应用对比增强 CT 的川崎病与其他发热伴颈部淋巴结肿大病因鉴别诊断评分系统。
Differentiation of Kawasaki Disease From Other Causes of Fever and Cervical Lymphadenopathy: A Diagnostic Scoring System Using Contrast-Enhanced CT.
机构信息
1 Department of Radiology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi, 467-8601 Japan.
2 Department of Radiology, Saishūkan Hospital, Kitanagoya-shi, Japan.
出版信息
AJR Am J Roentgenol. 2019 Mar;212(3):665-671. doi: 10.2214/AJR.18.20262. Epub 2019 Jan 15.
OBJECTIVE
The purpose of this study is to determine the characteristic findings of contrast-enhanced CT (CECT) of the neck in patients with Kawasaki disease (KD) and to develop a diagnostic scoring system to facilitate the diagnosis of KD versus other causes of fever and cervical lymphadenopathy.
MATERIALS AND METHODS
Two blinded radiologists evaluated CECT images of 37 patients with KD and 92 patients without KD who had febrile cervical lymphadenopathy, first independently and then in consensus. Significant findings in CECT images were evaluated through cervical edema and lymph node scores. CT attenuation of the nodal low-attenuation area and its ratio to the CT attenuation of the trapezius muscle were measured. On the basis of these indexes, a diagnostic scoring system was developed to differentiate between patients with and without KD. Its diagnostic performance was determined using ROC curve analysis.
RESULTS
Retropharyngeal edema, lateral cervical edema, nasopharyngeal wall edema, level IIA lymphadenopathy, and retropharyngeal lymphadenopathy were more common in patients with KD than in patients without KD (p < 0.001, < 0.001, < 0.001, 0.003, and 0.028, respectively). Level VB lymphadenopathy was more common in patients without KD (p = 0.013), and the presence of nodal low-attenuation areas with lower attenuation indexes (attenuation of nodal low-attenuation area ≤ 50 HU, or ratio of attenuation of nodal low-attenuation area to trapezius muscle attenuation ≤ 0.7) was specific to patients without KD. In cases of higher attenuation indexes and cervical edema and lymph node scores of 4 or higher, sensitivity, specificity, and accuracy of the diagnostic scoring system were 86% (32/37), 86% (79/92), and 86% (111/129), respectively, for diagnosing KD.
CONCLUSION
The proposed diagnostic scoring system was useful in differentiating between patients with and without KD.
目的
本研究旨在确定川崎病（KD）患者颈部对比增强 CT（CECT）的特征表现，并制定一个诊断评分系统，以利于KD 与其他发热伴颈淋巴结病病因的鉴别诊断。
材料与方法
两名盲法阅片的放射科医生独立评估了 37 例 KD 患者和 92 例无 KD 但有发热性颈淋巴结病患者的 CECT 图像，然后进行了共识评估。通过颈淋巴结肿大和颈淋巴结评分评估 CECT 图像的显著表现。测量淋巴结低衰减区的 CT 衰减值及其与斜方肌 CT 衰减值的比值。在此基础上，制定了一个诊断评分系统，以区分 KD 患者和非 KD 患者。通过 ROC 曲线分析确定其诊断性能。
结果
KD 患者比非 KD 患者更常见的 CECT 表现包括咽后间隙肿胀、颈外侧肿胀、鼻咽壁肿胀、ⅡA 水平淋巴结肿大和咽后淋巴结肿大（p<0.001、<0.001、<0.001、0.003 和 0.028）。非 KD 患者更常见 VB 水平淋巴结肿大（p=0.013），且存在淋巴结低衰减区，具有较低的衰减指数（淋巴结低衰减区衰减值≤50 HU，或淋巴结低衰减区衰减值与斜方肌衰减值的比值≤0.7）是特异性的非 KD 患者表现。对于诊断评分系统，较高的衰减指数和颈淋巴结肿大和淋巴结评分 4 分或更高的情况下，其诊断 KD 的敏感度、特异度和准确度分别为 86%（32/37）、86%（79/92）和 86%（111/129）。
结论
所提出的诊断评分系统有助于区分 KD 患者和非 KD 患者。
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