Reliability of radiographic findings and the relation to etiologic agents in community-acquired pneumonia
Reliability of radiographic findings and the relation to etiologic agents in community-acquired pneumonia
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DOI：
10.1016/j.rmed.2005.06.018
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发表时间：
2006-05-01
影响因子：
4.3
通讯作者：
van de Jagt, EJ
中科院分区：
文献类型：
--
作者：
Boersma, WG;Daniels, JMA;van de Jagt, EJ
在临床上，胸片是诊断社区获得性肺炎（CAP）的参考标准。本研究的目的是评估观察者间的可靠性（IR）的放射学检查结果和不同的病原体在CAP的关系。从数据库中获得的192例肺炎患者的胸片，由2名放射科医生和1名呼吸科医生没有具体的临床信息进行审查。对浸润的主要类型、肺炎的范围、胸膜（积液）的存在、支气管壁增厚、淋巴结肿大和支气管充气进行评分。此外，还确定了受累的肺叶。通过痰培养、血培养和血清学试验来确定致病病原体，IR对确定主要浸润形式和存在的支气管充气征、淋巴结肿大和支气管壁增厚的作用较差（Kappa < 0.4）。IR在确定胸腔积液的存在、肺炎的程度和识别受累肺叶方面为一般至良好（kappa 0.4-0.7）或甚至极好（kappa > 0.7）。肺炎支原体较肺炎链球菌更常与斑片状肺泡混浊相关（P = 0.05）。衣原体属物种与单侧受累相关（86%），尤其是与M.（P = 0.03）和S.肺炎（P = 0.004）。总之，简单的特征，如胸腔积液的存在、肺炎的范围和确定受累的肺叶，显示出良好的IR。其他特征，如主要的浸润模式，难以评估，显示出较差的IR。几乎没有发现不同病原体与放射学特征之间的任何关系。因此，胸片在预测病原体方面的价值有限，但在确定肺炎的范围和发现并发症如胸膜旁积液方面很有用。(c)2005爱思唯尔有限公司保留所有权利。
In a clinical setting the chest radiograph is the reference standard in establishing the diagnosis of community-acquired pneumonia (CAP). This study aimed to assess interobserver reliability (IR) of radiographic findings and the relationship to different causative pathogens in CAP.Chest radiographs of 192 patients with pneumonia, obtained from a database, were reviewed by 2 radiologists and 1 respiratory physician without specific clinical information. Main pattern of infiltrate, extent of pneumonia, presence of pleura( fluid, thickened bronchial walls, lymphadenopathy and air bronchogram were scored. Also, the involved lobes were identified. Sputum cultures, blood cultures and serological tests were performed to identify the causative pathogen.IR was poor (kappa < 0.4) for determining the main pattern of infiltrate and presence of air bronchogram, lymphadenopathy and thickening of bronchial walls. IR was fair to good (kappa 0.4-0.7) or even excellent (kappa > 0.7) for determining the presence of pleural effusion, the extent of pneumonia and for identifying the lobes involved. Mycoplasma pneumoniae was associated more often with patchy alveolar opacities than Streptococcus pneumoniae (P = 0.05). Chlamydia spp. were associated with unilobar involvement (86%), especially when compared to M. Pneumoniae (P = 0.03) and S. pneumoniae (P = 0.004).In conclusion, simple features such as presence of pleural fluid, the extent of pneumonia and identifying the involved lobes show fair to excellent IR. Other features such as main pattern of infiltrate are difficult to assess and show poor IR. Hardly any relation between different pathogens and radiological features was found. Therefore, chest radiographs are of limited value in predicting the causative pathogen, but are of good use to determine the extent of pneumonia and to detect complications such as parapneumonic effusion. (c) 2005 Elsevier Ltd. All rights reserved.