前瞻性评估 MRI 与 CT 对急诊科以阑尾炎为主要表现的腹痛患者病因的诊断价值。
Prospective evaluation of MRI compared with CT for the etiology of abdominal pain in emergency department patients with concern for appendicitis.
机构信息
BerbeeWalsh Department of Emergency Medicine, University of Wisconsin - Madison, Madison, Wisconsin, USA.
Department of Biostatistics and Medical Informatics, University of Wisconsin - Madison, Madison, Wisconsin, USA.
出版信息
J Magn Reson Imaging. 2019 Nov;50(5):1651-1658. doi: 10.1002/jmri.26728. Epub 2019 Mar 20.
BACKGROUND
Computed tomography (CT) is commonly used in the Emergency Department (ED) to evaluate patients with abdominal pain, but exposes them to ionizing radiation, a possible carcinogen. MRI does not utilize ionizing radiation and may be an alternative.
PURPOSE
To compare the sensitivity of MRI and CT for acute abdominopelvic ED diagnoses.
STUDY TYPE
Prospective, observational cohort.
POPULATION
ED patients ≥12 years old and undergoing CT for possible appendicitis.
FIELD STRENGTH/SEQUENCE: 1.5 T MRI, including T -weighted, T -weighted, and diffusion-weighted imaging sequences.
ASSESSMENT
Three radiologists independently interpreted each MRI and CT image set separately and blindly, using a standard case report form. Assessments included likelihood of appendicitis, presence of an alternative diagnosis, and likelihood that the alternative diagnosis was causing the patient's symptoms. An expert panel utilized chart review and follow-up phone interviews to determine all final diagnoses. Times to complete image acquisition and image interpretation were also calculated.
STATISTICAL TESTS
Sensitivity was calculated for each radiologist and by consensus (≥2 radiologists in agreement) and are reported as point estimates with 95% confidence intervals. Two-sided hypothesis tests comparing the sensitivities of the three image types were conducted using Pearson's chi-squared test with the traditional significance level of P = 0.05.
RESULTS
There were 15 different acute diagnoses identified on the CT/MR images of 113 patients. Using individual radiologist interpretations, the sensitivities of noncontrast-enhanced MRI (NCE-MR), contrast-enhanced MR (CE-MR), and CT for any acute diagnosis were 77.0% (72.6-81.4%), 84.2% (80.4-88.0%), and 88.7% (85.5-92.1%). Sensitivity of consensus reads was 82.0% (74.9-88.9%), 87.1% (81.0-93.2%), 92.2% (87.3-97.1%), respectively. There was no difference in sensitivities between CE-MR and CT by individual (P = 0.096) or consensus interpretations (P = 0.281), although NCE-MR was inferior to CT in both modes of analysis (P < 0.001, P = 0.031, respectively).
DATA CONCLUSION
The sensitivity of CE-MR was similar to CT when diagnosing acute, nontraumatic abdominopelvic pathology in our cohort.
LEVEL OF EVIDENCE
2 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2019;50:1651-1658.
背景
计算机断层扫描（CT）常用于急诊科（ED）评估腹痛患者，但会使他们暴露于电离辐射这一可能的致癌物中。磁共振成像（MRI）不利用电离辐射，可能是一种替代方法。
目的
比较 MRI 和 CT 对急性腹痛的诊断效能。
研究类型
前瞻性、观察性队列研究。
人群
年龄≥12 岁且接受 CT 检查以排除阑尾炎可能的 ED 患者。
场强/序列：1.5T MRI，包括 T1 加权、T2 加权和弥散加权成像序列。
评估
3 名放射科医生独立使用标准病例报告表分别对每一个 MRI 和 CT 图像进行独立盲法解读。评估内容包括阑尾炎的可能性、是否存在其他诊断以及其他诊断是否导致患者的症状。一个专家小组通过查阅病历和随访电话访谈来确定所有最终诊断。还计算了完成图像采集和图像解读所需的时间。
统计学检验
计算每位放射科医生和共识（≥2 位放射科医生意见一致）的敏感度，并以点估计值及其 95%置信区间报告。使用 Pearson 卡方检验对三种图像类型的敏感度进行双侧假设检验，传统的显著性水平 P=0.05。
结果
在 113 名患者的 CT/MR 图像上共识别出 15 种不同的急性诊断。使用单个放射科医生的解读，非增强 MRI（NCE-MRI）、增强 MRI（CE-MRI）和 CT 对任何急性诊断的敏感度分别为 77.0%（72.6%-81.4%）、84.2%（80.4%-88.0%）和 88.7%（85.5%-92.1%）。共识解读的敏感度分别为 82.0%（74.9%-88.9%）、87.1%（81.0%-93.2%）和 92.2%（87.3%-97.1%）。CE-MRI 和 CT 的敏感度在个体（P=0.096）或共识（P=0.281）解读之间没有差异，尽管在两种分析模式中，NCE-MRI 的敏感度均低于 CT（均 P<0.001，P=0.031）。
数据结论
在我们的队列中，CE-MRI 诊断急性非创伤性腹痛的敏感度与 CT 相似。
证据水平
2 级 技术功效：2 级 J. 磁共振成像 2019;50:1651-1658.
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