Fufezan Otilia, Asavoaie Carmen, Cherecheş Panta Paraschiva, Mihuţ Gheorghe, Bursaşiu Eugen, Anca Ioana, Iacob Daniela, Gocan Horatiu, Valean Cornel
Clinical Emergency Pediatric Hospital, Radiology Department, str. Campeni 2-4, Cluj-Napoca, Romania.
Med Ultrason. 2010 Mar;12(1):4-11.
Sinusitis in children may sometimes present non-specific signs and symptoms. The imaging techniques used for its diagnosis are computed tomography and magnetic resonance imaging, the standard radiography being used less and less. Ultrasonography is seldom mentioned in literature as a diagnosis method of sinusitis.
The purpose of this study is to evaluate the value of ultrasonography compared with the standard X-ray in the diagnosis of maxillary sinusitis in children.
The study was prospectively conducted. The study group included 76 patients who had an ultrasound of the maxillary sinuses. The including criteria were represented by uncontrolled or partially controlled asthma, symptomatology suggesting rhinosinusitis and age over 4. Patients with radiological anomalies of the maxillary sinuses were excluded from the study as well as the patients who were not examined through X-ray and the ultrasonography on the same day. The ultrasound was performed with a pediatric convex transducer with the patient in a sitting position. The ultrasonographic exam evaluated the presence of fluid collection and mucosal thickening within the maxillary sinuses. Signs evaluated by X-ray exam were: total opacity of the maxillary sinus, air-fluid level and mucosal thickening. The Wilcoxon matched-pairs tests was used in order correlate the results obtained through ultrasonography and radiograph. It was considered statistic significant p<0.05. Using the ROC curve the sensitivity and the specificity of the ultrasound compared with the standard radiograph were determined.
Based on the excluding criteria a number of 67 patients (35 male) were selected from the study group. The patient's mean age+/-standard deviation was 9 years 2 months+/-3 years 9 months. 134 maxillary sinuses were analyzed ultrasonographically and radiologically. There was a diagnosis agreement between the two techniques in 112 out of 134 sinuses (83.5%). Compared to the standard X-ray, ultrasonography had a 94.9 % sensitivity and a 98.4 % specificity. The error of the ultrasound exam compared to the standard X-ray evaluated in a divided interpretation was low for the normal aspect (1.58%) and for the fluid collection (5.12%), but the error for the thickening of the mucosa was high, over 50% (59.37%).
Ultrasonography may come to represent, on a larger scale, an accessible imaging alternative to the more invasive investigations used in the present in evaluating fluid collections in the maxillary sinus in pediatrics.
儿童鼻窦炎有时可能表现为非特异性体征和症状。用于其诊断的成像技术是计算机断层扫描和磁共振成像，标准的X线摄影使用得越来越少。超声检查在文献中很少被提及作为鼻窦炎的诊断方法。
本研究的目的是评估超声检查与标准X线检查相比在儿童上颌窦炎诊断中的价值。
本研究为前瞻性研究。研究组包括76例接受上颌窦超声检查的患者。纳入标准为未控制或部分控制的哮喘、提示鼻-鼻窦炎的症状以及年龄超过4岁。上颌窦有放射学异常的患者以及未在同一天进行X线和超声检查的患者被排除在研究之外。超声检查采用儿科凸阵探头，患者取坐位。超声检查评估上颌窦内有无液体积聚和黏膜增厚。X线检查评估的征象为：上颌窦完全致密、气液平面和黏膜增厚。采用Wilcoxon配对检验来关联超声检查和X线检查的结果。以p<0.05为差异有统计学意义。利用ROC曲线确定超声检查与标准X线检查相比的敏感性和特异性。
根据排除标准，从研究组中选取了67例患者（35例男性）。患者的平均年龄±标准差为9岁2个月±3岁9个月。对134个上颌窦进行了超声和放射学分析。134个鼻窦中有112个（83.5%）两种检查方法诊断一致。与标准X线检查相比，超声检查的敏感性为94.9%，特异性为98.4%。在分类解读中，与标准X线检查相比，超声检查正常表现的误差较低（1.58%），液体积聚的误差也较低（5.12%），但黏膜增厚的误差较高，超过50%（59.37%）。
在儿科评估上颌窦液体积聚时，超声检查可能在更大范围内成为一种比目前使用的侵入性更强的检查更容易获得的成像替代方法。
