Hochauflösende Computertomographie
der Lunge im Kindesalter

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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