Donnelly L F, Klosterman L A
Department of Radiology, Duke University Medical Center, Durham, NC 27710, USA.
Radiology. 1997 Dec;205(3):817-20. doi: 10.1148/radiology.205.3.9393541.
To determine if computed tomographic (CT) findings of decreased contrast material enhancement are predictive of more intense illness and of the development of cavitary necrosis in children with pneumonia.
Contrast-enhanced CT scans in 44 children with pneumonia who did not respond appropriately to therapy were compared with precontrast CT scans to evaluate enhancement of consolidated lung parenchyma. Enhancement was correlated with admission to the intensive care unit, length of hospital stay, cavitary necrosis in the lung at follow-up CT, and frequency of lung resection.
Parenchymal enhancement was decreased in 21 children; pneumonia was enhanced in the other 23 children. Decreased enhancement was associated with increased admission to intensive care (14 of 21 [67%] vs five of 23 [22%] children; P = .0026), increased length of hospital stay (15 vs 10 days; P = .0615), increased frequency of cavitary necrosis at follow-up CT (seven of seven [100%] vs none of three children; P = .0086), and increased frequency of resection (two of 21 [10%] vs none of 23 children). At histopathologic examination, diffuse cavitary necrosis was present in resected lobes in two patients.
Decreased parenchymal enhancement at CT is a predictor of more intense illness and may herald the development of cavitary necrosis in children with pneumonia.
确定计算机断层扫描（CT）显示的对比剂增强降低的表现是否可预测肺炎患儿病情更严重以及是否会出现空洞性坏死。
对44例对治疗反应不佳的肺炎患儿进行对比增强CT扫描，并与平扫CT扫描进行比较，以评估实变肺实质的强化情况。强化情况与入住重症监护病房、住院时间、随访CT时肺部空洞性坏死以及肺切除频率相关。
21例患儿的实质强化降低；另外23例患儿的肺炎有强化。强化降低与入住重症监护病房的增加（21例中的14例[67%]对比23例中的5例[22%]；P = 0.0026）、住院时间延长（15天对比10天；P = 0.0615）、随访CT时空洞性坏死频率增加（7例中的7例[100%]对比3例中的0例；P = 0.0086）以及切除频率增加（21例中的2例[10%]对比23例中的0例）相关。在组织病理学检查中，2例患者切除的肺叶出现弥漫性空洞性坏死。
CT上实质强化降低是病情更严重的预测指标，可能预示肺炎患儿会出现空洞性坏死。
