| Objective To compare the feasibility between VTQ and VTIQ in evaluating the diaphragm stiffness,and to explore the influential factors of diaphragm stiffness.Methods(1)Twenty-two volunteers were selected to accepted virtual tough tissue quantification(VTQ)and virtual touch tissue imaging quantification(VTIQ)simultaneously,and then the diaphragm stiffness at the end of calm inspiration were measured.The consistency and reproducibility of the results between the same physician and different physicians were analyzed by the Bland-Altman analysis and the intraclass correlation coefficient(ICC)(2)The diaphragm SWV was measured by VTIQ technique in 305 volunteers at the end of calm inspiration and forced inspiration and the difference between different groups of the following factors were compared: gender factor(male group,female group),age factor(Group A1: 20-30 years;group A2: 31-40 years;group A3: 41-50 years;group A4: 51-60 years;group A5: 60 years or older),BMI factor(low BMI group:BMI≤18.5kg/㎡;normal BMI group: 18.5 <BMI≤25kg / ㎡;high BMI group: BMI> 25 kg / ㎡),and smoking factor(smoking group,nonsmoking group).Results(1)Whether between the same physician or different physicians,the repeatability and consistency of VTIQ technology in measuring diaphragm SWV are all higher than VTQ technology,among them,the diaphragm SWV in the same physician is highly reproducible(ICC was 0.972,95% CI: 0.969 ~ 0.996)while between different physicians is highly consistency(mean difference was 0.02±0.11,95% CI :-0.19 ~ 0.22).(2)As to the diaphragm SWV at the end of calm inspiration and forced inspiration,there was no significant difference between the male group and the female group(P> 0.05),and only A5 group was increased than A1,A2,A3 group in age factor(P <0.05).In low BMI group,the diaphragm SWV at the end of calm inspiration and forced inspiration was reduced than normal BMI group and high BMI group was reduced(P <0.05),while there was no significant difference between the other groups of BMI factor(P> 0.05).At the meantime,the diaphragm SWV at the end of calm inspiration and forced inspiration of smoking group was higher than non-smoking group(P <0.05).Conclusion(1)It’s feasible to obtain diaphragm SWV though VTIQ and VTQ techniques and VTIQ technology is superior to later.(2)The diaphragm stiffness could be affected by the age,BMI and smoking.Objective(1)Analyzing the correlation of pulmonary function with diaphragm stiffness,mobility and thickness as well as the correlation of diaphragm stiffness with diaphragm mobility and thickness;(2)Evaluation the clinical value,feasibility and effectiveness of diaphragm stiffness in the diagnosis of COPD.Method(1)30 patients with COPD and 30 healthy adults were selected to accept high-frequency ultrasonography and VTIQ technique for measuring the stiffness(SWV)and the mobility of the right diaphragm during calm and forced respiration was measured by M ultrasonography.At the same time the relevant pulmonary function indicators including FEV1 / FVC and FEV1% were measured.And then the relationship including pulmonary function with diaphragm SWV,mobility,thickness and diaphragm SWV with diaphragm mobility,thickness were analyzed by Pearson correlation method(2)150 COPD patients were chosen according to the principles in 2016 edition of 《GOLD COPD Lung Function Classification》and then they were divided into mild group,moderate group,severe group and extremely severe group by lung function classification.At the same time,60 cases of healthy control group were underwent with VTIQ technique to acquire the diaphragm SWV during the end of forced inspiration of each group.Results(1)There was a certain correlation between diaphragm SWV(SWVe)during the end of calm inspiration and FEV1% with FEV1/FVC,diaphragm SWV(SWVf)during the end of forced inspiration and FEV1% with FEV1/FVC,diaphragm mobility(Me)during calm respiration and FEV1% with FEV1/FVC,diaphragm mobility(Mf)during forced respiration and FEV1/FVC,diaphragm thickness(De)during the end of calm inspiration and FEV1/FVC,diaphragm thickness(Df)during the end of forced inspiration and FEV1%(r=-0.32 ~-0.69,P<0.01);there was no significant correlation between diaphragm mobility(Mf)during forced respiration and FEV1%,the difference of diaphragm mobility between the forced respiration and calm respiration(ΔM)and FEV1% with FEV1/FVC,diaphragm thickness(De)during the end of calm inspiration and FEV1%,diaphragm thickness(Df)during the end of forced inspiration and FEV1/FVC,the difference of diaphragm thickness between the end of forced inspiration and calm inspiration(ΔD)and FEV1% with FEV1/FVC,the difference of diaphragm SWV between the end of forced inspiration and calm inspiration(ΔSWV)and FEV1% with FEV1/FVC(P>0.05);There was a certain correlation between diaphragm SWV(SWVe)during the end of calm inspiration and diaphragm mobility(Me)during calm respiration,diaphragm SWV(SWVf)during the end of forced inspiration and diaphragm mobility(Mf)during forced respiration,diaphragm SWV(SWVe)during the end of calm inspiration and diaphragm thickness(De)during the end of calm inspiration(r=-0.56 ~ 0.51,P<0.01),there was no significant correlation between diaphragm SWV(SWVf)during the end of forced inspiration and diaphragm thickness(Df)during the end of forced inspiration,the difference of diaphragm SWV between the end of forced inspiration and calm inspiration(ΔSWV)and the difference of diaphragm mobility between the forced respiration and calm respiration(ΔM),the difference of diaphragm SWV between the end of forced inspiration and calm inspiration(ΔSWV)and the difference of diaphragm thickness between the end of forced inspiration and calm inspiration(ΔD)(P>0.05);Among them,the more significant correlation was found between diaphragm SWV(SWVf)during the end of forced inspiration and FEV1%(r=-0.685,P<0.001).(2)There was no significant difference in diaphragm SWV between healthy control group and COPD mild group(P> 0.05);the diaphragm SWV of the other two groups was increased with COPD condition increased(P <0.05).(3)There was a positive correlation between the diaphragm SWV and the different grades of COPD.With the aggravation of COPD,the SWV of the diaphragmwas increased(r= 0.867,P<0.001).(4)According the COPD grade was determined by diaphragm SWV to draw the ROC curve.The best cut-off value of COPD for ≥ I grade was: 3.25 m / s,the sensitivity was 84.3%,the specificity was 87.6%,the area under the curve was 0.889;The best cut-off value of COPD for ≥ II grade was 3.60 m / s,the sensitivity was 86.2%,the specificity was 85.4%,the area under the curve was 0.907;The best cut-off value of COPD for ≥ III grade was 3.75 m / s,the sensitivity was 91.1%,the specificity was 84.9%,the area under the curve was 0.921;The best cut-off value of COPD for IV grade was 4.10 m / s,the sensitivity was 93.6%,the specificity was 86.0%,the area under the curve was 0.928.The accuracy of them were 65%,71%,80%,82% respectively.Conclusion(1)There was a certain correlation between pulmonary function with diaphragm stiffness,mobility and thickness as well as a certain correlation between diaphragm stiffness with mobility,thickness.Among them,the diaphragm stiffness has much more relevant during the end of forced inspiratory and FEV1%.(2)It has a good diagnostic value to assess the severity of COPD disease through the diaphragm stiffness measured by VTIQ technique,which has a certain clinical value. |
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