摘要
目的:探讨剪切波弹性成像(SWE)在婴幼儿先天性肌性斜颈(CMT)早期诊治中的应用价值.方法:采用常规超声对146例3岁以内CMT患儿的患侧胸锁乳突肌(SCM)进行Tatli分型;SWE技术分别对健侧与患侧SCM进行检测,取弹性模量平均值(Emean值)进行统计学分析,评价健侧与患侧Emean值的差异,探讨Emean值与Tatli分型的相关性;并随访患侧保守治疗前后Emean值的变化.结果:常规超声Tatli分型Ⅰ型74例,Ⅱ型45例,Ⅲ型18例,Ⅳ型9例.SWE技术检测SCM健侧Emean值为(8.25±2.31)kPa,患侧Emean值Ⅰ型为(10.82±1.76)kPa,Ⅱ型为(14.92±3.18)kPa,Ⅲ型为(18.89±3.75)kPa,Ⅳ型为(30.40±4.84)kPa,健侧与患侧及Ⅰ、Ⅱ、Ⅲ、Ⅳ型的Emean值比较,差异有统计学意义(P<0.001),Tatli分型与Emean值呈正相关(r=0.786,P=0.000).构建ROC曲线,SWE早期诊断CMT患儿Ⅰ型Emean的最佳诊断阈值为9.50 kPa、其对应的CMT曲线下面积(ACU)为0.948、灵敏度85%、特异度92%.患侧SCM保守治疗前后Emean值比较,差异有统计学意义(P<0.05),Tatli分型越高,治疗转归越差.结论:SWE技术可定量无创反映患侧胸锁乳突肌的纤维化程度,为CMT的早期诊治提供一种新的量化指标.
Objective:To evaluate the application of shear wave elastic imaging(SWE)in the early diagnosis and treatment of congenital muscular torticollis(CMT)in infants.Method:Tatli classification of sternocleidomastoid muscle(SCM)on the affected side of 146 children with CMT under 3 years old was performed by conventional ultrasound.SWE technology was used to detect SCM on the undamaged side and the damaged side respectively,the Emean value was taken as the mean value of elastic modulus for statistical analysis,the difference of Emean value between the uninjured side and the affected side was evaluated,and the correlation between Emean value and Tatli typing was discussed.The changes of Emean value before and after conservative treatment were followed up.Result:Conventional ultrasonic Tatli parting,74 cases of type Ⅰ,45 cases of type Ⅱ,type 18 cases of type Ⅲ,9 cases of type Ⅳ.The Emean value of SWE was(8.25±2.31)kPa,in the SCM affected side,the Emean was(10.82±1.76)kPa in type Ⅰ,(14.92±3.18)kPa in type Ⅱ,(18.89±3.75)kPa in type Ⅲ,and(30.40±4.84)kPa in type Ⅳ,there was significant difference between the healthy side and the affected side and type Ⅰ,Ⅱ,Ⅲ and Ⅳ(P<0.001).Tatli typing was positively correlated with Emean value (r=0.786,P=0.000).ROC curve was constructed,the optimal diagnostic threshold for early SWE diagnosis of Emean in children with CMT was 9.50 kPa,and the corresponding area under the CMT curve(ACU)was 0.948,with a sensitivity of 85% and specificity of 92%.Emean values of the affected side before and after SCM conservative treatment showed a statistically significant difference(P<0.05).The higher Tatli classification, the worse treatment outcome.Conclusion:SWE technology can quantitatively reflect the degree of fibrosis of the sternocleidomastoid muscle on the affected side,providing a new quantitative index for early diagnosis and treatment of CMT.
作者
李雪娇
高虹
刘乔建
苏业钦
樊伟
LI Xuejiao;GAO Hong;LIU Qiaojian(Children’s Hospital Affiliated to Kunming Medical University,Kunming 650228,China)
出处
《中国医学创新》
CAS
2019年第23期10-14,共5页
Medical Innovation of China
基金
云南省教育厅科学研究基金项目(2015Y156)
昆明市卫生科技人才培养项目(2017-SW(后备)-49)
关键词
实时剪切波弹性成像
Tatli分法
婴幼儿
先天性肌性斜颈
早期诊治
Real-time shear wave elastography
Tatli method
Infants
Congenital muscular torticollis
Early diagnosis and treatment
