Ruff Allison, Patel Krishna, Joyce Jennifer R, Gornik Heather L, Rothberg Michael B
Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
Department of Internal Medicine, Cleveland Clinic, Cleveland, OH, USA.
Vasc Med. 2016 Dec;21(6):515-519. doi: 10.1177/1358863X16651505. Epub 2016 May 28.
Ultrasound screening for abdominal aortic aneurysm (AAA) is recommended for male smokers >65 years of age, but screening rates remain low. If computed tomography (CT) performed for other indications could be considered adequate for screening, one-third of ultrasounds would potentially be unnecessary, and overall screening rates would be substantially higher. The objective of this study was to evaluate the sensitivity of CT imaging of the abdomen for the detection of AAA when performed for other clinical indications. We performed a retrospective study of patients eligible for AAA screening who had undergone an abdominal ultrasound as well as an abdominal CT scan for other indications within 3 years prior to that study. The primary outcome was identification of an AAA, recorded in the findings narrative or impression of the CT scan report. Of 142 patients with both a CT scan and an AAA on ultrasound, 127 (89.4%) were noted to have an AAA in the report of a CT scan performed within the 3 years prior to the ultrasound. An additional 10 films demonstrated an AAA that was not mentioned in the report. The sensitivity of pre-existing CT scans for AAA screening was 97.2% (137/141) [95% CI: 93.4-99.0%]; 123 (86.6%) of these positive findings were reported in the findings narrative and 120 (84.5%) were reported in the radiologist's final impression. The sensitivity for AAA identification in the report of a pre-existing CT scan of the abdomen performed for alternate indications appears high enough to use as a screening test. When radiologists note an AAA, they should be sure to include it in the final impression.
对于65岁以上的男性吸烟者，建议进行腹部主动脉瘤（AAA）超声筛查，但筛查率仍然很低。如果因其他指征进行的计算机断层扫描（CT）可被认为足以用于筛查，那么三分之一的超声检查可能就没有必要了，总体筛查率也会大幅提高。本研究的目的是评估在因其他临床指征进行腹部CT成像时，其检测AAA的敏感性。我们对符合AAA筛查条件的患者进行了一项回顾性研究，这些患者在该研究前3年内因其他指征接受了腹部超声和腹部CT扫描。主要结局是在CT扫描报告的结果叙述或印象中记录是否发现AAA。在142例同时进行了CT扫描和超声检查且患有AAA的患者中，127例（89.4%）在超声检查前3年内进行的CT扫描报告中被记录为患有AAA。另外10份影像显示存在AAA但报告中未提及。既往CT扫描对AAA筛查的敏感性为97.2%（137/141）[95%置信区间：93.4 - 99.0%]；其中123例（86.6%）的阳性结果在结果叙述中被报告，120例（84.5%）在放射科医生的最终印象中被报告。因其他指征进行的既往腹部CT扫描报告中识别AAA的敏感性似乎高到足以用作筛查测试。当放射科医生发现AAA时，应确保将其纳入最终印象中。
