Zusammenfassung
Seit Einführung der hochauflösenden Computertomographie (HRCT) vor gut 10 Jahren hat
sich diese Untersuchungstechnik für die Diagnostik von Erkrankungen der Atemwege und
des Lungenparenchyms etabliert. Dies gilt vor allem für Lungenerkrankungen im Erwachsenenalter.
Demgegenüber bestehen vergleichsweise wenig Erfahrungen mit der HRCT in der pädiatrischen
Lungendiagnostik. In der vorliegenden Übersichtsarbeit werden HRCT-Befunde bei häufigen
und seltener vorkommenden Lungenerkrankungen bei Kindern beschrieben. Ein rein retikuläres
Muster ist im Kindesalter selten. Demgegenüber werden mit einer pulmonalen Obstruktion
(Air trapping) einhergehende Erkrankungen gehäuft beobachtet. Paarige Inspirations-Exspirationsaufnahmen
ergänzen die rein strukturelle Analyse um eine funktionelle Komponente und haben sich
bei obstruktiven Lungenerkrankungen (u. a. postinfektiöse Bronchiolitis obliterans,
bronchopulmonale Dysplasie) bewährt. Der erhöhte Dosisbedarf der HRCT ist insbesondere
bei Kindern problematisch. Auch bei Verwendung eines Niedrigdosisprotokolls ist von
einer gegenüber der Übersichtsaufnahme um den Faktor 100 erhöhten Dosis auszugehen.
Die Indikation für eine HRCT des Thorax ist in der Pädiatrie auf Einzelfälle beschränkt,
sie sollte nur in Absprache mit den Kinderradiologen und pädiatrischen Pneumologen
gestellt werden.
Abstract
Since the introduction of the high-resolution technique more than ten years ago, HRCT
has become an established modality for diagnosing diseases of the respiratory system.
This is especially true for the diagnosis of lung diseases in adults. Experience in
HRCT of the lungs is limited in pediatric patients. This review gives an overview
of frequent and less frequent HRCT findings in pulmonary diseases in childhood. A
purely reticular pattern is rarely observed in infants. Pulmonary diseases associated
with overinflation are relatively frequent. Paired inspiratory-expiratory scans combine
morphological analysis with functional information and have improved the diagnosis
of air trapping, e. g. in post-infectious bronchiolitis obliterans or bronchopulmonary
dysplasia. Especially in children the high radiation exposure is a problem. Even when
applying a low-dose protocol the radiation dose of HRCT will still exceed the dose
of a chest X-ray by 100 times. The indication for pediatric pulmonary HRCT is limited
to selected cases and it should be decided in agreement with the pediatric radiologists
and the pediatric pulmonologists.
Schlüsselwörter
Computertomographie (CT) - Hochauflösende Computertomographie (HRCT) - Lunge - Lungenkrankheiten
- Kinder
Key words
Computed tomography (CT) - High resolution computed tomography (HRCT) - Respiratory
system - Lung, diseases - Infants
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PD Dr. M. Reuter
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