DTS 和 CT 在骨骼创伤影像诊断评估及辐射剂量方面的比较研究。
Comparative study of DTS and CT in the skeletal trauma imaging diagnosis evaluation and radiation dose.
机构信息
Clinical Medical College, Yangzhou University, Subei People's Hospital of Jiangsu Province, Yangzhou 225001, China.
出版信息
Eur J Radiol. 2013 Feb;82(2):e76-80. doi: 10.1016/j.ejrad.2012.09.008. Epub 2012 Oct 15.
PURPOSE
To compare the differences between CT (Computed tomography) and DTS (digital tomosynthesis) in the X-ray radiation dose, and to analyze the sensitivity and specificity of each examination to check the suspected fractures and dislocations cases.
METHODS
From May 2010 to February 2012, 46 patients suspected with fractures and/or dislocations were prospectively enrolled to do the CT and DTS examination on the basis of the results of DR examination. Patients were considered ineligible if they were pregnant or lactating (female subjects only). The Yangzhou Regional Ethical Review Board in Jiangsu province, China approved this study. All 46 patients signed the informed consent. To contrast radiation dose between CT and DTS group of the patients and make statistical analysis. Two experienced experts assess the image quality by I-III grade and make statistical analysis. Draw the ROC of reader A and B according to the golden standard of clinical diagnosis.
RESULTS
The average effective dose of CT Group is 5.46 msv, while average effective dose of DTS group is 0.07 msv.There is significant statistical difference (t=22.89, p<0.01) between them. Calculate and compare the area under the ROC curve of reader A and B. The area of reader A by CT and DTS is 0.999 ± 0.005, 0.973 ± 0.022. The area of reader B is 0.961 ± 0.026, 0.944 ± 0.032. Both of them perform z test, and P>0.05. There is no significant difference. Assess the uniformity of two readers with Kappa test. The Kappa value of reader A and B is respectively 0.757 and 0.783. When the value is greater than 0.75, two readers' uniformity is considered well. The two readers' sensitivity and specificity in diagnosing hidden skeletal trauma with CT and DTS are respectively 97.06% (reader A), 96.97% (reader B); 91.67% (reader A), 84.62% (reader B). Use the χ(2) test to them, then get the same result: P>0.05. There is no statistical significant.
CONCLUSION
Radiation dose of VolumnRAD DTS only account for 1.5% of CT, but its image can meet the requirements for clinical diagnosis. When fracture and/or dislocation is suspected with DR, VolumnRAD DTS can be recommended firstly as further checks.
目的
比较 CT（计算机断层扫描）和 DTS（数字断层合成）在 X 射线辐射剂量方面的差异，并分析每种检查方法对疑似骨折和脱位病例的灵敏度和特异性。
方法
从 2010 年 5 月至 2012 年 2 月，根据 DR 检查结果，前瞻性地对 46 例疑似骨折和/或脱位的患者进行 CT 和 DTS 检查。如果患者怀孕或哺乳期（仅限女性患者），则视为不合格。中国江苏省扬州市地区伦理审查委员会批准了这项研究。所有 46 名患者均签署了知情同意书。对比 CT 组和 DTS 组的患者的辐射剂量，并进行统计分析。两位有经验的专家按 I-III 级评估图像质量，并进行统计分析。根据临床诊断的金标准为读者 A 和 B 绘制 ROC。
结果
CT 组的平均有效剂量为 5.46 msv，而 DTS 组的平均有效剂量为 0.07 msv，两者差异有统计学意义（t=22.89，p<0.01）。计算并比较读者 A 和 B 的 ROC 曲线下面积。读者 A 通过 CT 和 DTS 获得的面积分别为 0.999±0.005 和 0.973±0.022。读者 B 的面积分别为 0.961±0.026 和 0.944±0.032。两者均进行 z 检验，P>0.05，差异无统计学意义。用 Kappa 检验评估两位读者的一致性。读者 A 和 B 的 Kappa 值分别为 0.757 和 0.783。当值大于 0.75 时，认为两位读者的一致性较好。使用 CT 和 DTS 诊断隐匿性骨骼创伤时，两位读者的灵敏度和特异性分别为 97.06%（读者 A）和 96.97%（读者 B）；91.67%（读者 A）和 84.62%（读者 B）。用 χ(2)检验进行检验，结果相同：P>0.05，差异无统计学意义。
结论
VolumnRAD DTS 的辐射剂量仅占 CT 的 1.5%，但其图像能够满足临床诊断的要求。当怀疑有骨折和/或脱位时，首先推荐使用 VolumnRAD DTS 作为进一步的检查。
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