多排螺旋CT对小儿支气管内异物的诊断应用价值

Applicationi of Multidetector Row Helical CT in the Diagnosis of the Trachea and Bronchial Foreign Bodies in Children

目的:评价多排螺旋CT常规扫描及联合MPR、MinIP、VR、CTVB后处理技术在小儿气管、支气管异物诊断中的应用。方法:对23例临床怀疑气道异物的患儿行多排螺旋CT常规扫描,螺1,层厚125mm,并行MPR、MinIP、VR和CTVB重建。结果:23例中,20发现异物,其中气管异物1例,气管隆突处异物2例,右侧支气管异物12例,左侧支气管异物5例,均经纤维支气管镜证实。2例清楚显示3级支气管而无明显异物,CT仅表现为肺炎征象,经抗感染治疗后痊愈。1例漏诊。常规CT诊断小儿支气管异物的敏感度、特异度及准确度分别为95%、98%和95%,结合MPR和CTVB成像其敏感度、特异度及准确度可达98%、100%、98%,经卡方检验,MPR、MinP及CTVB与轴位结合在诊断支气管异物方面有统计学差异P<0.05,而VR在显示异物方面无统计学差异,P>0.05。结论 多排螺旋CT常规扫描结合CTVB、MPR、MinIP、CTVB等后处理技术后对支气管异物的检出率明显优于常规CT检查,他不仅可准确、全面判断异物的位置大小、形态及与相应支气管的关系,并可清晰显示伴随病变,具有重要的临床价值。

Abstract Objective To evaluate the applied value of multidetector row helical CT （MDCT） with post processing techniques for diagnosing intrabronchial foreign bodies （IBFB） in children. Methods Twenty - three pediatric patients with IBFB confirmed by fiber bronchoscope underwent MDCT volume scans and then the source images were transferred into the workstation and post processed by multiplan reconstruction （MPR） and CT Virtual bronchoscopy （CTVB）. Results Among 23 cases of IBFB, 20 eases were found in trachea, 1 case in right main bronchus, 12 cases in right middle bronchus, and 5 eases in left main bronchus. The sensitivity, specificity and accuracy of axial CT images for detecting IBFBs were 95% , 98% and 95%, respective- ly. Following combined with MPR and CTVB images, these values as mentioned above were raised to 98% , 100% and 98% , respectively. MPR and axial, MinIP and CTVB display and compare the location of foreign body was significant difference P 〈 0.05, while VR comparison foreign show location and size of the area were no statistically significant P 〉 0.05. Conclusion MDCT With post processing techniques can not only accurately detect the site, size and shape of IBFBs or their relationship with neighbor bronchi but also can clearly reveal the complications so that it has important value to diagnose and to treat this disease.