超低位剂量 CT 与 X 光片在小脊柱和骨盆创伤中的应用：准确性的贝叶斯分析。
Ultra-low-dose CT versus radiographs for minor spine and pelvis trauma: a Bayesian analysis of accuracy.
机构信息
Medical Imaging Group, CHU Nimes, Univ Montpellier, Montpellier, France.
Department of Biostatistics, Epidemiology, Public Health and Innovation in Methodology (BESPIM), CHU Nimes, Univ Montpellier, Montpellier, France.
出版信息
Eur Radiol. 2021 Apr;31(4):2621-2633. doi: 10.1007/s00330-020-07304-8. Epub 2020 Oct 9.
OBJECTIVES
To compare diagnosis performance and effective dose of ultra-low-dose CT (ULD CT) versus radiographs in suspected spinal or pelvic ring or hip fracture for minor trauma.
METHODS
ULD CT, in addition to radiography, was prospectively performed in consecutive patients admitted to the emergency department for minor traumas, during working hours over 2 months. Presence of a recent fracture was assessed by two blind radiologists independently. Sensitivities and specificities were estimated using the best valuable comparator (BVC) as a reference and using a latent class model in Bayesian inference (BLCM). Dosimetric indicators were recorded and effective doses (E) were calculated using conversion coefficient.
RESULTS
Eighty areas were analyzed in 69 patients, including 22 dorsal spine, 28 lumbar spine, and 30 pelvic ring/hip. Thirty-six fractures (45%) were observed. Applying the BVC method, depending on location, ULD CT sensitivity was 80 to 100% for reader 1 and 85 to 100% for reader 2, whereas radiographic sensitivity was 60 to 85% for reader 1 and 50 to 92% for reader 2. With BLCM approach for reader 2, ULD CT sensitivity for all locations/dorsal spine/lumbar spine and pelvic ring-hip was 87.1/75.9/84.2/76.9% respectively. Corresponding radiograph sensitivity was 73.8, 54.8, 80.4, and 68.7%. Effective doses of ULD CT were similar to radiographs for dorsal and hip locations whereas for lumbar spine, ULD CT effective dose was 1.83 ± 0.59 mSv compared with 0.96 ± 0.59 mSv (p < 0.001).
CONCLUSION
Sensitivity for fracture detection was higher for ULD CT compared with radiographs with an effective dose comparable to radiographs.
KEY POINTS
• Ultra-low-dose spine and pelvis CT demonstrates better fracture detection when compared with radiographs. • The effective dose of ultra-low-dose spine and pelvis CT scan and radiographs is comparable. • Replacement of radiographs by ULD CT in daily practice for trauma patients is an option to consider and should be evaluated by a randomized trial.
目的
比较超低剂量 CT（ULD CT）与 X 线摄影在疑似脊柱或骨盆环或髋部骨折的小创伤患者中的诊断性能和有效剂量。
方法
在连续 2 个月的工作时间内，对因小创伤就诊于急诊科的患者，前瞻性地对 ULD CT 与 X 线摄影联合进行检查。两位盲法放射科医生独立评估最近骨折的存在情况。使用最佳有价值比较器（BVC）作为参考，使用贝叶斯推断中的潜在类别模型（BLCM）估计敏感性和特异性。记录剂量学指标，并使用转换系数计算有效剂量（E）。
结果
在 69 名患者的 80 个部位中分析了 E80 个部位，包括 22 个脊柱背侧、28 个腰椎和 30 个骨盆环/髋部。观察到 36 处骨折（45%）。根据位置应用 BVC 方法，读者 1 的 ULD CT 敏感性为 80%至 100%，读者 2 的敏感性为 85%至 100%，而读者 1 的 X 线摄影敏感性为 60%至 85%，读者 2 的敏感性为 50%至 92%。对于读者 2 ，采用 BLCM 方法，所有部位/脊柱背侧/腰椎和骨盆环-髋部的 ULD CT 敏感性分别为 87.1%/75.9%/84.2%/76.9%。相应的 X 线摄影敏感性分别为 73.8%、54.8%、80.4%和 68.7%。ULD CT 的有效剂量与 X 线摄影相似，适用于脊柱背侧和髋部部位，而对于腰椎，ULD CT 的有效剂量为 1.83±0.59mSv，而 0.96±0.59mSv（p<0.001）。
结论
与 X 线摄影相比，ULD CT 检测骨折的敏感性更高，且有效剂量相当。
关键要点
与 X 线摄影相比，超低剂量脊柱和骨盆 CT 显示出更好的骨折检测效果。
超低剂量脊柱和骨盆 CT 扫描和 X 线摄影的有效剂量相当。
在日常实践中用 ULD CT 替代 X 线摄影来检查创伤患者是一种选择，应通过随机试验进行评估。
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