Choh Naseer A, Parry Arshed H, Wani Abdul H, Feroz Imza, Bhat Mudasir H, Shaheen Feroze A
Department of Radiodiagnosis, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India.
Department of Radiodiagnosis, Government Medical College, Srinagar, Jammu and Kashmir, India.
Pol J Radiol. 2021 Jan 20;86:e53-e63. doi: 10.5114/pjr.2021.103237. eCollection 2021.
To describe the spectrum of imaging findings in pulmonary echinococcosis and to study the additive value of T2-weighted magnetic resonance imaging (MRI) in the characterisation of pulmonary hydatid disease.
This was a descriptive, prospective study conducted for a period of 3 years from December 2016 to November 2019. Patients suspected of having pulmonary echinococcosis ( = 110) on preliminary chest radiography were examined with chest computed tomography (CT). Among them 41 cases were additionally examined with T2-weighted MRI of thorax. Final diagnosis was based on surgery or histopathology.
Of the 110 patients enrolled for the study 15 were lost to attrition, and among the final cohort of 95 patients CT correctly diagnosed 68/84 (80.9%) as hydatid cyst, whereas 16/84 (19.1%) received an erroneous alternate diagnosis on CT. Based on the classical findings of hyperintense pulmonary cystic lesion with T2-weighted hypointense rim or detached internal T2-weighted hypointense membrane, a correct diagnosis of hydatid cyst was possible in 30 patients whereas a correct alternate diagnosis was made in 8 cases. T2-weighted MRI was found to have sensitivity of 96.7%, specificity of 80%, positive predictive value (PPV) of 93.7% and negative predictive value (NPV) of 88.9% with an overall diagnostic accuracy of 92.6%. Using the McNemar test, MRI was found to be diagnostically superior to CT ( = 0.019).
Most of the pulmonary hydatid cysts can be diagnosed on CT; however, sometimes the findings may be indeterminate or atypical, leading to a diagnostic dilemma. MRI, owing to its ability to demonstrate hypointense endocyst, can act as a useful adjunct to correctly diagnose hydatid cyst or suggest an alternative diagnosis.
描述肺包虫病的影像学表现谱，并研究T2加权磁共振成像（MRI）在肺包虫病特征性诊断中的附加价值。
这是一项描述性前瞻性研究，从2016年12月至2019年11月，为期3年。对初步胸部X线检查怀疑患有肺包虫病（n = 110）的患者进行胸部计算机断层扫描（CT）检查。其中41例患者还接受了胸部T2加权MRI检查。最终诊断基于手术或组织病理学检查。
在纳入研究的110例患者中，15例失访，在最终的95例患者队列中，CT正确诊断出84例中的68例（80.9%）为包虫囊肿，而84例中的16例（19.1%）在CT上得到了错误的其他诊断。基于T2加权像上肺囊性病变呈高信号、边缘呈低信号或内部有分离的T2加权低信号膜的典型表现，30例患者能够正确诊断为包虫囊肿，8例患者做出了正确的其他诊断。T2加权MRI的敏感性为96.7%，特异性为80%，阳性预测值（PPV）为93.7%，阴性预测值（NPV）为88.9%，总体诊断准确性为92.6%。使用McNemar检验，发现MRI在诊断上优于CT（P = 0.019）。
大多数肺包虫囊肿可通过CT诊断；然而，有时表现可能不明确或不典型，导致诊断困境。MRI由于能够显示低信号的内囊，可作为正确诊断包虫囊肿或提示其他诊断的有用辅助手段。
