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Refining diagnostic criteria for paediatric bronchiectasis using low-dose CT scan
Respiratory Medicine ( IF 4.3 ) Pub Date : 2021-07-24 , DOI: 10.1016/j.rmed.2021.106547
Johnny Wu 1 , Jennifer Bracken 2 , Adrienne Lam 2 , Kate L Francis 3 , Fiona Ramanauskas 2 , Anne B Chang 4 , Phil Robinson 5 , Paul McCallum 6 , Danielle F Wurzel 5
Affiliation  

Background

There is a current lack of consensus amongst paediatric radiologists and respiratory paediatricians as to the correct CT definition of bronchiectasis in children. Using contemporary low-dose CT, our objectives were to determine the upper limit of normal for broncho-arterial ratio (BAR) in children and to evaluate the effect of age and general anaesthesia.

Methods

Measurements of 330 broncho-arterial ratios from 51 children (0–19 years) undergoing low-dose CT chest for non-respiratory indications were performed by 3 blinded observers (two radiologists, one respiratory physician) using four different methods. Inter-observer reliability, mean BAR and reference ranges (mean±2SD) were calculated. Correlation between age and BARs were examined. Mean BAR for CT under general anaesthesia and CT awake were compared.

Results

Inter-observer correlation was extremely high for all measurements (0.93–0.97). There was a weak positive correlation between age and BAR in the CT-awake group (r = 0.33, 95%CI: 0.03–0.57; p = 0.031) using the inner-bronchial wall to artery, short-axis measurement. CT under general anaesthesia showed significantly higher BAR compared to CT-awake [mean difference 0.13 (95%CI: 0.05–0.22; p = 0.004)]. For the CT-awake group, the mean BAR was 0.65 (range: 0.42 to 0.89), with no child having a BAR above 0.9.

Conclusion

Using a standardised approach, we have shown that a broncho-arterial ratio above 0.9 in children undergoing awake CT is abnormal and suggests airway widening or radiological bronchiectasis. Children undergoing CT under anaesthesia have higher BARs than those undergoing awake CT. A weak positive correlation between broncho-arterial ratio and age was observed, hence, age-adjusted cut-offs for BAR warrant further study.



中文翻译:

使用低剂量CT扫描细化小儿支气管扩张的诊断标准

背景

目前儿科放射科医生和呼吸儿科医生对于儿童支气管扩张的正确 CT 定义缺乏共识。使用当代低剂量 CT,我们的目标是确定儿童支气管动脉比 (BAR) 的正常上限,并评估年龄和全身麻醉的影响。

方法

由 3 名盲观察员(两名放射科医师,一名呼吸科医师)使用四种不同的方法对 51 名接受低剂量胸部 CT 胸部 CT 治疗的非呼吸适应症儿童(0-19 岁)的 330 个支气管动脉比率进行测量。计算观察者间可靠性、平均 BAR 和参考范围(平均值±2SD)。检查了年龄和 BAR 之间的相关性。比较了全身麻醉和清醒时 CT 的平均 BAR。

结果

所有测量的观察者间相关性都非常高(0.93-0.97)。使用支气管内壁到动脉的短轴测量,CT 清醒组的年龄和 BAR 呈弱正相关(r = 0.33, 95% CI:0.03-0.57;p = 0.031)。与 CT 清醒相比,全身麻醉下的 CT 显示 BAR 显着更高 [平均差 0.13 (95%CI: 0.05–0.22; p = 0.004)]。对于 CT 清醒组,平均 BAR 为 0.65(范围:0.42 至 0.89),没有儿童的 BAR 高于 0.9。

结论

使用标准化方法,我们已经表明,在接受清醒 CT 的儿童中,支气管动脉比率高于 0.9 是异常的,提示气道增宽或放射性支气管扩张。在麻醉下接受 CT 的儿童比接受清醒 CT 的儿童具有更高的 BAR。观察到支气管动脉比率与年龄之间存在弱正相关,因此,BAR 的年龄调整截止值值得进一步研究。

更新日期:2021-07-30
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