Department of Radiology, 2348Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
Department of Diagnostic and Therapeutic Radiology, 432716Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Can Assoc Radiol J. 2021 Aug;72(3):519-524. doi: 10.1177/0846537120908852. Epub 2020 Mar 18.
To assess and compare detectability of pneumothorax on unprocessed baseline, single-energy, bone-subtracted, and enhanced frontal chest radiographs (chest X-ray, CXR).
Our retrospective institutional review board-approved study included 202 patients (mean age 53 ± 24 years; 132 men, 70 women) who underwent frontal CXR and had trace, moderate, large, or tension pneumothorax. All patients (except those with tension pneumothorax) had concurrent chest computed tomography (CT). Two radiologists reviewed the CXR and chest CT for pneumothorax on baseline CXR (ground truth). All baseline CXR were processed to generate bone-subtracted and enhanced images (ClearRead X-ray). Four radiologists (R1-R4) assessed the baseline, bone-subtracted, and enhanced images and recorded the presence of pneumothorax (side, size, and confidence for detection) for each image type. Area under the curve (AUC) was calculated with receiver operating characteristic analyses to determine the accuracy of pneumothorax detection.
Bone-subtracted images (AUC: 0.89-0.97) had the lowest accuracy for detection of pneumothorax compared to the baseline (AUC: 0.94-0.97) and enhanced (AUC: 0.96-0.99) radiographs ( < .01). Most false-positive and false-negative pneumothoraces were detected on the bone-subtracted images and the least numbers on the enhanced radiographs. Highest detection rates and confidence were noted for the enhanced images (empiric AUC for R1-R4 0.96-0.99).
Enhanced CXRs are superior to bone-subtracted and unprocessed radiographs for detection of pneumothorax.
CLINICAL RELEVANCE/APPLICATION: Enhanced CXRs improve detection of pneumothorax over unprocessed images; bone-subtracted images must be cautiously reviewed to avoid false negatives.
评估和比较未处理的基线、单能量、去骨 subtracted 和增强的正面胸部 X 线片（胸部 X 射线，CXR）对气胸的检测能力。
我们进行了一项回顾性的机构审查委员会批准的研究，纳入了 202 名患者（平均年龄 53 ± 24 岁；132 名男性，70 名女性），这些患者接受了正面 CXR 检查，并伴有微量、中度、大量或张力性气胸。所有患者（张力性气胸患者除外）均进行了胸部 CT（胸部 CT）检查。两名放射科医生在基线 CXR（ground truth）上对 CXR 和胸部 CT 进行气胸检查。对所有基线 CXR 进行处理，生成去骨 subtracted 和增强图像（ClearRead X-ray）。四位放射科医生（R1-R4）评估了基线、去骨 subtracted 和增强图像，并记录了每种图像类型的气胸存在情况（侧别、大小和检测信心）。通过接受者操作特征分析计算曲线下面积（AUC），以确定气胸检测的准确性。
与基线（AUC：0.94-0.97）和增强（AUC：0.96-0.99）X 射线相比，去骨 subtracted 图像（AUC：0.89-0.97）对气胸的检测准确性最低（<0.01）。大多数假阳性和假阴性气胸出现在去骨 subtracted 图像上，而增强图像上的气胸数量最少。增强图像的检测率和信心最高（R1-R4 的经验 AUC 为 0.96-0.99）。
增强 CXR 比去骨 subtracted 和未处理的 X 射线对气胸的检测更优。
临床相关性/应用：增强 CXR 提高了气胸的检测能力，优于未处理的图像；去骨 subtracted 图像必须仔细审查，以避免假阴性。
