X-ray dark-field chest imaging for detection and quantification of emphysema in patients with chronic obstructive pulmonary disease: a diagnostic accuracy study

作者：Konstantin Willer, Alexander A. Fingerle, Wolfgang Noichl, Fabio De Marco, Manuela Frank, Theresa Urban, Rafael Schick, Alex Gustschin, Bernhard Gleich, Julia Herzen, Thomas Koehler, Andre Yaroshenko, Thomas Pralow, G. Zimmermann, Bernhard Renger, Andreas Sauter, Daniela Pfeiffer, Marcus R. Makowski, Ernst J. Rummeny, Philippe Greniér, Franz Pfeiffer · 发表于：The Lancet Digital Health · 年份：2021 · DOI：10.1016/s2589-7500(21)00146-1 · 被引用次数：164 · 研究领域：Advanced X-ray Imaging Techniques、Atomic and Subatomic Physics Research、Advanced X-ray and CT Imaging

Background Although advanced medical imaging technologies give detailed diagnostic information, a low-dose, fast, and inexpensive option for early detection of respiratory diseases and follow-ups is still lacking. The novel method of x-ray dark-field chest imaging might fill this gap but has not yet been studied in living humans. Enabling the assessment of microstructural changes in lung parenchyma, this technique presents a more sensitive alternative to conventional chest x-rays, and yet requires only a fraction of the dose applied in CT. We studied the application of this technique to assess pulmonary emphysema in patients with chronic obstructive pulmonary disease (COPD). Methods In this diagnostic accuracy study, we designed and built a novel dark-field chest x-ray system (Technical University of Munich, Munich, Germany)—which is also capable of simultaneously acquiring a conventional thorax radiograph (7 s, 0·035 mSv effective dose). Patients who had undergone a medically indicated chest CT were recruited from the department of Radiology and Pneumology of our site (Klinikum rechts der Isar, Technical University of Munich, Munich, Germany). Patients with pulmonary pathologies, or conditions other than COPD, that might influence lung parenchyma were excluded. For patients with different disease stages of pulmonary emphysema, x-ray dark-field images and CT images were acquired and visually assessed by five readers. Pulmonary function tests (spirometry and body plethysmograp...