Norzailin A B, Noor Azman S, Mohd Helmee M N, Khairul Anuar Z
National University of Malaysia, Faculty of Medicine, Radiology Department, Jalan Yaacob Latif, Bandar Tun Razak, 56000 Cheras, Kuala Lumpur, Malaysia.
KPJ University College, Nilai, Negeri Sembilan, Malaysia.
Med J Malaysia. 2016 Feb;71(1):1-7.
The purpose of the study was to determine the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of post mortem computed tomography (PMCT) in detecting liver and splenic injuries due to road traffic accidents.
MATERIAL & METHOD: 61 road traffic accidental death cases underwent both PMCT and conventional autopsy. The imaging findings were compared to the conventional autopsy findings.
The sensitivity, specificity, PPV and NPV for liver injuries in PMCT was 71%, 82%, 68% and 85% while that of splenic injuries was 73%, 80%, 55% and 90% respectively. The accuracy of PMCT scan was 79% for both liver and splenic injuries. There is strong association between lower left ribs fracture and splenic injury (p=0.005) and significant association between positive liver and splenic PMCT finding and intraabdominal fatal injury (p=0.037).
In conclusion PMCT has high specificity and NPV for liver and splenic injuries; however the sensitivity and PPV are low. The overall accuracy is not high enough to enable PMCT to be used as a replacement for conventional autopsy; however it is a useful complementary examination and has potential to be used as decision making tool for selective internal autopsy.
本研究旨在确定尸检计算机断层扫描（PMCT）在检测道路交通事故所致肝脏和脾脏损伤方面的敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）。
61例道路交通事故死亡病例接受了PMCT和传统尸检。将影像学检查结果与传统尸检结果进行比较。
PMCT对肝脏损伤的敏感性、特异性、PPV和NPV分别为71%、82%、68%和85%，而对脾脏损伤的相应值分别为73%、80%、55%和90%。PMCT扫描对肝脏和脾脏损伤的准确率均为79%。左下肋骨骨折与脾脏损伤之间存在强关联（p = 0.005），肝脏和脾脏PMCT检查阳性结果与腹腔内致命伤之间存在显著关联（p = 0.037）。
总之，PMCT对肝脏和脾脏损伤具有较高的特异性和NPV；然而，其敏感性和PPV较低。总体准确率不足以使PMCT替代传统尸检；不过，它是一种有用的补充检查，有潜力用作选择性内部尸检的决策工具。
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