Lynch D A, Hay T, Newell J D, Divgi V D, Fan L L
Department of Radiology, National Jewish Medical and Research Center, University of Colorado Health Sciences Center, Denver 80262, USA.
AJR Am J Roentgenol. 1999 Sep;173(3):713-8. doi: 10.2214/ajr.173.3.10470910.
Our purpose was to categorize high-resolution CT findings in children with diffuse lung disease and to evaluate the accuracy of diagnoses made using CT.
The chest radiographs and high-resolution CT scans of 20 children (1-16 years old; median, 9 years old) with biopsy-proven chronic diffuse lung diseases were reviewed separately by two independent chest radiologists. Thirteen types of diffuse lung disease were included in the study. Radiographic and CT features were noted, and three choices of diagnosis were recorded, with the confidence level.
Diagnoses were made with a high degree of confidence (definite or probable) in 25 of 40 interpretations of CT scans, compared with only five of 40 interpretations of chest radiographs (p < .001). Fourteen (56%) of the 25 confident first-choice diagnoses on CT scans were correct, compared with two (40%) of the five interpretations on chest radiographs. Diseases were classified as belonging to one of five distinct groups on the basis of dominant CT features. Airway disease (n = 5) (bronchiolitis obliterans or bronchocentric granulomatosis) showed geographic hyperlucency on CT. Septal disease (n = 4) (lymphangiomatosis, hemangiomatosis, or microlithiasis) showed septal thickening. Infiltrative lung disease (n = 7) (desquamative interstitial pneumonitis, hypersensitivity pneumonitis, or lymphoid interstitial pneumonitis) showed ground-glass opacity. Air-space disease (n = 3) (aspiration, vasculitis, or bronchiolitis obliterans organizing pneumonia) showed lung consolidation. Langerhans' histiocytosis (n = 1) showed cysts and nodules. Surprisingly little overlap was seen among these groups.
CT increases the level of diagnostic confidence for pediatric infiltrative lung disease, improves diagnostic accuracy, and provides a useful classification system.
我们的目的是对患有弥漫性肺部疾病的儿童的高分辨率CT结果进行分类，并评估使用CT进行诊断的准确性。
两名独立的胸部放射科医生分别回顾了20名经活检证实患有慢性弥漫性肺部疾病的儿童（1至16岁；中位数为9岁）的胸部X光片和高分辨率CT扫描。该研究纳入了13种弥漫性肺部疾病。记录了影像学和CT特征，并记录了三种诊断选择及其置信度。
在40次CT扫描解读中，有25次做出了高度置信（确定或可能）的诊断，而在40次胸部X光片解读中只有5次（p <.001）。CT扫描上25个置信度高的首选诊断中有14个（56%）是正确的，而胸部X光片的5次解读中有2个（40%）是正确的。根据主要的CT特征，疾病被分为五个不同的组之一。气道疾病（n = 5）（闭塞性细支气管炎或支气管中心性肉芽肿病）在CT上表现为地图状透亮区。间隔疾病（n = 4）（淋巴管瘤病、血管瘤病或微结石症）表现为间隔增厚。浸润性肺部疾病（n = 7）（脱屑性间质性肺炎、过敏性肺炎或淋巴样间质性肺炎）表现为磨玻璃影。气腔疾病（n = 3）（吸入性、血管炎或机化性肺炎型闭塞性细支气管炎）表现为肺实变。朗格汉斯细胞组织细胞增多症（n = 1）表现为囊肿和结节。令人惊讶的是，这些组之间几乎没有重叠。
CT提高了对小儿浸润性肺部疾病的诊断置信度，提高了诊断准确性，并提供了一个有用的分类系统。
