Hilbert G, Vargas F, Valentino R, Gruson D, Chene G, Bébéar C, Gbikpi-Benissan G, Cardinaud J P
Medical Intensive Care Unit, University Hospital of Bordeaux, Bordeaux, France.
Crit Care Med. 2001 Jul;29(7):1337-42. doi: 10.1097/00003246-200107000-00007.
To compare B-mode ultrasound with sinus computed tomograph (CT) scan in the diagnosis of sinusitis in intubated patients undergoing mechanical ventilation.
Prospective, clinical investigation.
Medical intensive care unit of a university hospital.
Fifty patients undergoing intubation and mechanical ventilation more than 2 days, with a clinical suspicion of paranasal sinusitis with purulent nasal discharge.
One hundred paranasal sinuses were examined. A paranasal CT scan and a B-mode ultrasound were performed the same day. Radiologic maxillary sinusitis (RMS) was defined as complete opacification of the sinus or as the presence of an air-fluid level. Absence of RMS was defined as normal sinus or as the presence of mucosal thickening. Important RMS was defined by total opacity or air-fluid level larger than half of the sinus area. Moderate RMS was defined by air-fluid level inferior than half of the sinus area. For ultrasonographic procedure, the image defined as normal was an acoustic shadow arising from the front wall. Two levels of positive echography were described: 1) a moderate lesion was defined as the visualization only of the hyperechogenic posterior wall of the sinus; 2) an important lesion was defined as the hyperechogenic visualization of posterior wall and the extension by the internal wall of the sinus outlining the hypoechogenic sinus cavity.
Sensibility, specificity, positive predictive value, and negative predictive value of B-mode ultrasound compared with CT were, respectively: 100% (95% confidence intervals [95% CI] = 94.9-100.0), 96.7% (95% CI = 82.8-99.9), 98.6% (95% CI = 92.4-99.9), and 100% (95% CI = 88.1-100). The concordance between a moderate B-mode ultrasound lesion and a moderate RMS on CT, and between an important B-mode ultrasound lesion and an important RMS on CT, assessed using kappa statistics was 93%. The concordance between B-mode ultrasound's results and CT's results assessed using weighted kappa statistics was 97%.
B-mode ultrasound may be proposed first-line in a ventilated patient with suspicion of maxillary sinusitis.
比较B型超声与鼻窦计算机断层扫描（CT）在诊断接受机械通气的插管患者鼻窦炎中的应用。
前瞻性临床研究。
大学医院的医学重症监护病房。
50例接受插管和机械通气超过2天、临床怀疑患有伴有脓性鼻分泌物的鼻窦炎的患者。
对100个鼻窦进行检查。同一天进行鼻窦CT扫描和B型超声检查。放射性上颌窦炎（RMS）定义为鼻窦完全混浊或存在气液平面。无RMS定义为鼻窦正常或存在黏膜增厚。重要RMS定义为完全混浊或气液平面大于鼻窦面积的一半。中度RMS定义为气液平面小于鼻窦面积的一半。对于超声检查，定义为正常的图像是从前壁产生的声影。描述了两种阳性超声检查结果：1）中度病变定义为仅可见鼻窦高回声后壁；2）重要病变定义为高回声后壁及鼻窦内壁延伸勾勒出低回声鼻窦腔。
与CT相比，B型超声的敏感性、特异性、阳性预测值和阴性预测值分别为：100%（95%置信区间[95%CI]=94.9 - 100.0）、96.7%（95%CI = 82.8 - 99.9）、98.6%（95%CI = 92.4 - 99.9）和100%（95%CI = 88.1 - 100）。使用kappa统计评估，中度B型超声病变与CT上的中度RMS之间以及重要B型超声病变与CT上的重要RMS之间的一致性为93%。使用加权kappa统计评估，B型超声结果与CT结果之间的一致性为97%。
对于怀疑患有上颌窦炎的机械通气患者，可首先考虑使用B型超声。
Zotero 插件