| PartⅠ.CT image analysis of welders,coal workers’ pneumoconiosis,and silicosis1.Objective Due to the diversity and particularity of pneumoconiosis,hospitals with non-vocational specialties are prone to misdiagnosis.In this study,by analyzing the CT manifestations of the three common pneumoconiosis(welder pneumoconiosis,coal workers’ pneumoconiosis and silicosis),the characteristics of these three pneumoconiosis diseases are summarized and compared to improve the early detection rate and diagnostic accuracy of common pneumoconiosis by clinical and imaging physicians.2.Materials and methods A total of 230 cases of pneumoconiosis,coal pneumoconiosis and silicosis were newly diagnosed by the pneumoconiosis diagnostic team of t12 th People’s Hospital of Guangzhou from January 2015 to December 2020 according to GBZ 70-2009 "Diagnostic Criteria for Pneumoconiosis" or GBZ 70-2015 "Diagnostic Criteria for Occupational Pneumoconiosis",including 103 cases of welder pneumoconiosis,20 cases of coal pneumoconiosis and 107 cases of silicosis,and analyzed and compared the CT signs of the three.Statistical methods: Measurement data such as age and length of service were expressed as(x±s)and described as percentage(%).SPSS26.0 software was used to analyze the age of patients with three types of pneumoconiosis Kruskal-wallis test was used to compare age with age.The significance value was corrected by Bonferroni,P<0.05 was statistically significant.Image data were compared by chi-square test,P<0.05 was statistically significant.3.Results Among the 103 cases of welders with pneumoconiosis,the minimum age was 27 years old,the maximum age was 55 years,the average age(44±5.6)years old,and the age of onset was concentrated in 40-49 years,accounting for68.0% of the total;The minimum length of service is 5 years,the longest is 25 years,the average working experience is(12±4.4)years,and the dust service age is concentrated in 10-15 years,accounting for 41.7% of the total.In this group,57 cases of small nodules appeared in the CT images of 103 welders with pneumoconiosis in this group,none of which had small shadow aggregation and large shadow formation,and 63 cases of leaflet branching linear shadows,of which 20 cases of leaflet branching linear shadows combined with tiny ground glass nodular shadows in the center of leaflets;10 cases of diffuse ground glass changes;There were 6 cases of pulmonary interstitial fibrosis,10 cases of fibrous foci,6 cases of pulmonary tuberculosis,18 cases of emphysema,14 cases of alveoli,9 cases of hilus/lymphadenopathy(no calcification),and 19 cases of pleural thickening.Among the 107 cases of silicosis,the youngest age was 27 years,the maximum age was 69 years,and the average age was(48±8.9)years,the age group of onset is concentrated in 40-49 years,accounting for 68.0% of the total;The shortest length of service is 5 years,the longest is 25 years,and the average length of service is(12 4.4)years.The dust exposure length of service is concentrated in 10-15 years,accounting for 41.7% of the total.In this group,57 cases of small nodules appeared in the CT images of 103 welders with pneumoconiosis in this group,none of which had small shadow aggregation and large shadow formation,and 63 cases of leaflet branching linear shadows,of which 20 cases of leaflet branching linear shadows combined with tiny ground glass nodular shadows in the center of leaflets;10 cases of diffuse ground glass changes;There were 6 cases of pulmonary interstitial fibrosis,10 cases of fibrous foci,6 cases of pulmonary tuberculosis,18 cases of emphysema,14 cases of alveoli,9 cases of hilus/lymphadenopathy(no calcification),and 19 cases of pleural thickening.Among the 20 cases of pneumoconiosis of coal workers,the minimum age was 39 years,the maximum age was 63 years,the average age(50±6.4)years old,and the age of onset was concentrated in 40-49 years,accounting for 50.0% of the total;The minimum length of service is 2 years and8 months,the longest is 25 years,the average working age(11±7.6)years,and the dust service age is concentrated in 5-10 years,accounting for 50.0% of the total.In this group,20 cases of coal pneumoconiosis had small nodules in the CT manifestations,3 cases of small shadow aggregation and 11 cases of large shadow formation;There were 7 cases of lobular branched linear opacities,1case of diffuse ground glass changes,10 cases of pulmonary interstitial fibrosis,12 cases of emphysema,8 cases of alveoli,14 cases of hilus/mediastinal lymph node enlargement,10 cases of pleural thickening,and 1 case of pulmonary tuberculosis.After statistical analysis,the difference between welder’s pneumoconiosis and silicosis and coal workers’ pneumoconiosis in terms of age and working age is statistically significant,compared with silicosis and coal pneumoconiosis,welder pneumoconiosis patients have a lighter age than the other two types of pneumoconiosis,and the dust service age is longer.The difference between welder’s pneumoconiosis and silicosis and coal pneumoconiosis in terms of size,density and boundary clarity of small nodules is statistically significant,and the small nodules of welder’s pneumoconiosis are mainly low-density nodules with small diameter and blurred boundaries,while silicosis nodules are larger in diameter and higher density,and the boundaries are relatively clear,and the small nodules of coal workers’ pneumoconiosis are small in diameter but have higher density and relatively clear boundaries;The differences between welder’s pneumoconiosis and silicosis and coal-workers’ pneumoconiosis in lobe branched linear shadow,pulmonary interstitial fibrosis,emphysema,hilarium/mediastinal lymphadenopathy and/or calcification,pleural thickening are all statistically significant,welder’s pneumoconiosis is more often than silicosis and coal-worker’s pneumoconiosis,and silicosis and coal-worker’s pneumoconiosis are more likely to appear in pulmonary interstitial fibrosis,emphysema,enlargement and/calcification of the hilus/mediastinal lymph nodes and pleural thickening.4.Conclusion(1)Welder pneumoconiosis,silicosis and coal workers’ pneumoconiosis are different in the age of onset of dust exposure,which can indicate the incidence of patients.(2)Welder pneumoconiosis,silicosis and coal workers’ pneumoconiosis have corresponding characteristics in CT images,and the differential diagnosis of corresponding types of work is carried out by CT image features.PartⅡ.Quantitative CT study of pneumoconiosis before and after lavage of large volume lung1.Objective To compare and analyze the application value of quantitative CT in the efficacy evaluation of pneumoconiosis with large volume lung lavage before and after operation,so as to provide objective evaluation indexes for clinical practice.2.Materials and methods A total of 33 pneumoconiosis patients who underwent doublelung lavage in the 12 th People’s Hospital of Guangzhou from January 2015 to December2020 were retrospectively analyzed.The quantitative parameters of CT were obtained by the lung quantitative analysis software of the u CT 780 post-treatment system,and the quantitative parameters before and after large-volume lung lavage were compared,and the pulmonary function test and arterial blood gas results were statistically analyzed.SPSS26.0 statistical analysis software is adopted,SPSS26.0 software is used for statistical analysis.All measurement data is expressed in((?)±s).P<0.05 was statistically significant when paired samples ttest was used to analyze the differences in the average CT values of the whole lung and each lobe,the volume of the whole lung and each lobe,arterial blood gas,and lung function before and after lavage.The correlation analysis between the quantitative CT parameters and clinical blood gas and lung function indicators was carried out by Spearman-related analysis,and P<0.05 was statistically significant.3.Results(1)The average CT value of the whole lung and the average CT value of the left lung were correlated with FVC and FEV1%(P<0.05),the average CT value of the right lung was correlated with FVC%(p=0.022),and the volume of the whole lung,the volume of the right lung and the volume of the left lung were correlated with FVC,FEV1%,and FEFF75%(P<0.05).(2)After large-volume lung lavage surgery,the average CT values of the whole lung,right lung,left lung and lobes of the lungs were reduced to a certain extent,and the total lung CT values were reduced from(-835.99±41.40)HU to(-846.48±36.83)HU(p=0.028),the mean CT value of the left lung decreased from(-832.19±42.81)HU to(-845.13±37.29)HU(p=0.009),the mean CT value of the upper lobe of the left lung decreased from(-850.20±31.87)HU to(-859.74±30.45)HU(p=0.011),and the mean CT value of the lower lobe of the left lung decreased from(-810.99±55.14)HU to(-827.89± 45.84)HU(p=0.018)。 The volume of the whole lung increased from(4417.31 T values of the whole lung,right lung,left lung and lobes of the lungs were reduced to a certain extent,and t(2151.57±396.29)(p=0.015),and the volume of the upper lobe of the left lung increased from(1071.79±254.92)ml to(1110.57±252.82)ml(p=0.019),The volume of the lower left lung was increased from(962.04±283.05)m L to(1039.09±242.65)ml(p=0.026).The mean CT value of the right lung and its lobes also decreased to some extent,and the volume increased,but it was not statistically significant.Pulmonary function FVC and FEV1,arterial oxygen and oxygen saturation have improved to a certain extent(p<0.05).4.Conclusion(1)Quantitative CT parameters at the end of inspiration,lung function parameters and blood gas analysis could be used as postoperative evaluation indicators;(2)The quantitative CT parameters of pneumoconiosis obtained by spiral CT scan at the end of inspiration had a certain correlation with some clinical pulmonary function indicators;(3)CT quantitative parameters can objectively measure the whole lung,left and right lungs and each lung lobe,which is a non-invasive and objective postoperative efficacy evaluation method for large-volume lavage in patients with pneumoconiosis. |
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