目的:为了证明超声检查对接受超声检查并随后进行磁共振成像(MRI)的儿科患者合并或不合并骨髓炎的软组织感染的诊断价值。
方法:根据MRI将23例患者分为2组:12例患者和11例无骨髓炎患者。使用超声的骨髓炎的特征在于存在骨皮质不规则和/或骨膜下脓肿形成。将超声检查对骨髓炎和骨膜下脓肿形成的诊断性能与MRI进行比较。诊断准确性,灵敏度,特异性,正预测值,用95%置信区间(CI)计算阴性预测值。
结果:在12例骨髓炎病例中,11例骨髓增强异常(1例残留病例未进行对比增强研究),5例骨膜下脓肿。超声对骨髓炎的诊断准确率为82.6%(正确诊断骨髓炎的数量/总数=19/23;95%CI,61.2-95.0),对骨膜脓肿的诊断准确率为95.7%(正确诊断骨膜脓肿的数量/总数=22/23;95%CI,78.1-99.9),分别。超声诊断骨髓炎的敏感性和特异性分别为66.7%(95%CI,34.9-90.1)和100%(95%CI,71.5-100),分别。超声检测骨膜脓肿的敏感性和特异性均为80%(95%CI,28.4-99.5),和100%(95%CI,81.5-100),分别。使用超声无法检测到三分之一的骨髓炎病例。
结论:超声检查可能有助于诊断小儿骨髓炎;然而,该技术似乎受到低灵敏度的限制。然而,对这些患者的骨膜脓肿诊断更为准确。
OBJECTIVE: To demonstrate the usefulness of ultrasonography for differentiating soft tissue infections with or without osteomyelitis in pediatric patients who underwent ultrasonography and subsequent magnetic resonance imaging (MRI).
METHODS: Twenty-three patients were classified into 2 groups: 12 patients with and 11 patients without osteomyelitis based on MRI. Osteomyelitis using ultrasound is characterized by the presence of bone cortex irregularity and/or subperiosteal abscess formation. The diagnostic performance of ultrasonography for detecting osteomyelitis and subperiosteal abscess formation was compared with that of MRI. Diagnostic accuracy, sensitivity, specificity, positive predictive value, and negative predictive value were calculated with 95% confidence intervals (CIs).
RESULTS: Of 12 osteomyelitis cases, 11 had abnormal bone marrow enhancement (one residual case did not undergo contrast enhancement
study) and 5 had subperiosteal abscesses. The diagnostic accuracy of ultrasonography for osteomyelitis was 82.6% (number of correct diagnosis of osteomyelitis/total number = 19/23; 95% CI, 61.2-95.0) and for detecting periosteal abscess was 95.7% (number of correct diagnosis of periosteal abscess/total number = 22/23; 95% CI, 78.1-99.9), respectively. The sensitivity and specificity of ultrasonography for detecting osteomyelitis were 66.7% (95% CI, 34.9-90.1) and 100% (95% CI, 71.5-100), respectively. The sensitivity and specificity of ultrasonography for detecting periosteal abscess were 80% (95% CI, 28.4-99.5), and 100% (95% CI, 81.5-100), respectively. One-third of osteomyelitis cases could not be detected using ultrasonography.
CONCLUSIONS: Ultrasonography may be useful for diagnosing osteomyelitis in pediatric patients; however, the technique appears limited by low sensitivity. However, it is more accurate for diagnosis of periosteal abscess in these patients.