儿童塑型性支气管炎MRI应用价值

The application value of MRI in pediatric plastic bronchitis

目的探讨儿童塑型性支气管炎(PB)的MRI应用价值。方法回顾性分析CT以大叶性肺炎、肺实变为主要表现的具有完整临床及影像学资料的经支气管镜确诊PB患儿114例和非PB患儿37例,在支气管镜灌洗术前全部行MRI常规扫描,两检查时间间隔≤48 h,对比观察儿童PB组及非PB组在MRI上的临床及影像表现并分析PB特征。结果PB组与非PB组两组在临床的热程、住院时间及支气管镜检查次数方面比较,三者差异均有统计学意义(P<0.05)。在114例PB肺实变中,有103例在MRI表现为T2WI-fs不均匀混杂高信号,11例表现为T2WI-fs均匀高信号;37例非PB肺实变中,35例表现为T2WI-fs均匀高信号,2例表现为T2WI-fs混杂高信号,两者比较差异有统计学意义(P<0.05)。MRI诊断儿童PB的灵敏度为90.35%、特异度为76.09%、阳性预测值为98.10%、假阳性率为23.91%、假阴性率为9.65%、准确度为91.39%。结论儿童塑型性支气管炎诊断和治疗难度较大。PB容易发生在大叶性肺实变的情况中,常规MRI在肺实变的检查中判断存在儿童PB具有特征性表现,并为支气管镜灌洗术治疗提供诊断依据。

Objective To explore the MRI application value of plastic bronchitis(PB)in children.Methods Retrospective analysis of CT scans in the past 2 years,with lobar pneumonia and pulmonary consolidation as the main manifestations and complete clinical and imaging data of 114 children diagnosed with bronchoscopic pulmonary embolism(PB)and 37 children without PB.MRI scans were performed before bronchoscopic lavage,with a time interval of≤48 hours between the two examinations.The clinical and imaging manifestations of PB and non PB groups in children on MRI were compared and observed,and the characteristics of PB were analyzed.Results There were statistically significant differences(P<0.05)between the PB group and the non PB group in terms of clinical fever duration,length of hospital stay,and frequency of bronchoscopy.Among 114 cases of PB pulmonary consolidation,103 cases showed uneven mixed high signal on MRI,and 11 cases showed uniform high signal on MRI;Among 37 cases of non PB pulmonary consolidation,35 cases showed uniform high signal intensity in T2WI-fs,and 2 cases showed mixed high signal intensity in T2WI-fs.The difference between the two was statistically significant(P<0.05).The sensitivity,specificity,positive predictive value,false positive rate,false negative rate,and accuracy of MRI in diagnosing PB in children are 90.35%,76.09%,98.10%,23.91%,9.65%,and 91.39%,respectively.Conclusion The diagnosis and treatment of pediatric plastic bronchitis are difficult.PB is prone to occur in cases of lobar consolidation of the lungs.Routine MRI can determine the presence of characteristic features of pediatric PB in lung consolidation examination and provide diagnostic basis for bronchoscopic lavage treatment.