间质性肺异常CT定量：仰卧位与俯卧位的前瞻性比较
本研究前瞻性纳入38例间质性肺异常（ILA）患者，同日行仰卧与俯卧位CT，用深度学习软件定量纤维化及非纤维化成分。仰卧位总ILA及纤维化成分均高于俯卧位，纤维化成分一致性中等，非纤维化成分一致性差。仰卧与俯卧位CT不可互换用于qCT分析。
要点
- 仰卧位CT测得的ILA总范围及纤维化成分均高于俯卧位。
- 纤维化成分位置间一致性中等，非纤维化成分一致性差。
- 仰卧与俯卧位CT不应互换用于ILA的qCT分析。
核心结论
- 仰卧与俯卧位CT的ILA定量测量变异约1.9%。
- 纤维化成分位置间一致性中等，非纤维化成分一致性差。
- 仰卧与俯卧位CT不应互换用于ILA的qCT分析。
研究设计与样本
- 前瞻性研究，2024年2月至2025年2月，最终分析38例ILA患者。
- 同日行仰卧与俯卧位非增强CT，采集参数相同。
- 使用商业深度学习软件按Fleischner学会定义定量ILA成分。
关键影像表现/征象
- 仰卧位总ILA范围大于俯卧位（1.76% vs 1.39%，p=0.02）。
- 仰卧位纤维化ILA范围大于俯卧位（1.43% vs 1.12%，p=0.007）。
- 非纤维化成分在依赖肺区重复性最低。
诊断标准与关键数值
- 总ILA范围仰卧与俯卧位的95%一致性界限为-1.49%至2.23%。
- 纤维化成分95%一致性界限为-0.97%至1.58%。
- 非纤维化成分95%一致性界限为-0.89%至1.03%。
- 纤维化成分一致性相关系数CCC=0.770（中等）。
- 非纤维化成分一致性相关系数CCC=0.431（差）。
临床应用与阅片要点
- 纵向随访ILA定量时需保持患者体位一致。
- 报告qCT结果时注意仰卧位可能高估纤维化成分。
- 依赖肺区非纤维化成分测量变异大，解读需谨慎。
局限性
- 样本量较小（最终分析38例）。
- 单中心前瞻性研究。
以上解读依据论文摘要（全文未开放获取或许可不允许翻译转载）。
英文原文（摘要）· 点击展开
OBJECTIVE: To prospectively evaluate positional variability in quantitative CT (qCT)-derived measurements of interstitial lung abnormality (ILA) using the same-day supine and prone CT.
MATERIALS AND METHODS: In this prospective study (February 2024-February 2025), participants with ILA underwent sequential non-contrast supine and prone CT scans using identical acquisition parameters. A commercially available deep learning-based software quantified fibrotic (reticulation and honeycombing) and nonfibrotic (ground-glass opacity) ILA components in accordance with Fleischner Society definitions. qCT differences between supine and prone measurements were assessed using paired t tests, Bland-Altman analysis with 95% limits of agreement (LOA), and concordance correlation coefficients (CCC).
RESULTS: Of 47 consented participants, 38 (mean age, 70.9 ± 6.4 years; 27 men) were included in the final analysis. Mean total ILA extent was greater on supine than on prone scans (1.76% vs 1.39%, p = 0.02), largely due to a greater extent of fibrotic ILAs on supine images (1.43% vs 1.12%, p = 0.007). The 95% LOA between supine and prone scans were -1.49% to 2.23% for total ILA extent, -0.97% to 1.58% for the fibrotic component, and -0.89% to 1.03% for the nonfibrotic component. Agreement between positions was moderate for the fibrotic component (CCC = 0.770), and poor for the nonfibrotic component (CCC = 0.431), with the lowest reproducibility observed in dependent lung zones.
CONCLUSION: The measurement variability of qCT result of ILA between supine and prone scans was approximately 1.9%, with moderate agreement for the fibrotic component but poor agreement for the nonfibrotic component between the same-day supine and prone CT scans.
KEY POINTS: Question Whether qCT-derived measurements of ILA are interchangeable between supine and prone CT scans remains unknown. Findings qCT measurements showed approximately 1.9% positional variability, with moderate agreement for fibrotic components but poor agreement for nonfibrotic components, especially in dependent lung zones. Clinical relevance Supine and prone scans should not be used interchangeably for qCT analysis of ILA. Consistent patient positioning is essential to ensure accurate longitudinal assessment.
引用
- Ahn Y, Lee SM, Kim JI, et al. CT quantification of interstitial lung abnormalities: a prospective comparison between supine and prone positions. Eur Radiol. 2026. PMID: 42091660. doi:10.1007/s00330-026-12595-4
供执业医师工作参考，不替代临床判断；数值与分级以指南原文为准。