantly higher than the patients with emphysema (p<0,05). The FEV1/ FVC value has the strongest negative correlation with emphysema percentage value of the High Resolution CT (r= -0, 539) (p<0,001). FEV1/FVC had also negative correlation with bronchial wall diameter (r=-0,214) (p<0,05).
Conclusion: In quantitative CT the presence of emphysema and chronic bronchitis predicted the results of functional evaluation, but was not determinative in annual attack number and symptom scores. The cut-off value was found as 2,1% on quantitative CT for volume of empysema. Further studies are required in order to correlate the clinical state with radiological findings and determine the phenotype.
Keywords: Computed tomography, COPD, phenotype, spirometry

Anahtar Kelimeler

Computed tomography, COPD, phenotype, spirometry

Kaynakça

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