CT仿真支气管镜在儿童呼吸道异物诊断中的应用

Utilization of CT Virtual Bronchoscopy in the Diagnosis of Pediatric Patients with Foreign Body Aspiration

【目的】与支气管镜及胸透对比,探讨CT仿真支气管镜(CTVB)对儿童气管、支气管异物的诊断价值。【方法】对105例临床怀疑气管或支气管异物的患儿进行螺旋CT轴位容积扫描,经图像工作站重建出三维立体CTVB图像。将CTVB结果与胸透及支气管镜(RB)检查结果进行对比。【结果】105例CTVB检查中86例发现异物,其中RB检查83例发现并取出异物,形态、大小及位置均与CTVB显示相同;17例CTVB及RB均未发现异物;另有3例假阳性和2例假阴性。与RB对比,CTVB诊断异物的敏感度、特异度及阳性准确率分别为:97.6%,92.1%,96.5%。胸透的敏感度、特异度及阳性准确率分别为:91.8%,71.1%,87.6%。【结论】结合CT原始图像及MPR重建图像,CTVB可以准确显示小儿气管、支气管异物的直接征象与间接征象。能显示异物的形态、大小及确切位置,对指导支气管镜异物取出术具有重要指导意义。

[Objective]To assess the role of CT Virtual Bronchoscopy（CTVB） as compared with rigid bronchoscopy and chest fluoroscopy in the diagnosis of foreign body aspiration of the trachea and bronchi in children. [Methods] Volume CT scan was performed in 105 patients with suspicion of foreign body aspiration. CTVB images were obtained from the workstation in the same session. CTVB findings were retrospectively compared with the results of chest fluoroscopy and rigid bronchoscopy. [Results] All foreign bodies detected by rigid hronchoscopy were also revealed on CT virtual bronchoseopy in 83 patients. There were no foreign bodies in 17 patients on CTVB and rigid bronchoscopy. In the remaining five patients, the diagnosis in three was false-positive and two of them were false-negative. The sensitivity, specificity and accuracy of CTVB were 97.6%, 92.1%, 96.5% respectively. The sensitivity, specificity and accuracy of chest fluoroscopy were 91. 8%, 71.1%, 87.6% respectively. [Conclusion] CTVB combined with MPR can depict direct and indirect signs of foreign body in trachea and bronchus accurately. It may be useful in showing the exact location of a foreign body before bronchoscopy and be helpful in planning surgery.