Mueller Julia A, Martini Katharina, Eberhard Matthias, Mueller Mathias A, De Silvestro Alessandra A, Breiding Philipp, Frauenfelder Thomas
Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, 8091 Zürich, Switzerland.
Institute of Radiology, Cantonal Hospital of Frauenfeld, 8501 Frauenfeld, Switzerland.
Diagnostics (Basel). 2021 Oct 7;11(10):1849. doi: 10.3390/diagnostics11101849.
PURPOSE/OBJECTIVES: To compare the diagnostic performance of dual-energy subtraction (DE) and conventional radiography (CR) for detecting pulmonary emphysema using computed tomography (CT) as a reference standard.
Sixty-six patients (24 female, median age 73) were retrospectively included after obtaining lateral and posteroanterior chest X-rays with a dual-shot DE technique and chest CT within ±3 months. Two experienced radiologists first evaluated the standard CR images and, second, the bone-/soft tissue weighted DE images for the presence (yes/no), degree (1-4), and quadrant-based distribution of emphysema. CT was used as a reference standard. Inter-reader agreement was calculated. Sensitivity and specificity for the correct detection and localization of emphysema was calculated. Further degree of emphysema on CR and DE was correlated with results from CT. A -value < 0.05 was considered as statistically significant.
The mean interreader agreement was substantial for CR and moderate for DE (k = 0.611 vs. k = 0.433; respectively). Sensitivity, as well as specificity for the detection of emphysema, was comparable between CR and DE (sensitivity 96% and specificity 75% vs. sensitivity 91% and specificity 83%; = 0.157). Similarly, there was no significant difference in the sensitivity or specificity for emphysema localization between CR and DE (sensitivity 50% and specificity 100% vs. sensitivity 57% and specificity 100%; = 0.157). There was a slightly better correlation with CT of emphysema grading in DE compared to CR (r = 0.75 vs. r = 0.68; = 0.108); these differences were not statistically significant, however.
Diagnostic accuracy for the detection, quantification, and localization of emphysema between CR and DE is comparable. Interreader agreement, however, is better with CR compared to DE.
目的/目标：以计算机断层扫描（CT）作为参考标准，比较双能减影（DE）和传统X线摄影（CR）检测肺气肿的诊断性能。
在±3个月内，采用双能技术获取66例患者（24例女性，中位年龄73岁）的胸部侧位和后前位X线片及胸部CT，对患者进行回顾性纳入。两名经验丰富的放射科医生首先评估标准CR图像，其次评估骨/软组织加权DE图像，以确定肺气肿的存在（是/否）、程度（1-4级）以及基于象限的分布情况。CT用作参考标准。计算阅片者间的一致性。计算正确检测和定位肺气肿的敏感性和特异性。进一步将CR和DE上肺气肿的程度与CT结果进行相关性分析。P值<0.05被认为具有统计学意义。
CR的阅片者间平均一致性较高，DE的阅片者间一致性中等（分别为k = 0.611和k = 0.433）。CR和DE在检测肺气肿方面的敏感性和特异性相当（敏感性分别为96%和特异性75%，与敏感性91%和特异性83%；P = 0.157）。同样，CR和DE在肺气肿定位的敏感性或特异性方面也无显著差异（敏感性分别为50%和特异性100%，与敏感性57%和特异性100%；P = 0.157）。与CR相比，DE上肺气肿分级与CT的相关性稍好（r = 0.75与r = 0.68；P = 0.108）；然而，这些差异无统计学意义。
CR和DE在检测、量化和定位肺气肿方面的诊断准确性相当。然而，与DE相比，CR的阅片者间一致性更好。
