Galea Angela, Adlan Tarig, Gay David, Roobottom Carl, Dubbins Paul, Riordan Richard
*Peninsula Radiology Academy †Plymouth Hospital NHS Trust, Plymouth, Devon, UK.
J Thorac Imaging. 2015 Sep;30(5):328-35. doi: 10.1097/RTI.0000000000000144.
The aim of this study was to compare the sensitivity and specificity of chest digital tomosynthesis (DTS) with chest radiography (CXR) for the detection of noncalcified pulmonary nodules and hilar lesions using computed tomography (CT) as the reference standard.
A total of 78 patients with suspected noncalcified pulmonary lesions on CXR were included in the study. Two radiologists, blinded to the history and CT, analyzed the CXR and the DTS images (separately), whereas a third radiologist analyzed the CXR and DTS images together. Noncalcified intrapulmonary nodules and hilar lesions were recorded for analysis. The interobserver agreement for CXR and DTS was assessed, and the time taken to report the images was recorded.
A total of 202 lesions were recorded in 78 patients. There were 111 true lesions confirmed on CT in 53 patients; in 25 patients subsequent CT excluded a lesion. The overall sensitivity was 32% for CXR and 49% for DTS. This improved to 54% when the posteroanterior CXR and DTS were reviewed together (CXR-DTS). The overall specificities for CXR, DTS, and CXR-DTS were 49%, 96%, and 98%, respectively. There were 56 suspected hilar lesions with subgroup sensitivities of 76% for CXR, 65% for DTS, and 76% for CXR-DTS. The specificity for hilar lesions was 59%, 92%, and 97% for CXR, DTS, and CXR-DTS, respectively.
DTS significantly improves the detectability of noncalcified nodules when compared with and when used in combination with CXR. The specificity and interobserver agreement of DTS in the diagnosis of suspected noncalcified pulmonary nodules and hilar lesions are significantly better than those of CXR and approaches those of CT.
本研究旨在以计算机断层扫描（CT）作为参考标准，比较胸部数字断层合成（DTS）与胸部X线摄影（CXR）检测非钙化肺结节和肺门病变的敏感性和特异性。
本研究共纳入78例胸部X线摄影怀疑有非钙化肺病变的患者。两名对病史和CT结果不知情的放射科医生分别分析胸部X线摄影和数字断层合成图像，第三名放射科医生同时分析胸部X线摄影和数字断层合成图像。记录非钙化肺内结节和肺门病变以进行分析。评估了胸部X线摄影和数字断层合成图像的观察者间一致性，并记录报告图像所需的时间。
78例患者共记录到202个病变。53例患者的CT检查证实有111个真实病变；25例患者随后的CT检查排除了病变。胸部X线摄影的总体敏感性为32%，数字断层合成的总体敏感性为49%。当一起复查后前位胸部X线摄影和数字断层合成图像（CXR-DTS）时，敏感性提高到54%。胸部X线摄影、数字断层合成和CXR-DTS的总体特异性分别为49%、96%和98%。有56个可疑肺门病变，胸部X线摄影的亚组敏感性为76%，数字断层合成的亚组敏感性为65%，CXR-DTS的亚组敏感性为76%。胸部X线摄影、数字断层合成和CXR-DTS对肺门病变的特异性分别为59%、92%和97%。
与胸部X线摄影相比，数字断层合成在单独使用及与胸部X线摄影联合使用时，均能显著提高非钙化结节的可检测性。数字断层合成在诊断可疑非钙化肺结节和肺门病变时的特异性和观察者间一致性明显优于胸部X线摄影，接近CT的水平。
