先天性梨状窝瘘的X线吞钡造影与CT对比研究  

Comparative imaging studies of congenital pyriform sinus fistula using barium esophagography and CT

作　　者：张杰[1] 刘红军[2] 马小敏 丁雅玲 ZHANG Jie;LIU Hongjun;MA Xiaomin;DING Yaling(Department of Radiology,Women and Children's Hospital,Xiamen University,Xiamen 361003,China;Department of Radiology,Guangdong Provincial People's Hospital,Gruangdong Academy of Medical Sciences,Guangzhou 510080,Chira)

机构地区：[1]厦门大学附属妇女儿童医院厦门市妇幼保健院放射科,福建厦门361003 [2]广东省人民医院放射科广东省医学科学院,广东广州510080

出　　处：《实用放射学杂志》2019年第11期1743-1746,共4页Journal of Practical Radiology

摘　　要：目的探讨X线吞钡造影与CT对先天性梨状窝瘘(CPSF)的诊断价值.方法回顾性分析经手术证实的59例CPSF患者的术前X线吞钡造影及CT资料.55例行吞钡造影检查,57例行CT增强扫描;观察CPSF患者吞钡造影及CT表现,并比较2种影像检查方法及不同CT征象的阳性率.结果59例患者中左侧病变55例,右侧病变2例,双侧病变2例.行吞钡造影检查的患者中,52例(包括2例双侧病变患者)可见53条梨状窝窦道或瘘管形成,3例患者检查结果阴性.X线吞钡造影检查的诊断阳性率为93.0%(53/57).CPSF的CT表现包括梨状窝变小,颈部窦道或瘘管形成,甲状腺上极内侧气泡征,甲状腺密度减低,甲状腺形态改变(甲状腺上极缺损征)等.57例(包括双侧病变患者2例共59侧病变)行CT增强检查的患者中,患侧梨状窝变小26侧,阳性率为44.1%(26/59),颈部窦道或瘘管形成占13.6%(8/59),甲状腺上极内侧气泡征占55.9%(33/59),甲状腺密度减低占16.9%(10/59),甲状腺形态改变(甲状腺上极缺损征)占91.5%(54/59).甲状腺形态和(或)密度异常共占94.9%(56/59).结论X线吞钡造影诊断CPSF阳性率较高,可作为明确CPSF诊断的主要手段.CT显示CPSF的直接征象窦道或瘘管的阳性率不高,其间接征象甲状腺形态和(或)密度异常阳性率非常高,对于疑似CPSF患者CT具有重要提示诊断价值.Objective To evaluate the value of barium esophagography and CT in the diagnosis of congenital pyriform sinus fistula(CPSF).Methods The preoperative radiographic data of 59 CPSF patients were analyzed retrospectively,which were confirmed by operation.55 patients underwent barium esophagography,and 57 patients underwent pre-and post-contrast CT scans.The images of barium esophagography and CT were analyzed and the positive diagnostic rates(PDR)between the two imaging modalities and among the different CT features were compared.Results Among the 59 patients,left fistula was found in 55 cases,right fistula was found in 2 cases and bilateral fistula in 2 cases.For the patients examined with barium esophagography,53 sinus tracts or fistulas from the pyriform in 52 patients(including 2 patients with bilateral fistula)were depicted.The other 3 patients had negative results.The overall PDR of barium esophagography was 93.0%(53/57).CT findings of CPSF included the narrowness of pyriform fossa,sinus tract or fistula in the neck,bubble sign medial to the superior pole of thyroid,low density in thyroid,thyroid morphologic change,and so on.For the 57 patients(including 2 patients with bilateral fistula)examined with CT.The PDR of narrowness of pyriform fossa was 44.1%(26/59),the PDR of sinus tract or fistula was 13.6%(8/59),the PDR of bubble sign medial to the superior pole of thyroid was 55.9%(33/59),the PDR of low density in thyroid was 16.9%(10/59),the PDR of thyroid morphologic change(defect sign of superior pole of thyroid)was 91.5%(54/59).And the total PDR of thyroid density or morphologic change was 94.9%(56/59).Conclusion Barium esophagography can be the main modality to diagnose CPSF because of its high PDR.Although the PDR of CT for direct sign(sinus tract or fistula)is not high,its PDR for indirect sign(thyroid density or morphologic change)is very high.So CT has great value for patients suspected of CPSF.

关 键 词：先天性梨状窝瘘 计算机体层成像 吞钡造影 

分 类 号：R781.7[医药卫生—口腔医学] R814.42[医药卫生—临床医学]