Sodhi Kushaljit S, Bhatia Anmol, Nichat Vaibhav, Mathew Joseph L, Saxena Akshay K, Samujh Ram, Singh Meenu
Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Pediatr Pulmonol. 2021 Aug;56(8):2668-2675. doi: 10.1002/ppul.25457. Epub 2021 May 19.
To assess the diagnostic role of chest magnetic resonance imaging (MRI) for evaluating empyema in children with specific indications.
Nineteen children (5-16 years) with a diagnosis of empyema were enrolled in this prospective study from January 2018 to February 2020. MRI and multidetector computed tomography (MDCT) of the chest was performed within 48 h of each other. Two pediatric radiologists independently evaluated the MRI and CT images for the presence of fluid and air in the pleural cavity, septations within the fluid, pleural thickening, pleural enhancement, drainage tube tip localization, consolidation, and lymphadenopathy. Kappa test of agreement was used to determine the agreement between the MRI and MDCT findings. Chance-corrected kappa statistics were used for calculating the interobserver variation.
The kappa test showed almost perfect agreement (κ = 1) between MRI and MDCT for detecting fluid, pleural thickening, pleural enhancement, drainage tube tip localization, consolidation, and lymphadenopathy. Septations within the fluid were detected in 16 (84.2%) patients on MRI, and in 14 (73.7%) patients on MDCT. Almost perfect agreement (κ = 0.81-1.00) was seen for all the findings on CT and MRI between the two radiologists, except for pleural thickening for which a strong agreement (κ = 0.642) was observed.
MRI is comparable to MDCT for the detection of various findings in children with empyema. MRI may be considered in lieu of CT, as a problem-solving tool and as a radiation-reducing endeavor in children with empyema, specifically, only where CT is required for preoperative planning and evaluation of complications.
评估胸部磁共振成像（MRI）在有特定指征的儿童脓胸评估中的诊断作用。
2018年1月至2020年2月，19名诊断为脓胸的儿童（5 - 16岁）纳入本前瞻性研究。胸部MRI和多排螺旋计算机断层扫描（MDCT）在彼此48小时内进行。两名儿科放射科医生独立评估MRI和CT图像，以确定胸腔内有无液体和气体、液体内的分隔、胸膜增厚、胸膜强化、引流管尖端定位、实变和淋巴结病。采用一致性kappa检验来确定MRI和MDCT结果之间的一致性。使用校正机遇的kappa统计量来计算观察者间差异。
在检测液体、胸膜增厚、胸膜强化、引流管尖端定位、实变和淋巴结病方面，MRI和MDCT之间的kappa检验显示几乎完全一致（κ = 1）。MRI上16例（84.2%）患者检测到液体内的分隔，MDCT上14例（73.7%）患者检测到。除胸膜增厚观察到强一致性（κ = 0.642）外，两名放射科医生对CT和MRI上的所有结果几乎完全一致（κ = 0.81 - 1.00）。
在检测脓胸儿童的各种表现方面，MRI与MDCT相当。对于脓胸儿童，特别是仅在术前规划和并发症评估需要CT的情况下，MRI可作为解决问题的工具和减少辐射的手段，考虑替代CT使用。
