Kim Sung Jung, Bista Anjali Basnyat, Min Young Gi, Kim Eun Young, Park Kyung Joo, Kang Doo Kyoung, Sun Joo Sung
aDepartment of Radiology, Ajou University Hospital, Suwon, Korea bDepartment of Radiology, B&B Hospital, Lalitpur, Nepal cDepartment of Emergency Medicine, Ajou University Hospital, Suwon, Korea.
Medicine (Baltimore). 2017 Jan;96(2):e5888. doi: 10.1097/MD.0000000000005888.
We aimed to compare the diagnostic performance and inter-observer consistency between low dose chest CT (LDCT) and standard dose chest CT (SDCT) in the patients with blunt chest trauma.A total of 69 patients who met criteria indicative of blunt chest trauma (77% of male; age range, 16-85) were enrolled. All patients underwent LDCT without intravenous (IV) contrast and SDCT with IV contrast using parameters as following: LDCT, 40 mAs with automatic tube current modulation (ATCM) and 100 kVp (BMI <25, n = 51) or 120 kVp (BMI>25, n = 18); SDCT, 180 mAs with ATCM and 120 kVp. Transverse, coronal, sagittal images were reconstructed with 3-mm slice thickness without gap and provided for evaluation of 3 observers. Reference standard images (transverse, coronal, sagittal) were reconstructed using SDCT data with 1-mm slice thickness without gap. Reference standard was established by 2 experienced thoracic radiologists by consensus. Three observers independently evaluated each data set of LDCT and SDCT.Multiple-reader receiver operating characteristic analysis for comparing areas under the ROC curves demonstrated that there was no significant difference of diagnostic performance between LDCT and SDCT for the diagnosis of pulmonary injury, skeletal trauma, mediastinal injury, and chest wall injury (P > 0.05). The intraclass correlation coefficient was measured for inter-observer consistency and revealed that there was good inter-observer consistency in each examination of LDCT and SDCT for evaluation of blunt chest injury (0.8601-1.000). Aortic and upper abdominal injury could not be appropriately compared as LDCT was performed without using contrast materials and this was limitation of this study.The effective radiation dose of LDCT (average DLP = 1.52 mSv⋅mGy cm) was significantly lower than those of SDCT (7.21 mSv mGy cm).There is a great potential benefit to use of LDCT for initial evaluation of blunt chest trauma because LDCT could maintain diagnostic image quality as SDCT and provide significant radiation dose reduction. A further study of LDCT with IV contrast for evaluation of aortic and upper abdominal injury is needed.
我们旨在比较低剂量胸部CT（LDCT）和标准剂量胸部CT（SDCT）对钝性胸部创伤患者的诊断性能及观察者间的一致性。共有69例符合钝性胸部创伤标准的患者入组（男性占77%；年龄范围16 - 85岁）。所有患者均接受了未使用静脉内（IV）对比剂的LDCT检查以及使用如下参数的含IV对比剂的SDCT检查：LDCT，40 mAs，采用自动管电流调制（ATCM），100 kVp（BMI <25，n = 51）或120 kVp（BMI>25，n = 18）；SDCT，180 mAs，采用ATCM，120 kVp。重建横断面、冠状面、矢状面图像，层厚3 mm，无间隔，供3名观察者评估。使用SDCT数据重建参考标准图像（横断面、冠状面、矢状面），层厚1 mm，无间隔。参考标准由2名经验丰富的胸科放射科医生共同确定。3名观察者独立评估LDCT和SDCT的每个数据集。用于比较ROC曲线下面积的多读者接收器操作特征分析表明，LDCT和SDCT在诊断肺损伤、骨骼创伤、纵隔损伤和胸壁损伤方面的诊断性能无显著差异（P>0.05）。测量组内相关系数以评估观察者间的一致性，结果显示在LDCT和SDCT对钝性胸部损伤的各项评估中观察者间一致性良好（0.8601 - 1.000）。由于LDCT检查未使用对比剂，无法对主动脉和上腹部损伤进行适当比较，这是本研究的局限性。LDCT的有效辐射剂量（平均DLP = 1.52 mSv⋅mGy cm）显著低于SDCT（7.21 mSv mGy cm）。使用LDCT对钝性胸部创伤进行初始评估有很大潜在益处，因为LDCT可保持与SDCT相同的诊断图像质量并显著降低辐射剂量。需要进一步研究使用含IV对比剂的LDCT评估主动脉和上腹部损伤。
