Mandell Jacob C, Rocha Tatiana C, Duran-Mendicuti Maria Alejandra, Miskin Nityanand P, Shi Junzi, Khurana Bharti
Division of Musculoskeletal Imaging and Intervention, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Division of Emergency Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Emerg Radiol. 2018 Dec;25(6):639-645. doi: 10.1007/s10140-018-1626-7. Epub 2018 Jul 14.
The purpose of this study was to demonstrate the diagnostic performance and effect on reader confidence of a custom computed tomography (CT) color postprocessing algorithm for assessment of nondisplaced proximal femoral fractures.
Four radiologists, including two PGY-3 radiology residents and two emergency radiologists, independently interpreted 30 CT examinations of the hip and/or pelvis performed for trauma, consisting of a total of 15 cases positive for nondisplaced hip fracture and 15 age and sex-matched controls. Images were reviewed first with conventional CT images and after at least 8 weeks, all images were reviewed again with the addition of coronal color postprocessed images. Sensitivity and specificity were compared with McNemar's test, and diagnostic confidence was compared with paired t tests.
There was no significant difference in diagnostic performance between conventional and postprocessed images, although there was nominally increased sensitivity and decreased specificity with the postprocessed images: for all readers, the sensitivity and specificity for conventional images was 88.3 and 95.0%, compared to 93.3% (p = 0.25) and 88.3% (p = 0.14) for postprocessed images. Three of four readers (including both attending radiologists) reported an increase in confidence with postprocessed images for cases negative for fracture (10-point confidence scale of 7.25 for conventional images, compared to 8.2 for postprocessed images for all readers, p = 0.0053). There was no difference in diagnostic confidence for cases positive for fracture.
A custom color CT postprocessing algorithm did not demonstrate a significant difference in diagnostic performance for assessment of nondisplaced proximal femoral fractures within the limitations of a relatively small sample size; however, postprocessing increases confidence of experienced readers in cases negative for fracture.
本研究旨在证明一种定制的计算机断层扫描（CT）彩色后处理算法在评估无移位股骨近端骨折时的诊断性能及其对阅片者信心的影响。
四名放射科医生，包括两名三年级放射科住院医师和两名急诊放射科医生，独立解读了30例因创伤进行的髋部和/或骨盆CT检查，其中共有15例无移位髋部骨折阳性病例以及15例年龄和性别匹配的对照。首先使用传统CT图像进行阅片，至少8周后，所有图像在添加冠状位彩色后处理图像后再次进行阅片。使用McNemar检验比较敏感性和特异性，使用配对t检验比较诊断信心。
传统图像和后处理图像在诊断性能上无显著差异，尽管后处理图像名义上敏感性增加而特异性降低：对于所有阅片者，传统图像的敏感性和特异性分别为88.3%和95.0%，而后处理图像的敏感性和特异性分别为93.3%（p = 0.25）和88.3%（p = 0.14）。四名阅片者中有三名（包括两位主治放射科医生）报告称，对于骨折阴性病例，后处理图像使其信心增加（传统图像的10分信心量表评分为7.25，所有阅片者后处理图像的评分为8.2，p = 0.0053）。对于骨折阳性病例，诊断信心没有差异。
在样本量相对较小的局限性内，一种定制的彩色CT后处理算法在评估无移位股骨近端骨折时的诊断性能未显示出显著差异；然而，后处理增加了经验丰富的阅片者对骨折阴性病例的信心。
