Amrhein Timothy J, Mostertz William, Matheus Maria Gisele, Maass-Bolles Genevieve, Sharma Komal, Collins Heather R, Kranz Peter G
Department of Radiology, Duke University Medical Center|, Box 3808, Durham, NC, 27710, UK.
Department of Radiology and Radiological Science, Medical University of South Carolina, MSC 322 169 Ashley Avenue, Charleston, SC, 29425, USA.
Emerg Radiol. 2017 Feb;24(1):39-45. doi: 10.1007/s10140-016-1440-z. Epub 2016 Sep 12.
Subdural hematomas (SDHs) comprise a significant percentage of missed intracranial hemorrhage on axial brain CT. SDH detection rates could be improved with the addition of reformatted images. Though performed at some centers, the potential additional diagnostic sensitivity of reformatted images has not yet been investigated. The purpose of our study is to determine if the addition of coronal and sagittal reformatted images to an axial brain CT increases the sensitivity and specificity for detection of acute traumatic SDH. We retrospectively reviewed consecutive brain CTs acquired for acute trauma that contained new SDHs. An equivalent number of normal brain CTs served as control. Paired sets of images were created for each case: (1) axial images only ("axial only") and (2) axial, coronal, sagittal images ("reformat added"). Three readers interpreted both the axial only and companion reformat added for each case, separated by 1 month. Reading times and SDH detection rates were compared. One hundred SDH and 100 negative examinations were collected. Sensitivity and specificity for the axial-only scans were 75.7 and 94.3 %, respectively, compared with 88.3 and 98.3 % for reformat added. There was a 24.3 % false negative (missed SDH) rate with axial-only scans versus 11.7 % with reformat added (p = <0.001). Median reader interpretation times were longer with the addition of reformatted images (125 versus 89 s), but this difference was not significant (p = 0.23). The addition of coronal and sagittal images in trauma brain CT resulted in improved sensitivity and specificity as well as a reduction in SDH false negatives by greater than 50 %. Reformatted images substantially reduce the number of missed SDHs compared with axial images alone.
硬膜下血肿（SDH）在轴向脑CT上漏诊的颅内出血中占相当大的比例。通过添加重组图像可以提高SDH的检出率。尽管一些中心已经开展了相关检查，但重组图像潜在的额外诊断敏感性尚未得到研究。我们研究的目的是确定在轴向脑CT上添加冠状位和矢状位重组图像是否能提高急性创伤性SDH检测的敏感性和特异性。我们回顾性分析了因急性创伤而进行的连续脑CT检查，这些检查发现了新的SDH。同等数量的正常脑CT作为对照。为每个病例创建了配对的图像组：（1）仅轴向图像（“仅轴向”）和（2）轴向、冠状位、矢状位图像（“添加重组图像”）。三名阅片者分别对每个病例的仅轴向图像和配套的添加重组图像进行解读，间隔1个月。比较了阅片时间和SDH检出率。共收集了100例SDH和100例阴性检查。仅轴向扫描的敏感性和特异性分别为75.7%和94.3%，而添加重组图像后的敏感性和特异性分别为88.3%和98.3%。仅轴向扫描的假阴性（漏诊SDH）率为24.3%，而添加重组图像后的假阴性率为11.7%（p = <0.001）。添加重组图像后阅片者的中位解读时间更长（125秒对89秒），但这种差异不显著（p = 0.23）。在创伤性脑CT中添加冠状位和矢状位图像可提高敏感性和特异性，并使SDH假阴性减少超过50%。与单独的轴向图像相比，重组图像大大减少了漏诊SDH的数量。
