Bozovic Gracijela, Adlercreutz Catharina, Höglund Peter, Björkman-Burtscher Isabella, Reinstrup Peter, Ingemansson Richard, Schaefer-Prokop Cornelia, Siemund Roger, Geijer Mats
Departments of *Radiology ∥Neurosurgery ¶Cardiothoracic Surgery, Skåne University Hospital †Department of Laboratory Medicine ‡Divison of Clinical Chemistry and Pharmacology §Lund University Bioimaging Centre **Department of Clinical Sciences, Lund University, Lund ††Department of Radiology, Örebro University, Örebro, Sweden #Meander Medical Centre, Amersfoort, The Netherlands.
J Thorac Imaging. 2017 Mar;32(2):107-114. doi: 10.1097/RTI.0000000000000255.
The aim of the study was to retrospectively evaluate the diagnostic imaging that potential lung donors undergo, the reader variability of image interpretation and its relevance for donation, and the potential information gained from imaging studies not primarily intended for lung evaluation but partially including them.
Bedside chest radiography and computed tomography (CT), completely or incompletely including the lungs, of 110 brain-dead potential organ donors in a single institution during 2007 to 2014 were reviewed from a donation perspective. Two chest radiologists in consensus analyzed catheters and cardiovascular, parenchymal, and pleural findings. Clinical reports and study review were compared for substantial differences in findings that could have led to a treatment change, triggered additional examinations such as bronchoscopy, or were considered important for donation.
Among 136 bedside chest radiographs, no differences between clinical reports and study reviews were found in 37 (27%), minor differences were found in 28 (21%), and substantial differences were found in 71 (52%) examinations (P<0.0001). In 31 of 42 (74%) complete or incomplete CT examinations, 50 of 74 findings with relevance for lung donation were not primarily reported (P<0.0001).
The majority of donor patients undergo only chest radiography. A targeted imaging review of abnormalities affecting the decision to use donor lungs may be useful in the preoperative stage. With a targeted list, substantial changes were made from initial clinical interpretations. CT can provide valuable information on donor lung pathology, even if the lungs are only partially imaged.
本研究旨在回顾性评估潜在肺供体所接受的诊断性影像学检查、图像解读的阅片者变异性及其与捐赠的相关性，以及从并非主要用于肺评估但部分包含肺部的影像学研究中获得的潜在信息。
从捐赠角度回顾了2007年至2014年期间一家机构的110例脑死亡潜在器官供体的床边胸部X线摄影和计算机断层扫描（CT），肺部检查完整或不完整。两位胸部放射科医生共同分析导管、心血管、实质和胸膜的检查结果。比较临床报告和研究回顾中可能导致治疗改变、引发额外检查（如支气管镜检查）或被认为对捐赠很重要的检查结果的重大差异。
在136例床边胸部X线片中，37例（27%）临床报告和研究回顾之间未发现差异，28例（21%）发现微小差异，71例（52%）检查发现重大差异（P<0.0001）。在42例完整或不完整的CT检查中的31例（74%）中，74项与肺捐赠相关的检查结果中有50项未在主要报告中提及（P<0.0001）。
大多数供体患者仅接受胸部X线摄影。在术前阶段，对影响供体肺使用决策的异常情况进行有针对性的影像学评估可能会有所帮助。通过一份有针对性的清单，对初始临床解读做出了重大改变。即使肺部仅部分成像，CT也能提供有关供体肺病理的有价值信息。
