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在急诊科使用胆道即时超声检查后进行额外的影像学研究。

The use of additional imaging studies after biliary point-of-care ultrasound in the emergency department.

机构信息

Department of Emergency Medicine, Mount Sinai Medical Center, 4300 Alton Rd, Miami Beach, FL, 33140, USA.

Department of Emergency Medicine and Critical Care, Herbert Wertheim College of Medicine at Florida International University, Miami, FL, USA.

出版信息

Emerg Radiol. 2023 Feb;30(1):19-26. doi: 10.1007/s10140-022-02095-5. Epub 2022 Oct 24.

Abstract

PURPOSE

We sought to determine the test characteristics of biliary point-of-care ultrasound (POCUS) and to assess the usefulness of obtaining radiology ultrasound (RUS) or cholescintigraphy (HIDA) after biliary POCUS.

METHODS

We conducted a retrospective review of emergency department patients who underwent biliary POCUS between May 4, 2018 and November 28, 2021. To be included, patients had to have at least one of the following confirmatory evaluations (considered in this order): surgery, HIDA, RUS, or abdominal CT scan. When a discrepancy existed between the POCUS and the RUS or HIDA, they were compared to a higher criterion standard (if available).

RESULTS

Using 348 patients who had a confirmatory evaluation after biliary POCUS, we found the sensitivity and specificity of biliary POCUS for gallstones to be 97.0% (95% CI 92.6 to 99.2%) and 99.5% (95% CI 97.3 to 100%), respectively. For cholecystitis, the sensitivity and specificity were 83.8% (95% CI 72.9 to 91.6%) and 98.6% (95% CI 96.4 to 99.6%), respectively. RUS and POCUS were concordant in 72 (81.8%) of 88 cases in which the patient had both studies while HIDA and POCUS were concordant in 24 (70.6%) of 34 cases. POCUS was deemed correct in at least 50% of discrepant cases with RUS and at least 30% of discrepant cases with HIDA.

CONCLUSION

Biliary POCUS has excellent sensitivity and specificity for cholelithiasis; it has lower sensitivity for cholecystitis, but the specificity remains high. Performing a confirmatory RUS or cholescintigraphy after a positive biliary POCUS adds little value, but additional imaging may be useful when POCUS is negative for cholecystitis.

摘要

目的

我们旨在确定胆道即时超声检查(POCUS)的检测特征,并评估在胆道 POCUS 后获取放射科超声(RUS)或肝胆闪烁扫描(HIDA)的有用性。

方法

我们对 2018 年 5 月 4 日至 2021 年 11 月 28 日期间在急诊科接受胆道 POCUS 的患者进行了回顾性研究。纳入标准为:至少进行了以下一种有确认价值的检查(按此顺序考虑):手术、HIDA、RUS 或腹部 CT 扫描。当 POCUS 与 RUS 或 HIDA 之间存在差异时,将它们与更高的标准进行比较(如果有的话)。

结果

使用 348 例胆道 POCUS 后有确认评估的患者,我们发现胆道 POCUS 诊断胆囊结石的敏感性和特异性分别为 97.0%(95%CI 92.6%至 99.2%)和 99.5%(95%CI 97.3%至 100%)。对于胆囊炎,敏感性和特异性分别为 83.8%(95%CI 72.9%至 91.6%)和 98.6%(95%CI 96.4%至 99.6%)。当患者同时进行了这两项检查时,RUS 和 POCUS 在 88 例中有 72 例(81.8%)是一致的,HIDA 和 POCUS 在 34 例中有 24 例(70.6%)是一致的。在与 RUS 不一致的病例中,POCUS 至少有 50%被认为是正确的,在与 HIDA 不一致的病例中,POCUS 至少有 30%被认为是正确的。

结论

胆道 POCUS 对胆石症具有极好的敏感性和特异性;对胆囊炎的敏感性较低,但特异性仍然很高。在胆道 POCUS 阳性后进行确认性的 RUS 或肝胆闪烁扫描几乎没有增加价值,但在 POCUS 对胆囊炎阴性时,额外的影像学检查可能是有用的。

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