Department of Radiology, New York Presbyterian Hospital- Weill Cornell Medical School, New York, NY, United States of America.
Department of Radiology, University of Pennsylvania School of Medicine and the Children's Hospital of Philadelphia, Philadelphia, PA, United States of America.
Clin Imaging. 2022 Feb;82:103-109. doi: 10.1016/j.clinimag.2021.11.008. Epub 2021 Nov 14.
Recent literature has raised concerns about the sensitivity and accuracy of radiographs at diagnosing rib fractures. Studies have shown that chest computed tomography (CT) has far greater sensitivity at detecting rib fractures than radiographs. The purpose of this study was to evaluate the sensitivity of skeletal survey (SS) radiographs at diagnosis of rib fractures compared to CT in the pediatric population. This retrospective review included 57 patients who had undergone both a SS and a CT chest or CT chest/abdomen/pelvis within 30 days of each other for the indication of either non-accidental (NAT) or accidental trauma between 2009 and 2017. Images and reports were analyzed by a pediatric radiology fellow for presence/absence of fracture, evidence of healing and location of rib fracture, including rib level, location within the rib (anterior, lateral, and posterior), and side (right versus left). 225 rib fractures were identified in 25 patients on CT. 38 of those fractures were missed on the preceding SS, yielding a miss rate of 17%. Acute fractures were more likely to be missed than chronic or healing fractures (p ≤ 0.01). Location within the rib did not impact rib detection on radiographs. Left-sided rib fractures were not more common in NAT patients, compared to accidental trauma. SS miss approximately 17% of all rib fractures and CT is more sensitive modality in the detection of rib fractures, particularly acute rib fractures, regardless of location. Low-dose Chest CT could be a helpful modality in the work-up of NAT trauma.
最近的文献对 X 光片诊断肋骨骨折的敏感性和准确性提出了担忧。研究表明，与 X 光片相比，胸部计算机断层扫描（CT）在检测肋骨骨折方面具有更高的敏感性。本研究旨在评估与 CT 相比，骨骼扫描（SS）X 光片在诊断儿童肋骨骨折方面的敏感性。这项回顾性研究包括 57 名患者，他们在 30 天内因非意外伤害（NAT）或意外伤害而先后接受了 SS 和 CT 胸部或 CT 胸部/腹部/骨盆检查。由一名儿科放射科研究员对图像和报告进行分析，以确定是否存在骨折、愈合证据以及肋骨骨折的位置，包括肋骨水平、肋骨内的位置（前、侧和后）以及肋骨侧（左与右）。在 CT 上共发现 25 名患者的 225 处肋骨骨折。在前一次 SS 中漏诊了 38 处骨折，漏诊率为 17%。急性骨折比慢性或愈合骨折更有可能被漏诊（p ≤ 0.01）。肋骨内的位置不会影响 X 光片对肋骨的检测。与意外创伤相比，NAT 患者左侧肋骨骨折并不更常见。SS 漏诊了约 17%的所有肋骨骨折，而 CT 在检测肋骨骨折方面是更敏感的方式，特别是急性肋骨骨折，无论位置如何。低剂量胸部 CT 可能有助于 NAT 创伤的检查。
