Gezer Naciye Sinem, Balcı Pınar, Tuna Kemal Çağlar, Akın Işıl Başara, Barış Mustafa Mahmut, Oray Neşe Çolak
Department of Radiology, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey.
Department of Radiology, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey.
Am J Emerg Med. 2017 Apr;35(4):623-627. doi: 10.1016/j.ajem.2016.12.058. Epub 2017 Jan 18.
Chest radiography is the initial choice for thoracic imaging. However, the wide availability of computed tomography (CT) has led to a substantial increase in its use in the emergency department (ED). We evaluated the utility of chest CT after a chest X-ray in patients presenting to the ED with non-traumatic thoracic emergencies, and determined if the diagnosis and management decision changed after CT.
The study enrolled 500 consecutive patients with both chest X-rays and CT who presented to the ED with non-traumatic complaints. Chest X-rays and CT images obtained within 12h before any definitive treatment were randomly evaluated in consensus by two radiologists blinded to the clinical information.
The chest X-ray and CT image findings were concordant in 49.2% of the 500 patients and this concordance was negatively correlated with patient age. Leading diagnosis and management decisions based on the chest radiograph changed after CT in 35.4% of the study group and this finding was also correlated with age. In 55% of 205 patients, pneumonic infiltrations were undiagnosed with radiography. Pulmonary edema was the most specific (93.3%) and sensitive (85.4%) radiography finding. Posteroanterior chest radiographs taken in the upright position had higher concordance with CT than anteroposterior (AP) radiographs taken in the supine position.
Chest CT may be an appropriate imaging choice in patients presenting to the ED for non-traumatic reasons, particularly for elderly patients and when the radiograph is taken with the AP technique in a supine position.
胸部X线摄影是胸部成像的首选方法。然而，计算机断层扫描（CT）的广泛应用导致其在急诊科（ED）的使用大幅增加。我们评估了在因非创伤性胸部急症就诊于急诊科的患者中，胸部X线检查后进行胸部CT的效用，并确定CT检查后诊断和治疗决策是否发生改变。
该研究纳入了500例因非创伤性主诉就诊于急诊科且同时进行了胸部X线和CT检查的连续患者。在对临床信息不知情的情况下，由两名放射科医生对在任何确定性治疗前12小时内获得的胸部X线和CT图像进行随机一致评估。
在500例患者中，49.2%的患者胸部X线和CT图像结果一致，且这种一致性与患者年龄呈负相关。在研究组中，35.4%的患者基于胸部X线片的主要诊断和治疗决策在CT检查后发生了改变，这一发现也与年龄相关。在205例患者中，55%的患者肺部浸润在X线检查中未被诊断出来。肺水肿是X线检查中最具特异性（93.3%）和敏感性（85.4%）的表现。直立位后前位胸部X线片与CT的一致性高于仰卧位前后位（AP）X线片。
对于因非创伤性原因就诊于急诊科的患者，尤其是老年患者以及仰卧位采用AP技术进行X线摄影时，胸部CT可能是一种合适的成像选择。
