Marini C, Bulleri A, Cambi L, Marinari A, Bernardini M, Bartalena L, Falaschi F
Istituto di Radiodiagnostica, Università, Pisa.
Radiol Med. 1997 Nov;94(5):463-7.
Chest radiography is considered the most reliable diagnostic tool to study the respiratory distress syndrome in newborns and one of the few diagnostic investigations which can be used considering the clinical situation of these patients and the need of a prompt diagnosis.
We examined 124 newborns (56 males and 68 females) submitted to chest radiography at least once. Two radiologists analyzed the images investigating: a) chest expansion, b) reticulonodular opacities, c) aerial bronchograms, d) parenchymal consolidation, e) atelectasis, f) pneumothorax. The clinical diagnosis was made by neonatologists on the basis of clinical and instrumental data and of the clinical evolution of the patients.
Twenty of 23 clinically negative patients had negative chest radiographs and 3 were false positives. Transient tachypnea was diagnosed in 14 newborns where chest radiography showed reticulonodular opacities. Ten of 62 patients with hyaline membrane disease had a negative chest radiograph, 26 had fine granular opacities, 16 marked hypoexpansion with reticulonodular opacities and aerial bronchogram, and 10 diffuse parenchymal consolidations with aerial bronchogram also in the peripheral lung. Eleven patients had a clinical and radiological diagnosis of segmental or lobar atelectasis; 5 newborns had an aspiration syndrome and radiography showed parenchymal consolidations in 4 and was negative in one. Five patients had pneumothorax, 3 diaphragmatic hernia and 1 infective pneumonia; radiology confirmed the diagnosis in all cases. We had three false positives and 11 false negatives at conventional radiography--i.e., 10 had MMI and one the meconium aspiration syndrome. Diagnostic sensitivity was 89.1%, specificity 86.9% and diagnostic accuracy 88.7%.
Our results are partially limited by the lack of a reference gold standard. Nevertheless, if we consider the clinical condition and the respiratory distress syndrome evolution as a valid reference, the diagnostic accuracy of radiography is good.
胸部X线摄影被认为是研究新生儿呼吸窘迫综合征最可靠的诊断工具，也是少数可根据这些患者的临床情况及快速诊断需求而使用的诊断检查之一。
我们检查了至少接受过一次胸部X线摄影的124例新生儿（56例男性，68例女性）。两名放射科医生分析图像，检查内容包括：a）胸廓扩张；b）网状结节状阴影；c）空气支气管征；d）实质实变；e）肺不张；f）气胸。临床诊断由新生儿科医生根据临床和仪器检查数据以及患者的临床病程做出。
23例临床诊断为阴性的患者中，20例胸部X线摄影结果为阴性，3例为假阳性。14例新生儿诊断为短暂性呼吸急促，其胸部X线摄影显示网状结节状阴影。62例患有透明膜病的患者中，10例胸部X线摄影结果为阴性，26例有细颗粒状阴影，16例有明显的胸廓塌陷伴网状结节状阴影及空气支气管征，10例在肺外周也有弥漫性实质实变及空气支气管征。11例患者临床和影像学诊断为节段性或叶性肺不张；5例新生儿患有吸入综合征，4例胸部X线摄影显示实质实变，1例为阴性。5例患者患有气胸，3例患有膈疝，1例患有感染性肺炎；放射学检查在所有病例中均证实了诊断。在传统X线摄影中我们有3例假阳性和11例假阴性——即10例患有胎粪吸入综合征，1例患有胎粪吸入综合征。诊断敏感性为89.1%，特异性为86.9%，诊断准确性为88.7%。
我们的结果部分受到缺乏参考金标准的限制。然而，如果将临床情况及呼吸窘迫综合征的病程视为有效的参考标准，X线摄影的诊断准确性良好。
