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Abstract：
BACKGROUND: Computed tomography (CT) is routinely employed on the evaluation of dyspnea, yet limited data exist on its assessment of diaphragmatic muscle. This study aimed to determine the capability of CT in identifying structural changes in the diaphragm among patients with ultrasound-confirmed diaphragmatic dysfunction.
METHODS: Diaphragmatic ultrasounds conducted between 2018 and 2021 at our center in Marseille, France, were retrospectively collected. Diaphragmatic pillars were measured on CT scans at the L1 level and the celiac artery. Additionally, the difference in height between the two diaphragmatic domes in both diaphragmatic dysfunction cases and controls was measured and compared.
RESULTS: A total of 65 patients were included, comprising 24 with diaphragmatic paralysis, 13 with diaphragmatic weakness, and 28 controls. In the case group (paralysis and weakness) with left dysfunctions (n = 24), the CT thickness of the pillars at the level of L1 and the celiac artery was significantly thinner compared with controls (2.0 mm vs. 7.4 mm and 1.8 mm vs. 3.1 mm, p < 0.001 respectively). Significantly different values were observed for paralysis (but not weakness) in the right dysfunction subgroup (n = 15) (2.6 mm vs. 7.4 mm and 2.2 mm vs. 3.8 mm, p < 0.001 respectively, for paralysis vs. controls). Regardless of the side of dysfunction, a significant difference in diaphragmatic height was observed between cases and controls (7.70 cm vs. 1.16 cm and 5.51 cm vs. 1.16 cm, p < 0.001 for right and left dysfunctions, respectively). Threshold values determined through ROC curve analyses for height differences between the two diaphragmatic domes, indicative of paralysis or weakness in the right dysfunctions, were 4.44 cm and 3.51 cm, respectively. Similarly for left dysfunctions, the thresholds were 2.70 cm and 2.48 cm, respectively, demonstrating good performance (aera under the curve of 1.00, 1.00, 0.98, and 0.79, respectively).
CONCLUSIONS: In cases of left diaphragmatic dysfunction, as well as in paralysis associated with right diaphragmatic dysfunction, CT revealed thinner pillars. Additionally, a notable increase in the difference in diaphragmatic height demonstrated a strong potential to identify diaphragmatic dysfunction, with specific threshold values.
METHODS: Diaphragmatic ultrasounds conducted between 2018 and 2021 at our center in Marseille, France, were retrospectively collected. Diaphragmatic pillars were measured on CT scans at the L1 level and the celiac artery. Additionally, the difference in height between the two diaphragmatic domes in both diaphragmatic dysfunction cases and controls was measured and compared.
RESULTS: A total of 65 patients were included, comprising 24 with diaphragmatic paralysis, 13 with diaphragmatic weakness, and 28 controls. In the case group (paralysis and weakness) with left dysfunctions (n = 24), the CT thickness of the pillars at the level of L1 and the celiac artery was significantly thinner compared with controls (2.0 mm vs. 7.4 mm and 1.8 mm vs. 3.1 mm, p < 0.001 respectively). Significantly different values were observed for paralysis (but not weakness) in the right dysfunction subgroup (n = 15) (2.6 mm vs. 7.4 mm and 2.2 mm vs. 3.8 mm, p < 0.001 respectively, for paralysis vs. controls). Regardless of the side of dysfunction, a significant difference in diaphragmatic height was observed between cases and controls (7.70 cm vs. 1.16 cm and 5.51 cm vs. 1.16 cm, p < 0.001 for right and left dysfunctions, respectively). Threshold values determined through ROC curve analyses for height differences between the two diaphragmatic domes, indicative of paralysis or weakness in the right dysfunctions, were 4.44 cm and 3.51 cm, respectively. Similarly for left dysfunctions, the thresholds were 2.70 cm and 2.48 cm, respectively, demonstrating good performance (aera under the curve of 1.00, 1.00, 0.98, and 0.79, respectively).
CONCLUSIONS: In cases of left diaphragmatic dysfunction, as well as in paralysis associated with right diaphragmatic dysfunction, CT revealed thinner pillars. Additionally, a notable increase in the difference in diaphragmatic height demonstrated a strong potential to identify diaphragmatic dysfunction, with specific threshold values.
摘要：
背景：计算机断层扫描（CT）通常用于评估呼吸困难，然而，关于膈肌评估的数据有限。这项研究旨在确定CT识别超声证实的diaphragm肌功能障碍患者diaphragm肌结构变化的能力。
方法：2018年至2021年在我们马赛中心进行的膈肌超声检查，法国,是回顾性收集的。在L1水平和腹腔动脉的CT扫描中测量了the柱。此外,测量并比较了diaphragm肌功能障碍病例和对照组中两个diaphragm肌穹顶之间的高度差异。
结果：共纳入65例患者，包括24名膈肌麻痹患者，13与膈肌无力，28个控制在左侧功能障碍的病例组（瘫痪和虚弱）中（n=24），与对照组相比，L1和腹腔动脉水平的支柱CT厚度明显变薄（2.0mmvs.7.4毫米和1.8毫米与3.1mm,p分别<0.001)。在右侧功能障碍亚组（n=15）中观察到瘫痪（但不是虚弱）的显着差异值（2.6mmvs.7.4毫米和2.2毫米与3.8mm,p分别<0.001，对于瘫痪与controls).不管功能障碍的一面，病例和对照组之间的膈肌高度存在显着差异(7.70cmvs.1.16厘米和5.51厘米对比1.16cm,对于左右功能障碍，p<0.001，分别)。通过ROC曲线分析确定的两个膈穹顶之间的高度差异的阈值，指示正确功能障碍的瘫痪或虚弱，分别为4.44厘米和3.51厘米，分别。同样，对于左功能障碍，阈值分别为2.70厘米和2.48厘米，分别,表现良好(Aera分别在1.00、1.00、0.98和0.79的曲线下)。
结论：在左膈肌功能障碍的病例中，以及与右膈肌功能障碍相关的瘫痪，CT显示更薄的柱子。此外,diaphragm肌高度差异的显着增加显示出识别diaphragm肌功能障碍的强大潜力，具有特定阈值。
方法：2018年至2021年在我们马赛中心进行的膈肌超声检查，法国,是回顾性收集的。在L1水平和腹腔动脉的CT扫描中测量了the柱。此外,测量并比较了diaphragm肌功能障碍病例和对照组中两个diaphragm肌穹顶之间的高度差异。
结果：共纳入65例患者，包括24名膈肌麻痹患者，13与膈肌无力，28个控制在左侧功能障碍的病例组（瘫痪和虚弱）中（n=24），与对照组相比，L1和腹腔动脉水平的支柱CT厚度明显变薄（2.0mmvs.7.4毫米和1.8毫米与3.1mm,p分别<0.001)。在右侧功能障碍亚组（n=15）中观察到瘫痪（但不是虚弱）的显着差异值（2.6mmvs.7.4毫米和2.2毫米与3.8mm,p分别<0.001，对于瘫痪与controls).不管功能障碍的一面，病例和对照组之间的膈肌高度存在显着差异(7.70cmvs.1.16厘米和5.51厘米对比1.16cm,对于左右功能障碍，p<0.001，分别)。通过ROC曲线分析确定的两个膈穹顶之间的高度差异的阈值，指示正确功能障碍的瘫痪或虚弱，分别为4.44厘米和3.51厘米，分别。同样，对于左功能障碍，阈值分别为2.70厘米和2.48厘米，分别,表现良好(Aera分别在1.00、1.00、0.98和0.79的曲线下)。
结论：在左膈肌功能障碍的病例中，以及与右膈肌功能障碍相关的瘫痪，CT显示更薄的柱子。此外,diaphragm肌高度差异的显着增加显示出识别diaphragm肌功能障碍的强大潜力，具有特定阈值。
