The Diagnostic Value Of Pulmonary Ultrasonography In Children's Community Acquired Pneumonia

Objective: To observe the imaging features of lung ultrasound(LUS)in children with community-acquired pneumonia(CAP).Compare the imaging differences of lung ultrasound,chest CT and chest X-ray(CXR).To explore the value of LUS in child CAP diagnosis with chest CT as the "gold standard".In order to improve the diagnostic accuracy rate of children's CAP and to make a reasonable treatment plan.To observe the imaging manifestations of pulmonary consolidation,alveolar interstitial syndrome,pleural effusion,pleural effusion,pulmonary insufficiency,and dynamic/static bronchial signs.Compare these findings with chest CT and explore their significance to diagnostic CAP.Methods: We selected children who visited the respiratory department of a hospital from May 2014 to August 2016 and were diagnosed as CAP according to the guidelines.The imaging data of patients' LUS,chest CT and CXR were collected based on clinical needs and the consent of the patients' families.Chest CT was used as the "gold standard" for imaging.To observe the imaging manifestations of pulmonary consolidation,alveolar interstitial syndrome, pleural line abnormality,pleural effusion,pulmonary insufficiency,and dynamic/static bronchial signs.Compare these findings with chest CT and explore their significance to diagnostic CAP.To observe the differences of the above lung ultrasound imaging findings in CAP and non-cap groups,and to analyze the differences.The sensitivity,specificity,positive predictive value and negative predictive value of LUS were used to assess the diagnostic value of LUS for children CAP,and compared with the sensitivity and specificity of CXR.Results: A total of 180 patients with suspected CAP were included in this study.Among them,105(58.3%)were finally diagnosed as CAP after chest CT.There were 77 cases in the CAP group,accounting for 73.3%,but not in the CAP group.The difference was statistically significant.The pleural line abnormality of LUS was found in 57 cases in CAP group,accounting for 54.3%,but not in the CAP group.The difference was statistically significant in 0 cases of the CAP group(?2=59.582,P < 0.001).There were 19 cases in the CAP group with the pleural effusion of LUS,accounting for 18.1%,whereas in the non-cap group,there were 0 cases(?2=64.934,P < 0.001),and the difference was statistically significant.There were 10 cases in the CAP group in the lung of LUS,accounting for 9.5%,but not in the CAP group.There were 0 cases in the CAP group(?2=64.934,P < 0.001),and the difference was statistically significant.The occurrence of pleural line abnormality in the LUS and the occurrence of B-line or pulmonary consolidation in the CAP group were 101 cases,accounting for 96.2%,while in the non-cap group,0 cases,(?2=164.376,P < 0.001),the difference was statistically significant.Of different radiographic signs of lung ultrasound diagnosis of CAP sensitivity,specific,positive predictive value and negative predictive value are: 1.The consolidation of the lung: a sensitivity of 73.3%,100%(77/105),specific(75/75),positive predictive value 100%(77/77),and negative predictive value of 72.8%(75/103);2.Alveolar interstitial syndrome: sensitivity of 8.6%(9/105),specificity of 80%(60/75),positive predictive value 37.5%(9/77)and negative predictive value of38.5%(15/103);3.Abnormal pleural line: sensitivity 54.3%(57/105),specificity 100%(75/75),positive predictive value 54.3%(57/77)and negative predictive value 72.8%(75/103);4.The detection of abnormal pulmonary or pleural abnormalities occurred at the same time as b-line: sensitivity 96.6%(101/105),specificity 100%(75/75),100% positive predictive value(1010/101)and negative predictive value 94.9%(75/101).The sensitivity of chest CXR to the diagnosis of community acquired pneumonia was 92.4%(97/105),specificity 100%(75/75),positive predictive value of 100%(97/97)and negative predictive value 90.4%(75/105).From the above result,the "gold standard" on the results of chest CT imaging conditions,LUS diagnostic sensitivity for CAP is higher than CXR,respectively,96.2%(101/105)and92.4%(97/105),but there was no statistically significant difference(chi-square= 1.414,P = 1.414).The diagnosis of LUS and chest CT was consistent,and the Mc Nemer test result was P=0.125,Kappa=0.955(P < 0.001).Conclusion:LUS is a reliable imaging method for the diagnosis of CAP,which is as valuable as CXR,and is consistent with the diagnosis of chest CT.The advantages of no radiation injury and portability in LUS are of special value for children,pregnant women,long-term bedridden patients and others who cannot accept X-ray examination.LUS can observe the dynamic imaging performance of the dynamic bronchogram and pleural sliding sign,and have the characteristics of dynamic observation of the lesions.Compared with CXR and chest CT,LUS is cheaper and can be used as a low-cost option to evaluate therapeutic effect or follow up.