急诊科超低剂量胸部计算机断层扫描的诊断准确性
Diagnostic accuracy of ultra-low-dose chest computed tomography in an emergency department.
作者信息
Tækker Maria, Kristjánsdóttir Björg, Andersen Michael B, Fransen Maja L, Greisen Pernille W, Laursen Christian B, Mussmann Bo, Posth Stefan, Graumann Ole
机构信息
Research and Innovation Unit of Radiology, University of Southern Denmark, Odense, Denmark.
Department of Radiology and OPEN - Open Patient data Explorative Network, Odense University Hospital, Odense, Denmark.
出版信息
Acta Radiol. 2022 Mar;63(3):336-344. doi: 10.1177/0284185121995804. Epub 2021 Mar 4.
BACKGROUND
This study examined whether ultra-low-dose chest computed tomography (ULD-CT) could improve detection of acute chest conditions.
PURPOSE
To determine (i) whether diagnostic accuracy of ULD-CT is superior to supine chest X-ray (sCXR) for acute chest conditions and (ii) the feasibility of ULD-CT in an emergency department.
MATERIAL AND METHODS
From 1 February to 31 July 2019, 91 non-traumatic patients from the Emergency Department were prospectively enrolled in the study if they received an sCXR. An ULD-CT and a non-contrast chest CT (NCCT) scan were then performed. Three radiologists assessed the sCXR and ULD-CT examinations for cardiogenic pulmonary edema, pneumonia, pneumothorax, and pleural effusion. Resources and effort were compared for sCXR and ULD-CT to evaluate feasibility. Diagnostic accuracy was calculated for sCXR and ULD-CT using NCCT as the reference standard.
RESULTS
The mean effective dose of ULD-CT was 0.05±0.01 mSv. For pleural effusion and cardiogenic pulmonary edema, no difference in diagnostic accuracy between ULD-CT and sCXR was observed. For pneumonia and pneumothorax, sensitivities were 100% (95% confidence interval [CI] 69-100) and 50% (95% CI 7-93) for ULD-CT and 60% (95% CI 26-88) and 0% (95% CI 0-0) for sCXR, respectively. Median examination time was 10 min for ULD-CT vs. 5 min for sCXR (<0.001). For ULD-CT 1-2 more staff members were needed compared to sCXR (<0.001). ULD-CT was rated more challenging to perform than sCXR (<0.001).
CONCLUSION
ULD-CT seems equal or better in detecting acute chest conditions compared to sCXR. However, ULD-CT examinations demand more effort and resources.
背景
本研究探讨了超低剂量胸部计算机断层扫描（ULD-CT）是否能提高急性胸部疾病的检出率。
目的
确定（i）ULD-CT对急性胸部疾病的诊断准确性是否优于仰卧位胸部X线（sCXR），以及（ii）ULD-CT在急诊科的可行性。
材料与方法
2019年2月1日至7月31日，急诊科91例非创伤性患者若接受了sCXR检查，则被前瞻性纳入本研究。随后进行ULD-CT和非增强胸部CT（NCCT）扫描。三名放射科医生对sCXR和ULD-CT检查评估心源性肺水肿、肺炎、气胸和胸腔积液情况。比较sCXR和ULD-CT的资源和工作量以评估可行性。以NCCT作为参考标准计算sCXR和ULD-CT的诊断准确性。
结果
ULD-CT的平均有效剂量为0.05±0.01 mSv。对于胸腔积液和心源性肺水肿，ULD-CT和sCXR之间的诊断准确性无差异。对于肺炎和气胸，ULD-CT的敏感性分别为100%（95%置信区间[CI] 69 - 100）和50%（95% CI 7 - 93），sCXR的敏感性分别为60%（95% CI 26 - 88）和0%（95% CI 0 - 0）。ULD-CT的中位检查时间为10分钟，而sCXR为5分钟（<0.001）。与sCXR相比，ULD-CT需要多1 - 2名工作人员（<0.001）。ULD-CT被评为比sCXR更具挑战性（<0.001）。
结论
与sCXR相比，ULD-CT在检测急性胸部疾病方面似乎相同或更好。然而，ULD-CT检查需要更多的精力和资源。
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