Baratella Elisa, Quaia Emilio, Crimì Filippo, Minelli Pierluca, Cioffi Vincenzo, Ruaro Barbara, Cova Maria Assunta
Institute of Radiology, Department of Medical Surgical and Health Sciences, Cattinara Hospital, University of Trieste, 34149 Trieste, Italy.
Institute of Radiology, Department of Medicine-DIMED, University of Padova, 35128 Padova, Italy.
Diagnostics (Basel). 2023 Mar 7;13(6):1010. doi: 10.3390/diagnostics13061010.
To evaluate the capability of digital tomosynthesis (DTS) to characterize suspected pulmonary lesions in the so-called hidden areas at chest X-ray (CXR).
Among 726 patients with suspected pulmonary lesions at CXR who underwent DTS, 353 patients (201 males, 152 females; age 71.5 ± 10.4 years) revealed suspected pulmonary lesions in the apical, hilar, retrocardiac, or paradiaphragmatic lung zones and were retrospectively included. Two readers analyzed CXR and DTS images and provided a confidence score: 1 or 2 = definitely or probably benign pulmonary or extra-pulmonary lesion, or pulmonary pseudo-lesion deserving no further diagnostic work-up; 3 = indeterminate lesion; 4 or 5 = probably or definitely pulmonary lesion deserving further diagnostic work-up by CT. The nature of DTS findings was proven by CT ( = 108) or CXR during follow-up ( = 245).
In 62/353 patients the suspected lung lesions were located in the lung apex, in 92/353 in the hilar region, in 59/353 in the retrocardiac region, and in 140/353 in the paradiaphragmatic region. DTS correctly characterized the CXR findings as benign pulmonary or extrapulmonary lesion (score 1 or 2) in 43/62 patients (69%) in the lung apex region, in 56/92 (61%) in the pulmonary hilar region, in 40/59 (67%) in the retrocardiac region, and in 106/140 (76%) in the paradiaphragmatic region, while correctly recommending CT in the remaining cases due to the presence of true solid pulmonary lesion, with the exception of 22 false negative findings (60 false positive findings). DTS showed a significantly ( < 0.05) increased sensitivity, specificity, and overall diagnostic accuracy and area under ROC curve compared to CXR alone.
DTS allowed confirmation or exclusion of the presence of true pulmonary lesions in the hidden areas of the chest.
评估数字断层合成（DTS）对胸部X线（CXR）所谓隐匿区域可疑肺部病变的特征性诊断能力。
在726例接受DTS检查的CXR可疑肺部病变患者中，353例患者（201例男性，152例女性；年龄71.5±10.4岁）在肺尖、肺门、心后区或膈旁肺区发现可疑肺部病变，并进行回顾性纳入。两名阅片者分析CXR和DTS图像并给出可信度评分：1或2分=肯定或可能为良性肺部或肺外病变，或无需进一步诊断检查的肺部假病变；3分=病变性质不确定；4或5分=可能或肯定为肺部病变，值得进一步行CT诊断检查。DTS检查结果的性质通过CT（n=108）或随访期间的CXR（n=245）得以证实。
在353例患者中，62例可疑肺部病变位于肺尖，92例位于肺门区，59例位于心后区，140例位于膈旁区。DTS将肺尖区43/62例（69%）、肺门区56/92例（61%）、心后区40/59例（67%）和膈旁区106/140例（76%）的CXR检查结果正确判定为良性肺部或肺外病变（评分1或2分），而在其余存在真正实性肺部病变（22例假阴性结果，60例假阳性结果除外）的病例中正确推荐行CT检查。与单独使用CXR相比，DTS的敏感性、特异性、总体诊断准确性及ROC曲线下面积均显著增加（P<0.05）。
DTS能够证实或排除胸部隐匿区域真正肺部病变的存在。
