颅脑超声与CT在新生儿颅脑疾病检查中的应用价值比较

Comparison of the clinical value of cranial ultrasonography and CT in the diagnosis of neonatal brain diseases

目的 比较颅脑超声与头部CT在诊断新生儿颅脑疾病中的应用价值。方法 选取106例高危新生儿为研究对象，所有患儿进行颅脑超声及头部CT检查，比较两种检查方法的诊断效应。结果 106例疑似颅脑疾病的患儿中，颅脑超声诊断出阳性病例83例，阴性病例23例，其中误诊、漏诊14例；头部CT诊断出阳性病例66例，阴性病例40例，其中误诊、漏诊37例。颅脑超声的诊断敏感性为87.91%，特异性为80.00%，阳性预测值为96.39%，阴性预测值为52.17%，诊断准确率为86.79%；头部CT敏感性为65.93%，特异性为60.00%，阳性预测值为90.91%，阴性预测值为22.50%，诊断准确率为65.09%；两种检查方法诊断效应的比较，颅脑超声的诊断敏感性及准确率明显高于头部CT，差异均有统计学意义（χ2＝12.381，P＝0.00；χ2＝13.658，P＝0.00），两种检查方法的特异性、阳性预测值及阴性预测值比较，差异均无统计学意义（χ2＝1.429，P＝0.23；χ2＝1.943，P＝0.16；χ2＝2.759，P＝0.10）；颅脑超声检出蛛网膜及硬脑膜下腔出血患儿10例，脑实质内出血患儿13例，脑室扩张患儿25例，缺氧缺血性脑病患儿17例，脑水肿患儿18例，与实际诊断结果比较，差异无统计学意义（χ2＝1.134，P＝0.89）；头部CT检出蛛网膜及硬脑膜下腔出血患儿18例，脑实质内出血患儿10例，脑室扩张患儿16例，缺氧缺血性脑病患儿8例，脑水肿患儿14例，与实际诊断结果、颅脑超声诊断结果比较，差异均有统计学意义（χ2＝15.091，P＝0.00；χ2＝15.879，P＝0.00）。结论 颅脑超声对新生儿颅脑疾病的诊断敏感性及准确率均优于头部CT，颅脑超声对于新生儿多种颅脑疾病的检出与实际诊断的符合情况更好，可以在临床中大力推广。

Objective To compare the clinical value of cranial ultrasound and head CT in the diagnosis of neonatal brain diseases.Methods One hundred and six high risk newborns were selected.All the newborns underwent cranial ultrasonography and head CT examination,and the diagnostic effects of the two methods were compared.Results Of the 106 newborns,there were 83 cases of positive ultrasonic examination and 23 cases of negative,including 14 cases of misdiagnosis and missed diagnosis that diagnosed by cranial ultrasound.There were 66 cases of positive head CT examination and 40 cases of negative,including 37 cases of misdiagnosis and missed diagnosis that diagnosed by CT.The diagnostic sensitivity of the cranial ultrasound was 87.91%,the specificity was 80.00%,the positive predictive value was 96.39%,the negative predictive value was 52.17%,and the diagnostic accuracy was 86.79%.The sensitivity of head CT was 65.93%,the specificity was 60.00%,the positive predictive value was 90.91%,the negative predictive value was 22.50%,and the diagnostic accuracy was 65.09%.The diagnostic sensitivity and accuracy of cranial ultrasound were higher than those of head CT,and the differences were statistically significant（χ2=12.381,P=0.00;χ2=13.658,P=0.00）.The specificity,positive predictive value and negative predictive value between the two methods had no statistically significant differences（χ2=1.429,P=0.23;χ2=1.943,P=0.16;χ2=2.759,P=0.10）.In addition,10 cases of subarachnoid and subdural hemorrhage,13 cases of intracerebral hemorrhage,25 cases of ventricular dilatation,17 cases of hypoxic-ischemic encephalopathy,and 18 cases of hydrocephalus were detected by cranial ultrasound.Compared with the actual diagnosis,the difference was not statistically significant（χ2=1.134,P=0.89）.Head CT showed 18 cases of subarachnoid and subdural hemorrhage,10 cases of intracerebral hemorrhage,16 cases of ventricular dilatation,8 cases of hypoxic-ischemic encephalopathy,and 14 cases of hydrocephalus.Compared with the actual diagnostic results and the results of cranial ultrasonic diagnosis,the differences were statistically significant（χ2=15.091,P=0.00;χ2=15.879,P=0.00）.Conclusion The diagnostic sensitivity and accuracy of cranial ultrasound are higher than CT.The diagnosis of cranial ultrasound is consistent with the actual diagnosis.Cranial ultrasound can be widely promoted in clinical practice.