Department of Diagnostic, Interventional and Pediatric Radiology, University Hospital Bern, Freiburgstrasse 4, Bern CH-3010, Switzerland.
Eur J Radiol. 2011 Aug;79(2):e28-32. doi: 10.1016/j.ejrad.2010.01.016. Epub 2010 Feb 19.
To assess the sensitivity and image quality of chest radiography (CXR) with or without dual-energy subtracted (ES) bone images in the detection of rib fractures.
In this retrospective study, 39 patients with 204 rib fractures and 24 subjects with no fractures were examined with a single exposure dual-energy subtraction digital radiography system. Three blinded readers first evaluated the non-subtracted posteroanterior and lateral chest radiographs alone, and 3 months later they evaluated the non-subtracted images together with the subtracted posteroanterior bone images. The locations of rib fractures were registered with confidence levels on a 3-grade scale. Image quality was rated on a 5-point scale. Marks by readers were compared with fracture localizations in CT as a standard of reference.
The sensivity for fracture detection using both methods was very similar (34.3% with standard CXR and 33.5% with ES-CXR, p=0.92). At the patient level, both sensitivity (71.8%) and specificity (92.9%) with or without ES were identical. Diagnostic confidence was not significantly different (2.61 with CXR and 2.75 with ES-CXR, p=0.063). Image quality with ES was rated higher than that on standard CXR (4.08 vs. 3.74, p<0.001).
Despite a better image quality, adding ES bone images to standard radiographs of the chest does not provide better sensitivity or improved diagnostic confidence in the detection of rib fractures.
评估胸部 X 线摄影（CXR）加或不加双能减影（ES）骨图像在检测肋骨骨折中的敏感性和图像质量。
在这项回顾性研究中，39 例 204 处肋骨骨折患者和 24 例无骨折患者使用单曝光双能减影数字射线摄影系统进行检查。三位盲法读者首先单独评估非减影前后位和侧位胸部 X 线片，3 个月后，他们评估非减影图像和减影前后位骨图像。肋骨骨折的位置用 3 级可信度等级进行标记。图像质量用 5 分制评分。读者的标记与 CT 骨折定位进行比较作为参考标准。
两种方法的骨折检测敏感性非常相似（标准 CXR 为 34.3%，ES-CXR 为 33.5%，p=0.92）。在患者水平，无论是否使用 ES，敏感性（71.8%）和特异性（92.9%）均相同。诊断信心没有显著差异（CXR 为 2.61，ES-CXR 为 2.75，p=0.063）。ES 图像质量评分高于标准 CXR（4.08 对 3.74，p<0.001）。
尽管图像质量更好，但在标准胸部 X 线摄影中添加 ES 骨图像并不能提高检测肋骨骨折的敏感性或诊断信心。
