锥形束CT在儿童腺样体肥大诊断中的临床应用价值

The clinical value of cone-beam CT in the diagnosis of adenoid hypertrophy in children

目的:分析锥形束CT在儿童腺样体肥大诊断中的准确性,探讨其对腺样体肥大诊断的临床应用价值。方法:收集2018年1月-2022年1月因睡眠打鼾于本院耳鼻咽喉-头颈外科就诊的158例患儿锥形束CT和电子鼻内镜资料。测量计算腺样体正中矢状面A/N(腺样体-鼻咽腔比率)、PAS(后气道间隙)和腺样体占后鼻孔范围比值,并将患儿的锥形束CT诊断结果与电子鼻内镜检查结果进行比较。结果:锥形束CT图像上A/N诊断结果与鼻内镜检查相比敏感度为86.72%、特异度为70.00%、准确性为83.54%;PAS诊断结果与鼻内镜检查相比敏感度为92.19%、特异度为76.67%、准确性为89.24%。158例患儿合并鼻窦炎者106例,其中内镜诊断确诊率18.87%,锥形束CT诊断确诊率96.23%;158例患儿合并中耳炎者46例,其中内镜诊断确诊率71.74%,锥形束CT诊断确诊率78.26%。结论:锥形束CT是诊断腺样体肥大可靠和准确的工具,可以作为鼻内镜不耐受患儿的替代检查方法。且一次低剂量的精确扫描,在了解腺样体大小的同时,观察鼻窦及中耳有无积液,有助于全面把握患儿的病情,综合性考虑治疗方案。

Objective:To analyze the accuracy of cone-beam CT in the diagnosis of adenoid hypertrophy in children,and to explore its clinical application value.Methods:From January 2018 to January 2022,the data of cone-beam CT and electronic nasal endoscopy of 158 children with adenoid hypertrophy were collected from the Department of Otolaryngology-Head&Neck Surgery in Xinhua Hospital.The median sagittal plane A/N(adenoid-nasopharyngeal cavity ratio),PAS(posterior airway space)and the ratio of adenoids to posterior nostril were measured,and the cone-beam CT diagnosis results of children were compared with those of electronic nasal endoscopy.Results:Compared with nasal endoscopy,the sensitivity,specificity and accuracy of A/N diagnosis on cone-beam CT images were 86.72%,70.00%and 83.54%,respectively.Compared with nasal endoscopy,PAS has a sensitivity of 92.19%,a specificity of 76.67%and an accuracy of 89.24%.There were 106 cases with sinusitis were diagnosed by endoscopy(18.87%)and cone-beam CT(96.23%),There were 46 cases with otitis media were diagnosed by endoscopy(71.74%)and cone-beam CT(78.26%).Conclusion:Cone-beam CT is a reliable and accurate tool for diagnosing adenoid hypertrophy,and can be used as an alternative examination method for children with nasal endoscopic intolerance.Furthermore,a low dose accurate scan can help to understand the size of the adenoids and observe lesions in the sinuses and the middle ears,which is helpful to fully grasp children's condition and comprehensively consider the treatment plan.