仰卧位DR双能量减影投照法对阻塞性睡眠呼吸暂停低通气综合征的辅助诊断价值

 目的 探讨仰卧位DR双能量减影投照方法对阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea hypopnea syndrome,OSAHS)辅助诊断价值。方法 收集33例经临床及多导睡眠呼吸监测确诊为OSAHS的患者,所有病例均排除小颌畸形;分别行鼻咽部常规DR摄片和DR双能量减影(DES)摄片,其中DES摄片采用仰卧位。由3位放射诊断医师分别对两组影像学资料中的软腭、悬雍垂及舌根软组织形态,以及导致气道狭窄的情况进行观察和评价,结果采用ROC曲线进行统计分析。结果 在检出软腭后区及舌根后区气道狭窄方面,DES组的ROC曲线下面积分别为医师1(0.921/0.974)、医师2(0.950/0.942)、医师3(0.913/ 0.977),常规DR组为医师1(0.798/0.716)、医师2(0.771/0.583)、医师3(0.632/0.697),DES组均大于常规DR组,差异有统计学意义(P<0.05);在对软腭松弛后坠和舌根后坠的检出率方面,仰卧位DES组也明显高于常规DR组。结论 仰卧位DR双能量减影投照法应用于OSAHS的病因诊断,无论在图像清晰度还是诊断准确性上较常规方法均明显提高,有明确的辅助诊断价值。

Application of supine DR dual-energy subtraction digital radiography in auxiliary diagnosis of OSAHS

Objective To investigate the clinic value of supine DR dual-energy subtraction (DES) in auxiliary diagnosis of obstructive sleep apnea hypopnea syndrome (OSAHS). Methods Thirty-three patients with OSAHS proved by clinic and polysomnograph underwent the conventional digital radiography (DR) and DES examinations of nasopharyngeal part. Every patient was in supine position for DES. Micrognathism was not pathogenic cause in all patients.The morphological findings of soft palate, uvula and tongue root, as well as airway strictures at corresponding site, were evaluated by three radiologists respectively. The results were statistically analyzed with ROS curve. Results For the detection of airway strictures at retropalatal and retroglottal region level, the area under ROC curve in DES group:Doctor 1(0.921/0.974),Doctor 2(0.950/0.942),Doctor 3(0.913/ 0.977),was larger than that in DR group:Doctor 1(0.798/0.716),Doctor 2(0.771/0.583),Doctor 3(0.632/ 0.697),and there was significant difference between these two groups (P<0.05). As for the detection of soft palate loosening and tongue root retrusion, the area under ROC curve in DES group of patients at supine position was also significantly larger than that in DR group with P<0.05. Conclusions DES technique is obviously superior to conventional DR examination on exploring pathogenic cause of OSAHS, especially for displaying soft palate loosening and tongue root retrusion when DES examinations are performed at supine postures. This technique can eliminate efficiently the influence of bone tissue shadows. It is beneficial to showing pathological changes more clearly, measuring the airway and guiding the clinical therapy.