Department of Pediatric Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Lombardia, Italy.
Pediatric Radiology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Lombardia, Italy.
Eur J Pediatr Surg. 2020 Oct;30(5):452-458. doi: 10.1055/s-0039-1696669. Epub 2019 Oct 6.
Consensus on the best postnatal radiological evaluation of congenital lung malformations (CLMs) is still lacking. In recent years, the interest on magnetic resonance imaging (MRI) has grown, but its role is still unknown.
The aim of the study was to identify the best preoperative diagnostic assessment for CLM.
All patients with a prenatal suspicion of CLM between January 2014 and February 2018 were studied. Asymptomatic newborns underwent MRI, during spontaneous sleep without contrast. Patients with a positive MRI were scheduled for computed tomography (CT) within the fourth month of life. Thoracoscopic resection was performed in cases with a pathological CT. MRI, CT, and surgical findings were compared based on dimension, localization, and features of the CLM using the Cohen's kappa test (K).
A total of 20 patients were included (10 males). No difference was found in the diameter and site of the lesions always localized in the same side (K = 1) and in the same pulmonary lobe (K = 1). Infants who underwent thoracoscopic resection included: three congenital pulmonary airway malformations (CPAMs), five extralobar and eight intralobar sequestrations (bronchopulmonary sequestrations [BPSs]), three bronchogenic cysts, and one congenital emphysema. The concordance between MRI and CT and between radiological investigations and pathology was satisfactory for the greatest part of the studied variables. MRI showed sensitivity of 100%, specificity of 82%, positive predictive value of 50% and negative predictive value of 100% for CPAM and 77, 100, 100, and 80% for BPS, respectively.
MRI proved to be a reliable diagnostic investigation for CLM with high sensitivity and specificity. Early MRI in spontaneous sleep without contrast and preoperative contrast CT scan is a valuable preoperatory assessment.
先天性肺畸形（CLM）的最佳产后影像学评估仍存在共识。近年来，磁共振成像（MRI）的应用越来越受到关注，但它的作用仍不清楚。
本研究旨在确定 CLM 的最佳术前诊断评估方法。
研究对象为 2014 年 1 月至 2018 年 2 月期间产前疑似 CLM 的所有患者。无症状新生儿在自然睡眠时不使用造影剂进行 MRI 检查。MRI 阳性的患者在出生后第四个月内进行 CT 检查。如果 CT 检查结果为病理性，则进行胸腔镜切除术。基于 CLM 的尺寸、定位和特征，使用 Cohen's kappa 检验（K）比较 MRI、CT 和手术结果。
共纳入 20 例患者（男 10 例）。病变的直径和部位始终位于同一侧（K=1）和同一肺叶（K=1），无差异。行胸腔镜切除术的患儿包括：3 例先天性肺气道畸形（CPAM）、5 例肺外叶和 8 例肺内叶隔离症（支气管肺隔离症[BPS]）、3 例支气管囊肿和 1 例先天性肺气肿。MRI 与 CT 之间以及影像学检查与病理学之间的大部分研究变量的一致性都很好。MRI 对 CPAM 的敏感性为 100%、特异性为 82%、阳性预测值为 50%、阴性预测值为 100%，对 BPS 的敏感性为 77%、特异性为 100%、阳性预测值为 100%、阴性预测值为 80%。
MRI 是一种可靠的 CLM 诊断方法，具有较高的敏感性和特异性。在自然睡眠时不使用造影剂进行早期 MRI 检查和术前对比 CT 扫描是一种有价值的术前评估方法。
