Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, MN 55415, USA.
Am J Emerg Med. 2010 Jan;28(1):73-5. doi: 10.1016/j.ajem.2008.09.013.
Patients who sustain traumatic vertebral fractures often have multiple other associated injuries. Because of the mechanisms of injury, many of these patients routinely undergo chest computed tomographic (CCT) and/or abdominal/pelvic computed tomographic (APCT) scans to diagnose intrathoracic or intra-abdominal injuries. These scans are routinely reformatted to provide more detailed imaging of the spine. Although the patient does not incur more radiation, the charges associated with this are significant. This study compared the sensitivity of these CT modalities in detecting thoracolumbar spine fractures.
A retrospective chart review identified blunt trauma victims, admitted through the emergency department, with a discharge diagnosis of thoracic or lumbar spine fracture that received (1) a chest and T-spine CT, (2) an abdominal/pelvic and lumbar spine CT, or both. Final radiologic readings of these patients' CT scans were obtained, and the sensitivities of the different imaging methods were compared. Discharge diagnosis of spine fracture was considered the gold standard.
One hundred seventy-six APCT scans with reformatting and 175 CCT scans with reformatting were available for comparison. There were 9 of 176 false-negative APCT scans vs 3/176 false-negative lumbar spine CT scans. There were 14/175 false-negative CCT scans vs 2/175 false-negative thoracic spine CT scans. The differences in sensitivity were significant (P < .001) for both comparisons.
Reformatting of CCT and APCT scans gives improved sensitivity in the detection of thoracic and lumbar spine fractures in trauma patients. Future study looking at clinically significant fractures or those that change clinical management decisions may find that the reformatted images are not routinely needed as a screening tool.
遭受外伤性椎体骨折的患者通常还伴有其他多处相关损伤。由于受伤机制，许多此类患者通常需要进行胸部计算机断层扫描（CCT）和/或腹部/骨盆计算机断层扫描（APCT），以诊断胸内或腹内损伤。这些扫描通常会进行重新格式化，以提供更详细的脊柱成像。尽管患者不会受到更多辐射，但相关费用却很高。本研究比较了这些 CT 方式在检测胸腰椎骨折方面的敏感性。
回顾性病历分析确定了通过急诊科收治的钝器创伤患者，其出院诊断为胸腰椎骨折，这些患者接受了（1）胸部和 T 型脊柱 CT，（2）腹部/骨盆和腰椎 CT，或两者兼有。获得了这些患者 CT 扫描的最终放射学阅读结果，并比较了不同成像方法的敏感性。脊柱骨折的出院诊断被视为金标准。
有 176 次 APCT 扫描的重新格式化和 175 次 CCT 扫描的重新格式化可供比较。APCT 扫描有 9 次为假阴性，而 CCT 扫描有 3 次为假阴性。CCT 扫描有 14 次为假阴性，而 CCT 扫描有 2 次为假阴性。这两种比较的敏感性差异均具有统计学意义（P<.001）。
对 CCT 和 APCT 扫描进行重新格式化可提高创伤患者检测胸腰椎骨折的敏感性。未来的研究着眼于临床上有意义的骨折或那些改变临床管理决策的骨折，可能会发现重新格式化的图像作为筛查工具并不常规需要。
