Division of Pulmonary and Critical Care Medicine, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, TX 79905, USA.
J Crit Care. 2013 Aug;28(4):352-7. doi: 10.1016/j.jcrc.2012.12.002. Epub 2013 Apr 6.
The purpose of the study is to evaluate the diagnostic accuracy of the anteroposterior chest radiograph to detect pulmonary abnormalities consistent with acute respiratory distress syndrome (ARDS).
Ninety patients who met criteria for ARDS regardless of the radiographic one and had near simultaneous chest radiograph and computed tomography (CT) performed were identified. These radiologic studies were reviewed blindly and independently by 2 radiologists for the presence or absence of bilateral pulmonary abnormalities consistent with ARDS using defined radiologic criteria. Disagreements were resolved by consensus. Using the chest CT interpretation as reference standard, the chest radiograph diagnostic parameters were calculated.
Sensitivity (Se) was 0.73; specificity, 0.70; positive and negative predictive values were 0.88 and 0.47, respectively. Female sex was associated with higher Se and lower specificity. When patients were divided according to disease distribution by CT, the Se was significantly lower for focal as compared with diffuse.
The accuracy of the portable chest radiograph to detect pulmonary abnormalities consistent with ARDS is significantly limited. These findings suggest that the use of the chest radiograph results mainly in underrecognition of the syndrome, particularly when disease is not diffusely distributed, but also in overdiagnosis.
本研究旨在评估前后位胸部 X 线片诊断急性呼吸窘迫综合征（ARDS）肺部异常的准确性。
共纳入 90 名符合 ARDS 标准的患者，无论 X 线片如何，均进行了近同时期的胸部 X 线片和计算机断层扫描（CT）检查。这两项影像学研究由 2 名放射科医生进行盲法和独立评估，使用明确的影像学标准评估是否存在符合 ARDS 的双侧肺部异常。存在分歧时，通过共识解决。使用胸部 CT 解释作为参考标准，计算胸部 X 线片的诊断参数。
敏感性（Se）为 0.73；特异性为 0.70；阳性预测值和阴性预测值分别为 0.88 和 0.47。女性患者的 Se 较高，特异性较低。根据 CT 疾病分布对患者进行分组时，与弥漫性病变相比，局灶性病变的 Se 明显较低。
便携式胸部 X 线片诊断符合 ARDS 的肺部异常的准确性明显受限。这些发现表明，胸部 X 线片的使用主要导致该综合征的漏诊，特别是当疾病不是弥漫性分布时，但也存在过度诊断。
