Copley S J, Coren M, Nicholson A G, Rubens M B, Bush A, Hansell D M
Department of Radiology, Royal Brompton Hospital, London, United Kingdom.
AJR Am J Roentgenol. 2000 Feb;174(2):549-54. doi: 10.2214/ajr.174.2.1740549.
We assessed the accuracy of thin-section CT and chest radiography to diagnose pediatric interstitial lung disease.
We identified 20 infants, boys, and girls (age range, 1 month to 14 years) with histopathologic confirmation of interstitial lung disease. Six boys and girls without interstitial lung disease were also included. Two observers independently assessed chest radiograph and CT images. The observers stated the most likely diagnosis and a differential diagnosis. We evaluated individual CT features and their distribution.
Observers' diagnoses on CT images were correct (first choice or differential) in 66% of observations versus 45% on chest radiographs (p < 0.025). Correct diagnoses were made on first choice in 61% of CT observations versus 34% on chest radiographs (p < 0.005). Observers were confident (versus uncertain) in 42% of the CT observations versus 18% on chest radiographs; of the confident diagnoses made on CT, 91% were correct. CT interpretations were most accurate in the diagnosis of pulmonary alveolar proteinosis, congenital lymphangiectasia, and idiopathic pulmonary hemosiderosis. All healthy patients examined with CT were correctly identified as such. We noted a distinctive CT pattern in three patients with nonspecific interstitial pneumonitis and one patient with desquamative interstitial pneumonitis; the CT pattern consisted of upper zone predominant honeycombing on a background of ground-glass attenuation.
A higher proportion of pediatric interstitial lung diseases can be diagnosed on thin-section CT than on chest radiographs. In our study, confident and correct diagnoses were made more frequently with CT than with chest radiographs.
我们评估了薄层CT和胸部X线摄影诊断小儿间质性肺疾病的准确性。
我们纳入了20例经组织病理学证实为间质性肺疾病的婴儿、男孩和女孩（年龄范围为1个月至14岁）。还纳入了6例无间质性肺疾病的男孩和女孩。两名观察者独立评估胸部X线片和CT图像。观察者陈述最可能的诊断及鉴别诊断。我们评估了各个CT特征及其分布情况。
观察者对CT图像的诊断在66%的观察中是正确的（首选诊断或鉴别诊断），而胸部X线片的正确率为45%（p<0.025）。CT观察中61%的首选诊断是正确的，而胸部X线片为34%（p<0.005）。观察者在42%的CT观察中诊断确定（与不确定相对），而胸部X线片为18%；在CT做出的确定诊断中，91%是正确的。CT解释在肺泡蛋白沉积症、先天性淋巴管扩张症和特发性肺含铁血黄素沉着症的诊断中最准确。所有接受CT检查的健康患者均被正确识别。我们在3例非特异性间质性肺炎患者和1例脱屑性间质性肺炎患者中发现了一种独特的CT表现；CT表现为以磨玻璃影为背景的上叶为主的蜂窝状改变。
与胸部X线片相比，薄层CT能诊断出更高比例的小儿间质性肺疾病。在我们的研究中，CT比胸部X线片更常做出确定且正确的诊断。
