临床结合影像学指标对儿童颈前区甲状舌管囊肿诊断准确性研究  

The diagnosis of thyroglossal duct cyst in anterior cervical region in children : clinical and radiological appearance

作　　者：柏梅[1] 武兵[2] 谢梓建 杨鸣姝[1] 季敏[1] 乔中伟[1] 

机构地区：[1]复旦大学附属儿科医院放射科,上海201102 [2]山东省枣庄市妇幼保健院放射科,枣庄277100 [3]福建省福州儿童医院放射科,福州350005

出　　处：《中国循证儿科杂志》2016年第2期104-108,共5页Chinese Journal of Evidence Based Pediatrics

摘　　要：目的探讨临床结合影像学指标对儿童颈前区甲状舌管囊肿(TDC)的诊断价值。方法纳入复旦大学附属儿科医院2012年9月至2014年10月经手术病理证实的颈前部囊性病变、且术前行CT或MRI检查的患儿。以手术病理诊断为依据分为TDC组和非TDC组(颈前部其他囊性病变)。选择以下6项临床和影像学指标:①体格检查中囊肿是否随吞咽和伸舌而运动;②囊肿在CT、MRI上的解剖分区;③囊肿是否紧贴舌骨;④囊肿是否位于或偏离颈部中线;⑤囊肿在CT上的密度;⑥囊肿的最大直径。6项指标先行单因素分析,差异有统计学的指标计算单一指标和组合指标诊断TDC的敏感度、特异度、阳性预测值、阴性预测值及其95%CI。结果 49例颈前部囊性病变进入本文分析,TDC组32例,男19例,年龄(3.9±2.7)岁;非TDC组17例,男7例,年龄(5.2±3.0)岁,包括表皮样囊肿9例、皮样囊肿4例、畸胎样囊肿1例、囊性淋巴管瘤2例、舌下腺囊肿1例。TDC组32例行CT检查,2例行MR检查;非TDC组15例行CT检查,2例行MR检查。1单因素分析显示,囊肿随吞咽和伸舌运动、囊肿紧贴舌骨、囊肿在颈部分区的分布两组差异有统计学意义。2囊肿随吞咽运动、囊肿位于下颌下区和囊肿紧贴舌骨诊断TDC的敏感度分别为75.0%、65.6%和68.8%,特异度分别为70.6%、94.1%和82.4%;满足上述3项指标中任一项诊断TDC的敏感度为93.8%,特异度为29.4%;3项指标均满足的敏感度为0,特异度为100%;囊肿位于下颌下区和囊肿紧贴舌骨指标满足任一项,敏感度为84.4%,特异度为82.4%。结论体格检查联合影像学检查对于儿童TDC具有较高的诊断价值。Objective To diagnose thyroglossal duct cysts（ TDCs） in anterior cervical region in children based on imaging findings and clinical physical examnination. Methods Forty-nine patients with suspected congenital midline cervical anomalies in anterior cervical region and with radiologic images before surgery were categorized into TDCs group and non-TDCs group depending on their histopathologic diagnosis from September 2012 to October 2014. Comparative study was performed between the two groups with following 6 indicators： movement of cysts with deglutition and protrusion of the tongue,the location of cysts in CT and MRI,close proximity to the hyoid bone,relationship to the midline,density and size. Then the sensitivity,specificity,false positive ratio,positive predictive value,negative predictive value and 95% CI of single or combined indicators with statistical differences were evaluated.Results Of the 49 pediatric patients,32 patients[（ 3. 9 ± 2. 7） years old,19 boys]had histopathologically confirmed as TDCs. Other17 patients[（ 5. 2 ± 3. 0） years old,7 boys] had epidermoid cysts（ n = 9）,dermoid cysts（ n = 4）,teratoid cyst（ n = 1）,ranula（ n= 1）,and cystic lymphangioma（ n = 2）. ①Single factor analysis showed there were statistically significant differences in movements with deglutition and protrusion of the tongue,the location and relationship to the hyoid bone of cysts between the two groups. There were no statistical differences in relationship to the midline and size of masses between the two groups. ②The sensitivities of each ③indicators（ cysts moving with deglutition and protrusion of tongue,cysts in close promixity to hyoid bone,cysts located in submandibular region） were 75. 0%,65. 6%,68. 8% respectively,and specificities were 70. 6%,94. 1%,82. 4%respectively for TDCs. The sensitivity and specificity of any one of these 3 indicators were 93. 8%,29. 4% respectively for TDCs.The sensitivity and specificity of all these 3 indicators were 0%,100% respectively for TDCs.

关 键 词：颈部囊性病变 甲状舌管囊肿 体层摄影术 X线计算机 磁共振 儿童 

分 类 号：R725[医药卫生—儿科] R816.92[医药卫生—临床医学] R445.2