Yamasaki Yuzo, Hosokawa Kazuya, Kamitani Takeshi, Abe Kohtaro, Sagiyama Koji, Hino Takuya, Ikeda Megumi, Nishimura Shunsuke, Toyoda Hiroyuki, Moriyama Shohei, Kawakubo Masateru, Matsutani Noritsugu, Yabuuchi Hidetake, Ishigami Kousei
Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Japan.
Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kyushu University, Japan.
Eur J Radiol Open. 2024 Oct 5;13:100602. doi: 10.1016/j.ejro.2024.100602. eCollection 2024 Dec.
This study aimed to assess the diagnostic performance of dynamic chest radiography (DCR) and investigate its added value to chest radiography (CR) in detecting pulmonary embolism (PE).
Of 775 patients who underwent CR and DCR in our hospital between June 2020 and August 2022, individuals who also underwent contrast-enhanced CT (CECT) of the chest within 72 h were included in this study. PE or non-PE diagnosis was confirmed by CECT and the subsequent clinical course. The enrolled patients were randomized into two groups. Six observers, including two thoracic radiologists, two cardiologists, and two radiology residents, interpreted each chest radiograph with and without DCR using a crossover design with a washout period. Diagnostic performance was compared between CR with and without DCR in the standing and supine positions.
Sixty patients (15 PE, 45 non-PE) were retrospectively enrolled. The addition of DCR to CR significantly improved the sensitivity, specificity, accuracy, and area under the curve (AUC) in the standing (35.6-70.0 % [ < 0.0001], 84.8-93.3 % [ = 0.0010], 72.5-87.5 % [ < 0.0001], and 0.66-0.85 [ < 0.0001], respectively) and supine (33.3-65.6 % [ < 0.0001], 78.5-92.2 % [ < 0.0001], 67.2-85.6 % [ < 0.0001], and 0.62-0.80 [ = 0.0002], respectively) positions for PE detection. No significant differences were found between the AUC values of DCR with CR in the standing and supine positions (P = 0.11) or among radiologists, cardiologists, and radiology residents (P = 0.14-0.68).
Incorporating DCR with CR demonstrated moderate sensitivity, high specificity, and high accuracy in detecting PE, all of which were significantly higher than those achieved with CR alone, regardless of scan position, observer expertise, or experience.
本研究旨在评估动态胸部X线摄影（DCR）的诊断性能，并探讨其在检测肺栓塞（PE）方面相对于胸部X线摄影（CR）的附加价值。
在2020年6月至2022年8月期间于我院接受CR和DCR检查的775例患者中，纳入在72小时内还接受了胸部对比增强CT（CECT）检查的患者。通过CECT及后续临床病程确诊PE或非PE诊断。将纳入的患者随机分为两组。六名观察者，包括两名胸放射科医生、两名心脏病专家和两名放射科住院医师，采用交叉设计并设有洗脱期，对有和没有DCR的每张胸部X线片进行解读。比较站立位和仰卧位有和没有DCR的CR的诊断性能。
回顾性纳入60例患者（15例PE，45例非PE）。在CR基础上增加DCR显著提高了站立位（分别为35.6 - 70.0%[<0.0001]、84.8 - 93.3%[=0.0010]、72.5 - 87.5%[<0.0001]和0.66 - 0.85[<0.0001]）和仰卧位（分别为33.3 - 65.6%[<0.0001]、78.5 - 92.2%[<0.0001]、67.2 - 85.6%[<0.0001]和0.62 - 0.80[=0.0002]）检测PE的敏感性、特异性、准确性和曲线下面积（AUC）。站立位和仰卧位DCR与CR的AUC值之间无显著差异（P = 0.11），放射科医生、心脏病专家和放射科住院医师之间也无显著差异（P = 0.14 - 0.68）。
将DCR与CR相结合在检测PE方面显示出中等敏感性、高特异性和高准确性，无论扫描体位、观察者专业知识或经验如何，所有这些均显著高于单独使用CR时的水平。
