Department of Radiology, Toho University Sakura Medical Center, 564-1 Shimoshizu, Sakura 285-8741, Japan.
Jpn J Radiol. 2012 Oct;30(8):617-23. doi: 10.1007/s11604-012-0097-0. Epub 2012 Jul 6.
To retrospectively assess the diagnostic efficacy of radiography in detecting vertebral body fractures of the thoracic spine compared with MDCT, to assess the confounding factors reducing the diagnostic efficacy, and to investigate the outcomes of radiographically overlooked patients.
Two hundred fifty-five patients suspected of thoracic spine fractures were enrolled. We assessed the diagnostic efficacy of radiography for the patients sub-grouped based on five confounding factors: chest abnormalities, head injuries, cervical spine fractures, upper extremity injuries, and age of 65 years or older. We investigated the outcomes of radiographically overlooked patients.
Three hundred fifty-one vertebral body fractures were detected. The per-fracture sensitivities and specificities were 55 % and 94 % for vertebral body fractures and 41 and 99 % for unstable fractures. In patients with upper extremity injuries or aged 65 years or older, radiography was less sensitive in detecting the unstable fractures (P < 0.05). Nineteen patients were overlooked by radiography; two had neurological deficits and needed surgical fixation; 15 with no neurological deficit were conservatively treated with uneventful outcomes.
Radiography had low sensitivity but high specificity. In daily practice, primary use of MDCT is beneficial for patients with neurological deficit or upper extremity injuries or elderly patients.
回顾性评估与 MDCT 相比，X 线摄影在检测胸腰椎体骨折中的诊断效能，评估降低诊断效能的混杂因素，并研究 X 线摄影漏诊患者的结局。
共纳入 255 例疑似胸腰椎骨折患者。我们根据五个混杂因素对患者进行分组，评估 X 线摄影的诊断效能：胸部异常、头部损伤、颈椎骨折、上肢损伤和年龄 65 岁或以上。我们研究了 X 线摄影漏诊患者的结局。
共检出 351 个椎体骨折。每处骨折的敏感性和特异性分别为 55%和 94%，不稳定骨折的敏感性和特异性分别为 41%和 99%。在上肢损伤或年龄 65 岁或以上的患者中，X 线摄影对不稳定骨折的检出敏感性较低（P<0.05）。19 例患者 X 线摄影漏诊，其中 2 例有神经功能缺损，需要手术固定；15 例无神经功能缺损的患者接受保守治疗，结果良好。
X 线摄影的敏感性较低，但特异性较高。在日常实践中，对有神经功能缺损或上肢损伤或老年患者，优先使用 MDCT 有益。
