Chemeda Leul Adane, Solomon Daniel Zewdneh, Taddese Hanna Damtew, Hailemichael Henok
Pediatric Radiology Fellow, Addis Ababa University, College of Health Sciences, Department of Radiology.
Pediatric Radiologist, Addis Ababa University, College of Health Sciences, Department of Radiology.
Ethiop J Health Sci. 2024 Oct;34(Spec Iss 1):47-52. doi: 10.4314/ejhs.v34i1.8S.
Traditionally, pediatric pneumonia is diagnosed through clinical examination and chest radiography (CXR), with computed tomography (CT) reserved for complications. Lung ultrasound (LUS) has gained popularity due to its portability and absence of ionizing radiation. This study evaluates LUS's accuracy compared to CXR in diagnosing pneumonia in children.
We conducted a cross-sectional study from April to September 2023 involving 108 children aged 14 or younger admitted with pneumonia. Each child underwent LUS using a 5-zone scanning protocol, followed by CXR, with the latter interpreted independently by two consultant radiologists. Agreement between LUS and CXR for diagnosing consolidation and interstitial pneumonia patterns was assessed using Cohen's Kappa (k) with SPSS version 26.0.
Pneumonia was radiographically confirmed in 79 children (73.1%). LUS detected consolidation in 41.7% of cases, compared to 43.5% for CXR, demonstrating a sensitivity of 97.8%, specificity of 95.2%, positive predictive value (PPV) of 93.6%, and negative predictive value (NPV) of 98.4%. LUS showed higher accuracy for interstitial lung patterns (sensitivity 93.6%, specificity 97.4%). The agreement between LUS and CXR was excellent, with Cohen's Kappa values of 0.908 for consolidation and 0.863 for interstitial pneumonia. LUS also identified more pleural effusions (11.1%) compared to CXR (6.5%).
LUS demonstrates comparable diagnostic accuracy to CXR for pneumonia, exhibiting high sensitivity and specificity for pneumonia-related features. It outperforms CXR in detecting small-volume consolidations and effusions, supporting its routine use in clinical settings.
传统上，小儿肺炎通过临床检查和胸部X线摄影（CXR）进行诊断，计算机断层扫描（CT）则用于诊断并发症。肺部超声（LUS）因其便携性和无电离辐射而受到欢迎。本研究评估了LUS与CXR相比在诊断儿童肺炎方面的准确性。
我们于2023年4月至9月进行了一项横断面研究，纳入了108名14岁及以下因肺炎入院的儿童。每个儿童均采用5区扫描方案进行LUS检查，随后进行CXR检查，后者由两名放射科顾问独立解读。使用SPSS 26.0软件，通过Cohen's Kappa（k）评估LUS与CXR在诊断实变和间质性肺炎模式方面的一致性。
79名儿童（73.1%）经影像学证实患有肺炎。LUS检测到41.7%的病例存在实变，CXR检测到43.5%的病例存在实变，LUS的敏感性为97.8%，特异性为95.2%，阳性预测值（PPV）为93.6%，阴性预测值（NPV）为98.4%。LUS对间质性肺模式的准确性更高（敏感性93.6%，特异性97.4%）。LUS与CXR之间的一致性极佳，实变的Cohen's Kappa值为0.908，间质性肺炎的Cohen's Kappa值为0.863。与CXR（6.5%）相比，LUS还发现了更多的胸腔积液（11.1%）。
LUS在诊断肺炎方面显示出与CXR相当的诊断准确性，对肺炎相关特征具有高敏感性和特异性。在检测小体积实变和积液方面，LUS优于CXR，支持其在临床环境中的常规使用。
