MRI在感染期儿童先天性梨状窝瘘诊断中的价值

Value of MRI in Diagnosis of Children’s Congenital Pyriform Sinus Fistula at Infection Stage

目的探讨MRI在感染期儿童先天性梨状窝瘘(CPSF)诊断中的临床应用价值。方法回顾性分析37例经术后病理证实CPSF患儿的临床和MRI影像学资料。结果37例CPSF均为单侧发病,术前MRI诊断准确34例,诊断符合率为92%。本组患儿临床表现主要为颈部肿痛、肿块,且近期大多有过上呼吸道感染症状。MRI表现:颈部梨状窝周围至甲状腺水平显示团片状或斑片状等及长T1、脂肪抑制混杂长T2信号,部分累及上纵隔;增强扫描时病变明显强化。37例MRI平扫中,19例断续显示窦道;30例行MRI增强扫描者均清楚显示窦道,1例合并皮肤瘘管。结论MRI不仅能清晰显示儿童感染期CPSF窦道是否存在及其走向,还可明确感染范围、脓肿大小、累及甲状腺程度,从而大大降低了对CPSF误诊率,可为临床抗感染治疗及手术治疗提供可靠的影像学依据。

Objective To explore the clinical value of magnetic resonance imaging(MRI)in diagnosis of children’s congenital pyriform sinus fistula(CPSF)in the infection stage.Methods Clinical data and MRI data of 37 children with CPSF were analyzed retrospectively.Results In 37 children with CPSF,all cases were diagnosed on the unilateral neck.34 cases were diagnosed accurately by MRI,the diagnosis accordance rate with MRI was 92%.The main clinical manifestations of the children in this group were neck swelling and pain,masses,and most of them had symptoms of recent upper respiratory tract infection.MRI findings:The isointense T1 signal and the mixed prolonged T2 signal of the fat-suppression sequence could be seen around the pyriform fossa of the neck to the level of the thyroid gland,part of which involved the upper mediastinum,and the lesions were obviously enhanced during enhanced scanning.MRI plain scan showed fistula in 19 of 37 cases,MRI enhanced scan showed fistula in 30 cases and 1 case displayed a cutaneous fistula.Conclusion MRI can not only clearly show the presence and orientation of fistula during the infection period,but also the scope of infection,the size of abscess,and the degree of thyroid involvement,which greatly reduces the chance of misdiagnosis of CPSP,and can provide reliable evidence for anti-infective and surgical treatment.