Heyer C M, Nüsslein T G, Stephan V, Kuhnen C, Rieger C H L, Nicolas V
Institut für Diagnostische Radiologie, Interventionelle Radiologie und Nuklearmedizin, BG Universitätsklinikum Bergmannsheil, Ruhr-Universität Bochum.
Pneumologie. 2007 Aug;61(8):499-508. doi: 10.1055/s-2007-959218. Epub 2007 May 25.
Children with interstitial pneumonitis (IP) of unknown origin often have to undergo open lung biopsy to establish a final diagnosis. Open lung biopsy is an invasive procedure with major potential complications. In the meantime, CT-guided transthoracic lung biopsy (TLB) has become a common diagnostic procedure in adults.
The aim of this study was to retrospectively evaluate the efficacy and radiation exposure of low-dose CT-guided TLB in children with non-infectious IP of unknown origin.
Twelve children (7-males, age range: 7 months-15 years) with non-infectious IP of unknown origin and inconclusive clinical tests underwent CT-guided TLB with a 20-gauge biopsy instrument. A low-dose protocol with acquisition of single slices was used on a 16-row CT scanner: 80 kVp, 20 mAs, slice thickness 10 mm. Biopsy specimens were processed by standard histopathological and immunohistochemical techniques and effective doses were individually calculated.
All biopsies were performed without major complications. Two children (17 %) developed a small pneumothorax/pulmonary haemorrhage that resolved spontaneously. A final diagnosis could be established in 9/12 patients (75 %) by CT-guided TLB. In 2 patients (17 %) the results of TLB were inconclusive; however, the clinical suspicion could be disproved. Open lung biopsy was performed in 1 patient (8 %), which demonstrated idiopathic pulmonary fibrosis. On average, the effective dose of CT-guided TLB was 0.78 mSv (0.4 - 1.1 mSv).
Low-dose CT-guided TLB can be a helpful method for investigating children with non-infectious IP of unknown origin thus making open lung biopsy unnecessary. Application of a low-dose protocol leads to a significant reduction of radiation exposure in CT-guided TLB.
病因不明的间质性肺炎（IP）患儿常需接受开胸肺活检以明确最终诊断。开胸肺活检是一种侵入性操作，存在重大潜在并发症。与此同时，CT引导下经胸肺活检（TLB）已成为成人常用的诊断方法。
本研究旨在回顾性评估低剂量CT引导下TLB对病因不明的非感染性IP患儿的疗效及辐射暴露情况。
12例病因不明的非感染性IP患儿（7例男性，年龄范围：7个月至15岁），临床检查结果不明确，采用20G活检针在CT引导下行TLB。在16排CT扫描仪上采用单层面采集的低剂量扫描方案：80 kVp，20 mAs，层厚10 mm。活检标本采用标准组织病理学和免疫组织化学技术处理，并分别计算有效剂量。
所有活检均未出现重大并发症。2例患儿（17%）出现少量气胸/肺出血，均自行吸收。9/12例患者（75%）通过CT引导下TLB明确了最终诊断。2例患者（17%）TLB结果不明确，但可排除临床怀疑。1例患者（8%）接受了开胸肺活检，结果显示为特发性肺纤维化。CT引导下TLB的平均有效剂量为0.78 mSv（0.4～1.1 mSv）。
低剂量CT引导下TLB可能是一种有助于研究病因不明的非感染性IP患儿的方法，从而无需进行开胸肺活检。低剂量扫描方案的应用可显著减少CT引导下TLB的辐射暴露。
