儿童先天性肺气道畸形的CT表现及诊断
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摘要
目的:探讨儿童先天性肺气道畸形(CPAM)的CT影像特征及诊断要点,以提高对本病的认识和诊断准确性。方法:34例确诊CPAM并于术前行CT检查的患儿纳入研究,其中男性24例,女性10例。所有病例均行胸部CT检查,回顾性分析CT影像表现,并对全部病例进行诊断试验。结果:CPAM的CT主要表现可分为多发大囊(23/34,67.6%)、多发小囊(6/34,17.6%)、片状高密度影(3/34,8.8%)、单发大囊(2/34,5.9%)四种,可以合并感染、体循环供血及其他肺内外畸形等。诊断试验显示,未经过培训的医生对CPAM的诊断准确率(44.1%)远低于培训后医生(79.4%)。结论:儿童CPAM的CT表现具有特征性,以囊性病变、尤其是多囊性病变最为常见,通过学习可以提高对该疾病的认识及诊断水平。
Purpose: To investigate the CT features and diagnostic criteria of congenital pulmonary airway malformation(CPAM) in children in order to improve the understanding and diagnostic accuracy of the disease. Methods: Thirty-four patients with confirmed CPAM who underwent CT before surgery were enrolled in the study, including 24 males and 10 females. All patients with chest CT examination were retrospectively analyzed, while diagnostic tests were carried out in all cases. Results: The main manifestations of CPAM on CT images were divided into four types: multiple large cysts(23/34,67.6%), multiple small cysts(6/34, 17.6%), patchy consolidation(3/34, 8.8%), and single large cysts(2/34, 5.9%).Besides,CPAM could also be combined with infection, systemic blood supply and other malformations. Diagnostic tests showed that the accuracy of the diagnosis of CAPM by untrained doctors(44.1%) was much lower than that of the post-training doctors(79.4%). Conclusions: The CT findings of CPAM are characteristic, and the multi-cystic lesion is the most common feature. Therefore, radiologists can improve awareness and diagnostic accuracy of the disease.
Purpose: To investigate the CT features and diagnostic criteria of congenital pulmonary airway malformation(CPAM) in children in order to improve the understanding and diagnostic accuracy of the disease. Methods: Thirty-four patients with confirmed CPAM who underwent CT before surgery were enrolled in the study, including 24 males and 10 females. All patients with chest CT examination were retrospectively analyzed, while diagnostic tests were carried out in all cases. Results: The main manifestations of CPAM on CT images were divided into four types: multiple large cysts(23/34,67.6%), multiple small cysts(6/34, 17.6%), patchy consolidation(3/34, 8.8%), and single large cysts(2/34, 5.9%).Besides,CPAM could also be combined with infection, systemic blood supply and other malformations. Diagnostic tests showed that the accuracy of the diagnosis of CAPM by untrained doctors(44.1%) was much lower than that of the post-training doctors(79.4%). Conclusions: The CT findings of CPAM are characteristic, and the multi-cystic lesion is the most common feature. Therefore, radiologists can improve awareness and diagnostic accuracy of the disease.
引文
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[7]牛会林,刘威,王凤华,等.小儿肺囊性病变临床病理学观察.临床与实验病理学杂志,2015:413-417.
[8]张娜,曾骐,陈诚豪,等.175例小儿连续胸腔镜肺切除术回顾性研究.中华小儿外科杂志,2017,38:591-594.
[9]K L.Management of congenital cystic adenomatous malformations of the lung.Archives of disease in childhood.Fetal and neonatal edition,2009,94:F73-F76.
[10]任甄华,徐赛英,李东辉,等.小儿先天性肺囊性腺瘤样畸形的影像学表现.中华放射学杂志,2002,36:54-57.
[11]Calvert J K,Lakhook.Antenatally suspected congenital cystic adenomatoid malformation of the lung:postnatal investigation and timing of surgery.J Pediatr Surg,2007,42:411-414.
[12]Stocker J T.Cystic lung disease in infants and children.Fetal Pediatr Pathol,2009,28:155-184.
[13]LANGSTON C.New concepts in the pathology of congenital lung malformations.Semin Pediatr Surg,2003,12:17-37.
[14]Kwak H J,Moon J Y,Kim S I,et al.Congenital cystic adenomatoid malformation with bronchial atresia in elderly patients.Tuberc Respir Dis(Seoul),2012,72:501-506.
[15]Biyyam D R,Chapman T,Ferguson M R,et al.Congenital lung abnormalities:embryologic features,prenatal diagnosis,and postnatal radiologic-pathologic correlation.Radiographics,2010,30:1721-1738.
[2]Stocker J T,Madewell J E,Drake R M.Congenital cystic adenomatoid malformation of the lung.Classification and morphologic spectrum.Hum Pathol,1977,8:155-171.
[3]Stocker JT.Congenital pulmonary airway malformation:a new name and expanded classification of congenital cystic adenomatoid malformation of the lung.Histopathology,2002,41:424-431.
[4]虞凌明,唐雯娟.儿童胸膜肺母细胞瘤的影像学分析.中国医学计算机成像杂志,2017,23:136-139.
[5]Stocker L J,Wellesley D G,Stanton M P,et al.The increasing incidence of foetal echogenic congenital lung malformations:an observational study.Prenat Diagn,2015,35:148-153.
[6]Gornall A S,Budd J L,Draper E S,et al.Congenital cystic adenomatoid malformation:accuracy of prenatal diagnosis,prevalence and outcome in a general population.Prenat Diagn,2003,23:997-1002.
[7]牛会林,刘威,王凤华,等.小儿肺囊性病变临床病理学观察.临床与实验病理学杂志,2015:413-417.
[8]张娜,曾骐,陈诚豪,等.175例小儿连续胸腔镜肺切除术回顾性研究.中华小儿外科杂志,2017,38:591-594.
[9]K L.Management of congenital cystic adenomatous malformations of the lung.Archives of disease in childhood.Fetal and neonatal edition,2009,94:F73-F76.
[10]任甄华,徐赛英,李东辉,等.小儿先天性肺囊性腺瘤样畸形的影像学表现.中华放射学杂志,2002,36:54-57.
[11]Calvert J K,Lakhook.Antenatally suspected congenital cystic adenomatoid malformation of the lung:postnatal investigation and timing of surgery.J Pediatr Surg,2007,42:411-414.
[12]Stocker J T.Cystic lung disease in infants and children.Fetal Pediatr Pathol,2009,28:155-184.
[13]LANGSTON C.New concepts in the pathology of congenital lung malformations.Semin Pediatr Surg,2003,12:17-37.
[14]Kwak H J,Moon J Y,Kim S I,et al.Congenital cystic adenomatoid malformation with bronchial atresia in elderly patients.Tuberc Respir Dis(Seoul),2012,72:501-506.
[15]Biyyam D R,Chapman T,Ferguson M R,et al.Congenital lung abnormalities:embryologic features,prenatal diagnosis,and postnatal radiologic-pathologic correlation.Radiographics,2010,30:1721-1738.