Galea Angela, Dubbins Paul, Riordan Richard, Adlan Tarig, Roobottom Carl, Gay David
Peninsula Radiology Academy, William Prance Road, Plymouth PL65WR, UK.
Plymouth Hospital NHS Trust, Plymouth PL68DH, UK.
Eur J Radiol. 2015 May;84(5):1012-8. doi: 10.1016/j.ejrad.2015.02.007. Epub 2015 Feb 23.
To assess the capability of digital tomosynthesis (DTS) of the chest compared to a postero-anterior (PA) and lateral chest radiograph (CXR) in the diagnosis of suspected but unconfirmed pulmonary nodules and hilar lesions detected on a CXR. Computed tomography (CT) was used as the reference standard.
78 patients with suspected non-calcified pulmonary nodules or hilar lesions on their CXR were included in the study. Two radiologists, blinded to the history and CT, prospectively analysed the CXR (PA and lateral) and the DTS images using a picture archiving and communication workstation and were asked to designate one of two outcomes: true intrapulmonary lesion or false intrapulmonary lesion. A CT of the chest performed within 4 weeks of the CXR was used as the reference standard. Inter-observer agreement and time to report the modalities were calculated for CXR and DTS.
There were 34 true lesions confirmed on CT, 12 were hilar lesions and 22 were peripheral nodules. Of the 44 false lesions, 37 lesions were artefactual or due to composite shadow and 7 lesions were real but extrapulmonary simulating non-calcified intrapulmonary lesions. The PA and lateral CXR correctly classified 39/78 (50%) of the lesions, this improved to 75/78 (96%) with DTS. The sensitivity and specificity was 0.65 and 0.39 for CXR and 0.91 and 1 for DTS. Based on the DTS images, readers correctly classified all the false lesions but missed 3/34 true lesions. Two of the missed lesions were hilar in location and one was a peripheral nodule. All three missed lesions were incorrectly classified on DTS as composite shadow.
DTS improves diagnostic confidence when compared to a repeat PA and lateral CXR in the diagnosis of both suspected hilar lesions and pulmonary nodules detected on CXR. DTS is able to exclude most peripheral pulmonary nodules but caution and further studies are needed to assess its ability to exclude hilar lesions.
评估胸部数字断层合成（DTS）相较于后前位（PA）和侧位胸片（CXR）在诊断CXR上疑似但未确诊的肺结节和肺门病变方面的能力。计算机断层扫描（CT）用作参考标准。
本研究纳入了78例CXR上疑似非钙化肺结节或肺门病变的患者。两名对病史和CT结果不知情的放射科医生，使用图像存档与通信工作站对CXR（PA和侧位）以及DTS图像进行前瞻性分析，并被要求指定两种结果之一：真正的肺内病变或假的肺内病变。在CXR检查后4周内进行的胸部CT用作参考标准。计算CXR和DTS的观察者间一致性以及报告各检查方式所需的时间。
CT证实有34个真正的病变，其中12个为肺门病变，22个为周边结节。在44个假病变中，37个病变为伪影或复合阴影，7个病变是真实的但为肺外病变，模拟非钙化的肺内病变。PA和侧位CXR正确分类了78个病变中的39个（50%），使用DTS时这一比例提高到了78个中的75个（96%）。CXR的敏感性和特异性分别为0.65和0.39，DTS的敏感性和特异性分别为0.91和1。基于DTS图像，阅片者正确分类了所有假病变，但漏诊了34个真正病变中的3个。漏诊的病变中有2个位于肺门，1个是周边结节。所有3个漏诊病变在DTS上均被错误分类为复合阴影。
与重复的PA和侧位CXR相比，DTS在诊断CXR上检测到的疑似肺门病变和肺结节时提高了诊断信心。DTS能够排除大多数周边肺结节，但需要谨慎并进一步研究以评估其排除肺门病变的能力。
