急诊室中用于检测急性腹部病变的超低剂量 CT 腹部和盆腔成像：来自一家学术医院的初步经验。

Ultra-low dose CT abdomen and pelvis for the detection of acute abdominal pathology in the emergency room: initial experience from an academic hospital.

机构信息

Joint Department of Medical Imaging, Princess Margaret Cancer Centre, University Health Network, Mount Sinai Hospital and Women's College Hospital, University of Toronto, 610 University Ave, Suite 3-960, Toronto, ON, M5G 2M9, Canada.

出版信息

Emerg Radiol. 2021 Feb;28(1):15-21. doi: 10.1007/s10140-020-01804-2. Epub 2020 Jun 17.

DOI:10.1007/s10140-020-01804-2

PMID:32557166

Abstract

PURPOSE

The aim of this study is to describe our initial experience using ULDCT performed in the emergency room in the evaluation of acute abdominal pathology.

METHODS

Data from consecutive patients who underwent ULDCT for assessment of bowel obstruction, free intraperitoneal air, unexplained abdominal pain, or fecal loading for constipation between June 1, 2016 and March 31, 2017 was retrospectively assessed. Demographic data, radiation dose, CT findings, and clinical outcomes including performance of full dose contrast-enhanced CT (CECT), hospitalization, and surgery was collected. Concordance of ULDCT to CECT was calculated.

RESULTS

ULDCT was performed in 325 patients (188 women and 137 men; mean age, 65.1 years). ULDCT detected acute abdominal pathology in 134/325 (41.2%), and in 89/134 (66.4%) it was concordant with the clinical working diagnosis. The average dose length product (DLP) was 101.6 mGy cm (range 51.7-614; median, 82.6). CECT was performed in 44/325 patients (13.5%). In 7/44 (15.9%), CECT identified discordant findings which likely impacted management. A greater proportion of patients were admitted to hospital after a positive ULDCT 99/137 (72.3%), compared to those with a negative study 81/188 (43.1%); p < 0.0001(Chi, 27.30). Of those admitted to hospital, 11/99 (11.1%) with positive ULDCT had surgery compared to 1/81 (1.2%) with a negative ULDCT; p < 0.008 (Chi, 6.98).

CONCLUSION

With its high clinical yield and similar radiation dose, ULDCT appears as a suitable alternative to abdominal radiography for the detection of select acute abdominal pathology in the emergency room.

摘要

目的

本研究旨在描述我们在急诊室使用 ULDCT 评估急性腹部病变的初步经验。

方法

回顾性评估了 2016 年 6 月 1 日至 2017 年 3 月 31 日期间连续接受 ULDCT 评估肠梗阻、游离腹腔积气、不明原因腹痛或便秘粪便负荷的患者的数据。收集了人口统计学数据、辐射剂量、CT 结果以及临床结果，包括全剂量对比增强 CT（CECT）、住院和手术的执行情况。计算了 ULDCT 与 CECT 的一致性。

结果

325 例患者进行了 ULDCT（188 例女性和 137 例男性；平均年龄 65.1 岁）。ULDCT 在 134/325 例（41.2%）中检测到急性腹部病变，其中 89/134 例（66.4%）与临床工作诊断一致。平均剂量长度乘积（DLP）为 101.6mGy·cm（范围 51.7-614；中位数，82.6）。在 325 例患者中，44 例（13.5%）进行了 CECT。在 7/44 例（15.9%）中，CECT 发现了可能影响治疗的不一致发现。阳性 ULDCT 后住院患者比例高于阴性 ULDCT，分别为 137/99（72.3%）和 188/81（43.1%）；p<0.0001（Chi，27.30）。在住院患者中，99/137（11.1%）例阳性 ULDCT 患者进行了手术，而 81/188（1.2%）例阴性 ULDCT 患者进行了手术；p<0.008（Chi，6.98）。