Department of Radiology, Division of Nuclear Medicine, Children's Hospital Boston and Harvard Medical School, Boston, MA 02115, USA.
AJR Am J Roentgenol. 2013 Feb;200(2):437-41. doi: 10.2214/AJR.12.8792.
The purpose of our study was to correlate the results of the radionuclide salivagram with the corresponding chest radiography findings on patients being evaluated for salivary aspiration to determine the utility of the salivagram.
We identified 222 patients younger than 21 years who underwent salivagram and chest radiography within 3 months of each other. Salivagrams were blindly interpreted by two readers and chest radiographs were blindly interpreted by two other readers. The kappa coefficient with 95% CI was used to measure the level of interobserver agreement. Multivariate logistic regression was applied to determine whether age, sex, and neurologic diagnosis were predictors of a positive salivagram, with the odds ratio used to estimate association.
Interobserver agreement on salivagram interpretation was excellent (κ = 0.988; p < 0.0001; 95% CI, 0.968-1.000). Interobserver agreement on chest radiography interpretation was excellent (κ = 0.905; p < 0.0001; 95% CI, 0.845-0.965). The salivagram was positive for aspiration in 55 patients (25%). Chest radiography was positive in 54 patients (24%). When the interpretations of the salivagram (normal or abnormal) were compared with interpretations of the chest radiograph (normal or abnormal), there were 213 agreements and nine disagreements (intermethod agreement κ = 0.891; p < 0.0001; 95% CI, 0.831-0.952). Independent of age (p = 0.80) and sex (p = 0.31), patients with a neurologic diagnosis had odds of a positive salivagram 5.6 times higher than other diagnoses (odds ratio = 5.6; 95% CI, 2.5-13.1; p < 0.0001).
Infants with abnormal findings on salivagrams also had a high rate of abnormal findings on chest radiographs, which may indicate that some of the lung disease may be due to aspirated saliva. Salivagrams may be useful in children at risk of aspiration to identify those in whom intervention may help minimize the consequences of aspiration.
本研究旨在通过对比唾液放射性核素显像结果与同期进行的唾液吸入患者的相应胸部 X 线摄影结果，确定唾液显像的作用。
我们共纳入了 222 名年龄小于 21 岁的患者，这些患者在 3 个月内分别接受了唾液显像和胸部 X 线摄影。由两位读者分别对唾液显像进行盲法解读，由另外两位读者对胸部 X 线摄影进行盲法解读。使用 95%置信区间的 κ 系数来衡量观察者间的一致性水平。应用多元逻辑回归分析确定年龄、性别和神经诊断是否为唾液显像阳性的预测因素，使用比值比来估计关联程度。
唾液显像解读的观察者间一致性极好（κ=0.988；p＜0.0001；95%CI，0.968-1.000）。胸部 X 线摄影解读的观察者间一致性极好（κ=0.905；p＜0.0001；95%CI，0.845-0.965）。55 名患者（25%）的唾液显像呈阳性提示有吸入。54 名患者（24%）的胸部 X 线摄影呈阳性。当将唾液显像（正常或异常）的解读与胸部 X 线摄影（正常或异常）的解读进行比较时，有 213 次一致和 9 次不一致（方法间一致性 κ=0.891；p＜0.0001；95%CI，0.831-0.952）。无论年龄（p=0.80）还是性别（p=0.31）如何，神经诊断患者唾液显像阳性的可能性均比其他诊断高 5.6 倍（比值比=5.6；95%CI，2.5-13.1；p＜0.0001）。
唾液显像异常的婴儿胸部 X 线摄影也有很高的异常发现率，这可能表明一些肺部疾病可能是由于吸入的唾液引起的。唾液显像可能对有吸入风险的儿童有用，有助于确定哪些患者需要干预，以尽量减少吸入的后果。
