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http://ir.cmu.edu.tw/ir/handle/310903500/32590
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| 題名: | 使用超音波鑑別具有氣液界面的肺膿瘍及膿胸
Ultrasound in Peripheral Pulmonary Air-fluid Lesions: Color Doppler Imaging as an Aid in Differentiating Empyema and Abscess |
| 作者: | 陳鴻仁;Hung-Jen Chen |
| 貢獻者: | 醫學院臨床醫學研究所碩士班 |
| 關鍵詞: | 肺膿瘍;膿胸;氣液界面;都卜勒彩色超音波;Lung abscess;empyema;air-fluid level;color Doppler ultrasound |
| 日期: | 2010 |
| 上傳時間: | 2010-09-29 12:17:00 (UTC+8) |
| 摘要: | 背景：此實驗的目的是試圖以超音波影像（特別是都卜勒彩色超音波的運用）來鑑別診斷肺部週邊的氣液界面病灶究竟是由肺膿瘍或膿胸所引起。
方法：在2003年一月至2007年十月的回朔性資料庫裏，尋找具有氣液界面病灶而且接受過彩色超音波檢查的病患。共有34位肺膿瘍及30位膿胸。有四項超音波影像的特徵特別被觀察分析：1. 氣液界面病灶的外圍特徵（包括壁的厚度，內緣外緣是否平整，以及氣液界面與邊界所形成的角度）；2. 壁層及臟層肋膜是否能以超音波看出分離； 3. 氣液界面病灶的裏面特徵（包括是否有懸浮的微小氣泡、複雜分隔的肋膜積液或肺塌陷）；4. 以都卜勒彩色超音波觀察包圍氣液界面的血管是屬於肺部實質化或塌陷所有。
結果：在超音波的影像裏，複雜分隔的肋膜積液以及肺塌陷是膿胸的專屬特徵，但敏感度分別只有40% (12/30)及 47% (14/30)。但是假若以都卜勒彩色超音波觀察氣液界面，發現所包圍的血管是肺部實質化所有，那此氣液界面就是肺膿瘍。此特徵的敏感度，專一性，陽性預測率以及陰性預測率分別為94%，100%，100%以及94%。
結論：以都卜勒彩色超音波鑑別肺部週邊的氣液界面病灶究竟是肺膿瘍或膿胸所引起，具有高度專一性而且沒有危險性。
Background: The aim of this study was to re-evaluate the clinical significance of sonographic appearances, in particular the application of color Doppler ultrasound (US) imaging, in discriminating peripheral air-fluid lung abscess from empyema.
Methods: We retrospectively collected those patients who had had peripheral air-fluid lesions due to empyema or lung abscess, and undergone color Doppler US and gray-scale US examinations between January 2003 and October 2007. A total of 34 patients with confirmed lung abscess and 30 patients with empyema were identified. Four sonographic characteristics were observed and analyzed: 1. the wall characteristics of the lesions (wall width, luminal margin, outer margin and chest wall angle); 2. split pleura sign; 3. internal echogenicity (suspended microbubble sign, complex-septated effusions and passive atelectasis); 4. identification of color Doppler US vessel signals in peri-cavitary lesions (consolidation or atelectasis).
Results: Among the sonographic characteristics, complex-septated effusions and passive atelectasis were specific for empyema, but the sensitivity was only 40% (12/30) and 47% (14/30), respectively. Identification of color Doppler US vessel signals in peri-cavitary consolidation was the most useful and specific for lung abscess. In our series, if we define the identification of color Doppler US vessel signals in peri-cavitary consolidation as a predictor for peripheral lung abscess, we can achieve sensitivity, specificity, positive predictive value and negative predictive value of 94%, 100%, 100% and 94%, respectively.
Conclusions: Color Doppler US is powerful in differentiating the peripheral air-fluid abscess from empyema, with high specificity and without any risk. |
| 顯示於類別: | [臨床醫學研究所] 博碩士論文
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