Kiekara O, Korppi M, Tanska S, Soimakallio S
Department of Clinical Radiology, Kuopio University Hospital, Finland.
Ann Med. 1996 Feb;28(1):69-72. doi: 10.3109/07853899608999077.
During 12 months in 1981-82, 201 children were hospitalized due to radiologically verified definite or probable pneumonia. In 1985, 194 chest radiographs (anteroposterior views) were re-evaluated jointly by two radiologists, and classified into three categories: alveolar, interstitial and probable pneumonia. In 127 cases definite pneumonia was diagnosed on both occasions, alveolar in 48 cases and interstitial in 79 cases. Variation between the two evaluations 3 years apart was observed in 46 (24%) of the 194 cases; the adjusted kappa (0.47) was in the modest region. Factors contributing to this variation were young age, less than 12 months, and the presence of interstitial infiltration, bronchial obstruction and low C-reactive protein. Factors associated with less marked variation were the presence of alveolar infiltration, auscultatory fine rates and elevated C-reactive protein. The microbial aetiology of infection, assessed by viral and bacterial antigen and antibody assays, showed no association with diagnostic variation. A lateral view of the chest radiograph was obtained from 158 patients; it was positive in 99 (91%) of the 109 cases with definite pneumonia. In only three cases the diagnosis was based on the lateral view alone. Our results show that the radiological diagnosis of pneumonia is difficult in children, especially in young children with interstitial pneumonia.
在1981 - 1982年的12个月期间，201名儿童因经放射学证实的明确或可能的肺炎而住院。1985年，两名放射科医生共同重新评估了194张胸部X光片（前后位片），并将其分为三类：肺泡性、间质性和可能的肺炎。在127例病例中，两次诊断均为明确的肺炎，其中肺泡性肺炎48例，间质性肺炎79例。在194例病例中的46例（24%）观察到相隔3年的两次评估之间存在差异；调整后的kappa值（0.47）处于中等水平。导致这种差异的因素包括年龄小于12个月、存在间质性浸润、支气管阻塞和低C反应蛋白。与差异不太明显相关的因素包括存在肺泡浸润、听诊细湿啰音和C反应蛋白升高。通过病毒和细菌抗原及抗体检测评估的感染微生物病因与诊断差异无关。从158例患者获得了胸部X光片的侧位片；在109例明确肺炎病例中的99例（91%）侧位片呈阳性。仅在3例病例中诊断仅基于侧位片。我们的结果表明，儿童肺炎的放射学诊断很困难，尤其是患有间质性肺炎的幼儿。
