Makerere University, College of Health Sciences, Kampala, Uganda.
Mulago National Referral Hospital, Kampala, Uganda.
J Egypt Natl Canc Inst. 2023 Jul 10;35(1):20. doi: 10.1186/s43046-023-00179-y.
In the Ugandan setting, investigation for PHNM with CT uses a protocol with both unenhanced and contrast enhanced procedures hence doubling the ionizing radiation exposure. The purpose of this study was to determine the feasibility of single CT procedures in diagnosing PHNM.
This was a cross-sectional study using CT images from patients, aged fifteen years and below, investigated for head and neck malignancies at the Uganda Cancer Institute. Three radiologists, observers A, B and C, with 12, 5 and 2 years of experience, respectively, participated in the study. They independently reported contrast enhanced images (protocol A), unenhanced images (protocol B), then both unenhanced and contrast enhanced images (protocol C) in 2 months intervals. Inter- and intra- observer agreement was determined using Gwen's Agreement coefficient.
Seventy-three CT scans of 36 boys and 37 girls, with a median age of 9 (3-13) years, were used. Intra-and inter-observer agreement on primary tumour location ranged from substantial to almost perfect with the highest intra-observer agreement observed when protocols A and C were compared. Inter-observer agreement for tumour calcifications was substantial for protocol A. Observers A and C demonstrated an almost perfect intra-observer agreement when protocols A and C were compared. There was a substantial inter-observer agreement on diagnosis for all protocols.
In our setting and examining a limited number of CT images, we demonstrated that contrast-enhanced CT scans provide sufficient information with no evidence of additional value of unenhanced images. Using contrast-enhanced images alone reduced the radiation exposure significantly.
在乌干达，使用 CT 对 PHNM 进行检查时采用了一种同时包含平扫和增强扫描的方案，从而使电离辐射暴露加倍。本研究旨在确定单 CT 检查程序诊断 PHNM 的可行性。
这是一项使用乌干达癌症研究所对 15 岁及以下头颈部恶性肿瘤患者的 CT 图像进行的横断面研究。三位放射科医生（观察者 A、B 和 C）参与了这项研究，他们分别具有 12、5 和 2 年的经验。他们分别独立报告增强扫描图像（方案 A）、平扫图像（方案 B），然后在 2 个月间隔内同时报告平扫和增强扫描图像（方案 C）。使用 Gwen's 一致性系数来确定观察者间和观察者内的一致性。
共使用了 73 例 36 名男孩和 37 名女孩的 CT 扫描，中位年龄为 9（3-13）岁。主要肿瘤位置的观察者间和观察者内一致性从显著到几乎完美，当比较方案 A 和 C 时，观察者内一致性最高。观察者 A 和 C 比较方案 A 时，肿瘤钙化的观察者内一致性几乎完美。所有方案的观察者间诊断一致性均显著。
在我们的环境中，检查了有限数量的 CT 图像，我们证明了增强 CT 扫描提供了足够的信息，平扫图像没有额外的价值。单独使用增强扫描图像可以显著减少辐射暴露。
