Zangos Stephan, Steenburg Scott D, Phillips K Dan, Kerl J Matthias, Nguyen Shaun A, Herzog Christopher, Schoepf U Joseph, Vogl Thomas J, Costello Phillip
Department of Diagnostic and Interventional Radiology, Institute for Diagnostic and Interventional Radiology, University Hospital Frankfurt, Johann Wolfgang Goethe-University, Theodor-Stern-Kai 7, D-60590 Frankfurt/Main.
Acad Radiol. 2007 Jan;14(1):19-27. doi: 10.1016/j.acra.2006.09.050.
We sought to assess retrospectively the added value of coronal reformations from isotropic voxels obtained with 64-slice multidetector row computed tomography (CT) of the acute abdomen.
This retrospective study was approved by the institutional review board and informed consent was waived. Multidetector helical 64-section CT (section thickness, 0.6 mm; pitch 1.75; table speed 35 mm/sec) was performed in 100 patients (60 women and 40 men; age range, 9-/+85 years; mean age, 45.2 years) with acute nontraumatic abdominal pain who had been referred from the emergency department. Axial images were reconstructed with 5-mm-thick sections at 5-mm intervals. The second data set was reformatted coronally, with 3-mm-thick sections at 3-mm intervals. Four independent, blinded readers with various level of training interpreted first the axial scans alone and then followed immediately by the coronal scans. Confidence in the visualization of anatomy and pathology was scored on a 5-point scale. The final diagnosis was determined by surgical and pathologic reports and by clinical follow-up in those who did not undergo surgery.
Based upon the individual patient's clinical history and other comorbid factors, 92 patients received intravenous contrast and 90 patients received oral contrast. In 45 patients, no CT abnormalities were detected for an explanation of the abdominal pain. Mean sensitivity and specificity of axial CT alone were 92.5% and 91%, respectively. No significant differences in sensitivity and specificity were observed for the use of combined axial and coronal images. For the most inexperienced reader, the coronal reformations were helpful in 95% of cases, while for the most experienced reader, the coronal reformations were helpful in 35% of the cases. The coronal images were deemed helpful in an average of 62.3% of the cases for the four readers. However, diagnosing subtle pathology in the abdominal wall was difficult on coronal reformations alone. Overall, coronal reformations improved diagnostic confidence and interobserver agreement over axial images alone for visualization of normal abdominal structures and in the diagnosis of abdominal pathology.
Axial and coronal reformations of 64-section multidetector row CT have equal sensitivity and specificity for the diagnosis of acute abdominal pathology. However, coronal reformations improved the diagnostic confidence for all readers but most significantly for the least experienced. Therefore, radiology departments with residents should consider routinely generating coronal images in patients with acute abdominal pain.
我们旨在回顾性评估利用64层多排螺旋计算机断层扫描（CT）获取的各向同性体素进行冠状位重建对急腹症的附加价值。
本回顾性研究经机构审查委员会批准，且无需患者签署知情同意书。对100例（60例女性，40例男性；年龄范围9～85岁；平均年龄45.2岁）因急性非创伤性腹痛由急诊科转诊而来的患者进行了多排螺旋64层CT检查（层厚0.6mm；螺距1.75；床速35mm/秒）。轴位图像以5mm层厚、5mm间隔重建。第二组数据集进行冠状位重建，层厚3mm、间隔3mm。4名经过不同程度培训的独立、不知情的阅片者先单独解读轴位扫描图像，然后立即解读冠状位扫描图像。对解剖结构和病变可视化的信心采用5分制评分。最终诊断依据手术和病理报告以及未接受手术患者的临床随访确定。
根据个体患者的临床病史和其他合并症因素，92例患者接受了静脉造影剂，90例患者接受了口服造影剂。45例患者未发现CT异常可解释腹痛原因。单独轴位CT的平均敏感性和特异性分别为92.5%和91%。联合使用轴位和冠状位图像时，敏感性和特异性未观察到显著差异。对于经验最少的阅片者，冠状位重建在95%的病例中有所帮助，而对于经验最丰富的阅片者，冠状位重建在35%的病例中有所帮助。4名阅片者中，冠状位图像平均在62.3%的病例中被认为有帮助。然而，仅通过冠状位重建很难诊断腹壁的细微病变。总体而言，对于正常腹部结构的可视化以及腹部病变的诊断，冠状位重建比单独的轴位图像提高了诊断信心和观察者间的一致性。
64层多排螺旋CT的轴位和冠状位重建对急性腹部病变的诊断具有相同的敏感性和特异性。然而，冠状位重建提高了所有阅片者的诊断信心，对经验最少的阅片者提高最为显著。因此，有住院医师的放射科应考虑对急性腹痛患者常规生成冠状位图像。
