1. 广州医科大学附属第三医院放射科,广东,广州,510150
2. 茂名市电白区人民医院影像中心,广东,茂名,525400
网络首发:2020-11-20,
纸质出版:2020
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郑海莲, 唐文艳, 陈永露, 等. CT 在婴幼儿先天性肺畸形的诊断价值[J]. 中山大学学报(医学科学版), 2020,41(6).
Diagnostic Value of CT in Infantile Congenital Lung Malformation[J]. Journal of Sun Yat-sen University (Medical Sciences), 2020, 41(6).
【目的】探讨计算机体层成像(CT)在婴幼儿先天性肺畸形(CLM)的诊断价值。【方法】选取 2019 年5 月至2020 年5 月在我院手术并确诊的CLM 患者,以病理结果为金标准,比较术前CT 与产前超声(US)对CLM 的 诊断准确性,并分析术前 CT 的 CLM 影像特点及鉴别诊断,探索 CT 在婴幼儿 CLM 术前诊断的临床应用价值。【结果】共纳入患有CLM 婴幼儿76 例,其中先天性肺气道畸形(CPAM)36 例,肺隔离症(PS)26 例,先天性肺气肿(CLE)8 例,混合型 CLM6 例。US 和 CT 诊断 CLM 结果一致性一般(Kappa 值=0.465,P < 0.05),CT 诊断准确率为 85.5%,高于US 诊断(69.7%),McNemar 检验结果为P = 0.001,差异具有统计学意义。婴幼儿CLM 的CT 影像学特征表现为:CPAM 为大小不等囊性病变为主;PS 为肺部肿块伴异常供血动脉,主要来自于主动脉分支;CLE 为肺叶过度膨胀,肺血管变细。【结论】在CLM 诊断中,术前CT 是产前US 的重要补充,是CLM 术前评估的主要检查手段;不同类型的婴幼儿CLM 的CT 表现不一,CT 可诊断并区分不同类型的婴幼儿CLM,为术前临床评估提供了重要依据。
【Objective】To study the diagnostic value of computed tomography(CT)in the diagnosis of infantile congenital lung malformation(CLM).【Methods】A total of 76 CLM patients diagnosed in the Third Affiliated Hospital of Guangzhou Medical University from May 2019 to May 2020 were selected. The diagnostic accuracy of preoperative CT and prenatal ultrasound(US)diagnosis of CLM was compared based on the gold standard of pathological results. The preopera⁃ tive CT findings and differential diagnosis were analyzed.【Results】Among the 76 cases of CLM,there were 36 cases of congenital pulmonary airway malformation(CPAM),26 cases of pulmonary sequestration(PS),8 cases of congenital lobar emphysema(CLE),and 6 cases of mixed type. There was a moderate agreement between CT and US diagnosis of CLM(Kappa = 0.465,P < 0.05). The accuracy rate of CT diagnosis was 85.5%,which was higher than that of US(69.7%). McNemar test result is P =0.001,the difference of diagnostic value between CT and US was statistically significant. In terms of CT manifestations,CPAM was mainly characterized by cystic lesions of different sizes. PS showed pulmonary mass with abnormal blood supply artery,mainly from the aortic branch. CLE was characterized by overexpansion of the pulmonary lobes and thinning of the pulmonary blood vessels.【Conclusions】In infantile CLM,preoperative CT is an im⁃ portant supplementary examination for prenatal US. Different types of CLM have different manifestations. CT can diagnose and distinguish different types of CLM,which provides an important basis for preoperative clinical evaluation.
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