HRCT in the treatment of bronchiolitis obliterans in children
-
摘要:
目的 探讨高分辨率CT在儿童闭塞性毛细支气管炎（BO）中的应用价值。 方法 回顾性分析经临床证实的38例BO患儿的影像资料，所有患儿均行肺部高分辨率CT扫描。 结果 38例患儿，均不同程度具备“马赛克”灌注征像，呈弥漫性多发片状分布，部分边界清晰，部分模糊，少部分清晰与模糊并存。血流灌注减少35例；肺内气体潴留37例；支气管壁增厚21例、支气管扩张23例，二者均以下叶发病最高；单侧或局限性透明肺7例；肺实质病变25例，其中肺不张11例、肺炎13例、肺实变11例；肺内结节16例、胸膜下结节7例；支气管粘液栓3例。 结论 高分辨率CT能够对儿童BO各种征象进行直观显示，其中以“马赛克”灌注最为典型，为本病的首要影像学表现，从而能够更早的为临床治疗提供依据。高分辨率CT是儿童BO不可缺少的一种影像学检查手段。 Abstract:Objective To explore the applicative value of high resolution CT (HRCT) in the treatment of bronchiolitis obliterans (BO) in children. Methods The pulmonary HRCT findings of 38 cases with clinically confirmed BO were retrospectively analyzed. Results All the 38 cases had " mosaic” perfusion signs to different degrees, which displayed a diffuse and patchy distribution, and some cases showed clear boundary, some fuzzy, while in other cases both conditions exist. Blood perfusion in 35 cases decreased, and pulmonary air trapping, bronchial wall thickening, and bronchial dilatation were found in 35, 21 and 23 cases respectively, the latter two of which have a higher incidence in the lower lobe. 7 cases had unilateral hyperlucent lung, and 25 cases had pulmonary parenchyma, including 11 cases of atelectasis, 13 cases of pneumonia, and 11 cases of pulmonary consolidation. Lung nodules were found in 16 cases, subpleural nodules in 7 cases, and bronchial mucus plugs 3 cases. Conclusion HRCT could directly display all sorts of signs of BO in children, wherein the most typical symptom and the primary imaging feature of these diseases is the " mosaic” perfusion pattern. Therefore, HRCT can provide the basis for earlier clinical treatment, and it is an indispensable imaging examination method in children BO treatment. -
Key words:
- high resolution /
- children /
- bronchiolitis obliterans /
- tomography /
- X-ray computed
-
图 1 马赛克灌注征像一
男，1岁2月，咳喘，腺病毒感染，重度肺炎肺不张，肺功能示混合性气道阻塞性通气功能障碍; A:双肺广泛弥漫性“马赛克征”; B、C：左下肺实变并支扩，右肺下叶部分段以下支气管壁增厚.
-
[1] Kurland G, Michelson P. Bronchiolitis obliterans in children[J]. Pediatr Pulmonol, 2005, 39（3）: 193-208. doi: 10.1002/(ISSN)1099-0496 [2] Yalcin E, Dogru D, Haliloglu M, et al. Postinfectious bronchiolitis obliterans in children:clinical and radiological, profile and prognostic factors[J]. Respiration, 2003, 70（4）: 371-5. doi: 10.1159/000072900 [3] Yu RK, Seok JH, Yoon GP. Lung transplantation for bron-chiolitis obliterans after allogeneic hematopoietic stem cell trans-plantation[J]. Yonsei Med, 2012, 53（5）: 1054-7. doi: 10.3349/ymj.2012.53.5.1054 [4] 戎冬冬, 李坤成, 杜祥颖, 等. 慢性阻塞性肺疾病气道病变的64层MSCT与肺功能的相关性研究[J]. 医学影像学杂志, 2009, 19（10）: 1241-5. doi: 10.3969/j.issn.1006-9011.2009.10.009 [5] 王宏伟, 李广威, 丁长伟, 等. 肺高分辨力CT" 马赛克”衰减的表现及其诊断价值[J]. 中国医学影像学杂志, 2006, 14（01）: 16-8. doi: 10.3969/j.issn.1005-5185.2006.01.005 [6] Barbosa J, Song G, Tustison NA, et al. Computational analysis of thoracic multidetector row HRCT for segmentation and quantification of small airway air trappin emphysema in obstructive pulmonary disease[J]. Acad Radiol, 2011, 18（10）: 1258-69. doi: 10.1016/j.acra.2011.06.004 [7] 于 寰, 江海林, 范 丽, 等. 慢性阻塞性肺疾病与正常志愿者的小气道HRCT定量分析的对照研究[J]. 实用放射学杂志, 2013, 29（5）: 726-9. http://med.wanfangdata.com.cn/Paper/Detail?id=PeriodicalPaper_syfsxzz201305011 [8] 赵宝英, 卫宏江, 郝 哲, 等. 肺高分辨率CT" 马赛克”衰减与肺功能的相关性研究[J]. 放射学实践, 2003, 18（07）: 479-82. doi: 10.3969/j.issn.1000-0313.2003.07.007 [9] 彭 芸, 马大庆, 孙国强, 等. 儿童闭塞性毛细支气管炎影像学表现[J]. 中华放射学杂志, 2006, 40（7）: 752-5. https://www.wenkuxiazai.com/doc/0f0a7104e87101f69e319556.html [10] Davies C, Tasker AD, Padley S, et al. Air-trapping in sarcoidesis on computed tomgraphy:correlation with lung function[J]. Clin Radiol, 2000, 55（4）: 217-21. https://www.sciencedirect.com/science/article/pii/S0009926099903665 [11] 王文秀, 纪俊雨, 李 雯, 等. 肺高分辨率CT马赛克样灌注与小气道功能指数的相关分析[J]. 河北医药, 2011, 33（3）: 343-5. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=hbyy201103009 [12] 李茂胜. 支气管扩张的HRCT征象分析（附38例报告） [J]. 医学影像学杂志, 2011, 21（10）: 1615-6. doi: 10.3969/j.issn.1006-9011.2011.10.066 [13] 侯印西, 毕立军, 姜荣兴, 等. 特发性单侧透明肺的影像诊断[J]. 实用放射学杂志, 2006, 22（10）: 1207-10. doi: 10.3969/j.issn.1002-1671.2006.10.013 [14] Akira M, Toyokawa K, Inoue Y, et al. Quantitative CT in chronic obstructive pulmonary disease: inspiratory and expiratory assessment[J]. AJR Am J Roentgenol, 2009, 192（1）: 267-72. doi: 10.2214/AJR.07.3953 [15] Lee YK, Oh YM, Lee JH, et al. Quantitative assessment of emphysema, air trapping, and airway thickening on computed tomography[J]. Lung, 2008, 186（3）: 157-65. doi: 10.1007/s00408-008-9071-0 [16] O'donnell RA, Peebles C, Ward JA, et al. Relationship between peripheral airway dysfunction,airway obstruction,and neutrophilie inflammation in COPD[J]. Thorax, 2004, 59（10）: 837-42. doi: 10.1136/thx.2003.019349 [17] 隋昕, 宋伟, 薛华丹, 等. CT双相扫描三维定量分析慢性阻塞性肺疾病CT肺功能与常规肺功能的关系[J]. 中华放射学杂志, 2013, 47（5）: 405-9 -
下载:
点击查看大图
图(2)
计量
- 文章访问数: 1718
- HTML全文浏览量: 715
- PDF下载量: 7
- 被引次数: 0
