双源CT三维重建在儿童喘息性疾病中的诊断价值

Diagnostic value of dual-source CT three-dimensional reconstruction in children with wheezing disease

目的探讨双源CT三维重建对病因可疑的儿童喘息性疾病的诊断价值。方法对我院儿科于2018年1月~2019年6月收治的50例表现为喘息、胸片或多层螺旋CT(Multi-slice computer tomography,MSCT)考虑为支气管肺炎或支气管炎、怀疑误诊或漏诊的患儿行DSCT三维气道重建检查,对比DSCT三维气道重建检查前的入院诊断与检查后的诊断是否相同。结果入院诊断为支气管肺炎的38例中于检查后发现合并支气管狭窄3例、合并气管软化1例、合并肺气肿2例、合并肺不张3例、合并胸腔积液3例,发现气道异物3例,发现肺结核1例。入院诊断为毛细支气管炎的5例中,于检查后发现为闭塞性细支气管炎1例。入院诊断为支气管炎7例中,检查后发现支气管肺炎1例,发现气管性支气管炎2例。共发现误诊8例,误诊率为16%,发现漏诊12例,漏诊率为24%。结论DSCT气道三维重建技术能清晰显示气道及其周围组织的结构,对明确小儿喘息性疾病的病因诊断、减少误诊及漏诊有着重要的临床价值。

Objective To investigate the diagnostic value of three-dimensional reconstruction of dual-source CT in children with wheezing disease with suspected etiology.Methods 50 children with wheezing,bronchial pneumonia or bronchitis considered by chest X-ray or multi-slice spiral CT(Multi-slice computer tomography,MSCT)and suspected of being misdiagnosed or missed who were admitted to our hospital from January 2018 to June 2019 underwent DSCT three-dimensional airway reconstruction examination.The admission diagnosis before the DSCT three-dimensional airway reconstruction examination and the diagnosis after the examination were compared.Results Of the 38 patients diagnosed with bronchial pneumonia,3 cases had bronchial stenosis,1 case had tracheal softening,2 cases had emphysema,3 cases had atelectasis,and 3 cases had pleural effusion.Airway foreign body was found in 3 cases and tuberculosis was found in 1 case.Among the 5 cases diagnosed with bronchiolitis,1 case of obliterative bronchiolitis was found after the examination.Of the 7 patients with admission diagnosis of bronchitis,1 patient with bronchial pneumonia was found after examination and 2 patients with tracheal bronchitis were found.A total of 8 misdiagnosed cases were found,the misdiagnosis rate was 16%.12 cases of missed diagnosis were found,and the missed diagnosis rate was 24%.Conclusion DSCT airway three-dimensional reconstruction technology can clearly show the structure of airway and its surrounding tissues.It has important clinical value for clarifying the etiology diagnosis,reducing misdiagnosis and missed diagnosis of pediatric wheezing disease.