CT在婴幼儿先天性肺畸形的诊断价值  

Diagnostic Value of CT in Infantile Congenital Lung Malformation

作　　者：郑海莲 宋亭[1] 唐文艳[1] 陈永露[1] 陈庭威 董天发[1] 温美青 ZHENG Hai-lian;SONG Ting;TANG Wen-yan;CHEN Yong-lu;CHEN Ting-wei;DONG Tian-fa;WEN Mei-qing(Department of Radiology,the Third Affiliated Hospital of Guangzhou Medical University,Guangzhou 510150,China;Image centor of Dianbai People′s Hospital of Maoming,Maoming 525400,China)

机构地区：[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

出　　处：《中山大学学报（医学科学版）》2020年第6期959-966,共8页Journal of Sun Yat-Sen University:Medical Sciences

基　　金：广州市卫生健康科技一般引导项目(2019A010060)。

摘　　要：【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.

关 键 词：计算机体层成像 先天性肺畸形 先天性肺气道畸形 肺隔离症 先天性肺气肿 

分 类 号：R445[医药卫生—影像医学与核医学]