Liang Teresa, McLaughlin Patrick, Arepalli Chesnal D, Louis Luck J, Bilawich Ana-Maria, Mayo John, Nicolaou Savvas
Department of Radiology, Vancouver General Hospital, 3350-950 W 10th Avenue, Vancouver, BC, V5Z 1M9, Canada.
Emerg Radiol. 2016 Apr;23(2):127-32. doi: 10.1007/s10140-015-1365-y. Epub 2015 Dec 4.
The purpose of this study was to compare diaphragmatic motion on dual-source high-pitch (DS-HP) and conventional single-source (SS) CT scans in trauma patients. Seventy-five consecutive trauma patients who presented to a level one trauma center over a 6-month period were scanned with a standardized whole body trauma CT protocol including both DS-HP chest (pitch = 2.1-2.5) and SS abdominal CT scans. Subjective analysis of diaphragmatic motion was performed by two readers using a four-point motion scale in seven regions of the diaphragm on coronal and axial slices. An overall confidence score to exclude a diaphragmatic tear was determined (1 to 10, 10: completely confident and 1: impossible to exclude). Wilcoxon rank sum tests were used for statistical analysis, and p < 0.05 was considered significant. Mean confidence score of 9.85 for DS-HP was significantly better than the mean score of 7.66 for SS images (p < 0.0001). Diaphragmatic motion scores and subjective diaphragmatic motion artifact on coronal and axial images were significantly better for DS-HP images in all areas when compared individually (p < 0.0001) and overall (p < 0.0001). Regions of DS-HP (99.2 %) were diagnostic, whereas only 87.0 % % regions on SS were. Complete agreement of motion scores was present in 92 % of cases, with moderate overall agreement for confidence to exclude a diaphragmatic tear (κ = 0.45). Dual-source high-pitch CT scanning is advantageous as it allows for significantly better evaluation of diaphragmatic structures by minimizing motion artifacts on images of freely breathing trauma patients.
本研究的目的是比较双源高螺距（DS-HP）CT扫描和传统单源（SS）CT扫描在创伤患者中的膈肌运动情况。在6个月期间，对连续75例到一级创伤中心就诊的创伤患者进行了标准化的全身创伤CT检查，包括DS-HP胸部扫描（螺距=2.1-2.5）和SS腹部CT扫描。两名阅片者在冠状面和轴位片上的膈肌七个区域使用四点运动量表对膈肌运动进行主观分析。确定了排除膈肌撕裂的总体置信度评分（1至10分，10分表示完全确定，1分表示无法排除）。采用Wilcoxon秩和检验进行统计分析，p<0.05被认为具有统计学意义。DS-HP的平均置信度评分为9.85，显著优于SS图像的平均评分7.66（p<0.0001）。与SS图像相比，DS-HP图像在所有区域的冠状面和轴位图像上的膈肌运动评分和主观膈肌运动伪影均显著更好（分别比较时p<0.0001，总体比较时p<0.0001）。DS-HP的诊断区域为99.2%，而SS的诊断区域仅为87.0%。92%的病例运动评分完全一致，在排除膈肌撕裂的置信度方面总体一致性中等（κ=0.45）。双源高螺距CT扫描具有优势，因为它可以通过最大限度减少自由呼吸创伤患者图像上的运动伪影，显著更好地评估膈肌结构。
