Kanglie Maadrika M N P, van den Berk Inge A H, van Engelen Tjitske S R, Bipat Shandra, Bossuyt Patrick M M, Prins Jan M, Stoker Jaap
Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
Department of Radiology, Spaarne Gasthuis, Haarlem and Hoofddorp, Haarlem, The Netherlands.
Eur Radiol. 2025 Jan 29. doi: 10.1007/s00330-024-11223-3.
To compare the diagnostic accuracy of ULDCT to CXR for detecting non-traumatic pulmonary diseases at the emergency department (ED) and to study diagnostic confidence levels.
Secondary analysis of the prospective OPTIMACT trial (2418 ED participants randomly allocated to ULDCT or CXR). Diagnoses at imaging at the ED were compared to the reference diagnosis on day 28. Ratios of positive diagnoses, true positives (TP), false positives (FP), false negatives (FN), and positive predictive values (PPV) were assessed with 95% confidence intervals (CI). The diagnostic confidence levels of the radiologists were studied.
One thousand one hundred sixty-one ULDCT participants (mean age, 59 years ± 18 [standard deviation], 587 female) and 1151 CXR participants (mean age, 59 years ± 18 [standard deviation], 561 female) were evaluated. With ULDCT, pneumonia was 1.55 times (95% CI: 1.33-1.80) more often diagnosed at imaging at the ED, with significantly more TP (ratio 1.50; 95% CI: 1.26-1.76) and fewer FN (0.61; 95% CI: 0.37-0.99) but more FP (1.75; 95% CI: 1.19-2.58); a similar pattern was observed for other lower respiratory tract infections (LRTI). Pulmonary congestion was less often observed with ULDCT (0.45; 95% CI: 0.34-0.61), with fewer TP (0.50; 95% CI: 0.34-0.73), and FP (0.40; 95% CI: 0.24-0.65). PPVs were not significantly different. With ULDCT, radiologists were more often certain in diagnosing pneumonia (ULDCT 121/324, 37% vs CXR 48/208, 23%), LRTI (84/192, 44% vs 18/63, 29%), and no established disease (350/382, 92% vs 447/544, 82%).
Compared to CXR, ULDCT led to more TP but also more FP in detecting pneumonia and LRTI, while fewer TP and FP were found for pulmonary congestion. PPVs were comparable.
Question Is ultra-low dose CT (ULDCT) more accurate than chest X-ray (CXR) for identifying non-traumatic pulmonary diseases in patients presenting at the ED? Findings ULDCT detects more pulmonary infections in patients presenting at the ED with non-traumatic pulmonary complaints, while CXR detects more pulmonary congestion. Clinical relevance ULDCT is superior to CXR in detecting pneumonia and other LRTI in ED patients, while CXR is superior in detecting pulmonary congestion. ULDCT can be an alternative for CXR in a selected group of patients.
比较超低剂量计算机断层扫描（ULDCT）与胸部X线摄影（CXR）在急诊科检测非创伤性肺部疾病的诊断准确性，并研究诊断置信度。
对前瞻性OPTIMACT试验（2418名急诊科参与者被随机分配至ULDCT组或CXR组）进行二次分析。将急诊科影像学诊断结果与第28天的参考诊断进行比较。评估阳性诊断率、真阳性（TP）、假阳性（FP）、假阴性（FN）及阳性预测值（PPV）的比值，并给出95%置信区间（CI）。研究放射科医生的诊断置信度。
对1161名接受ULDCT检查的参与者（平均年龄59岁±18[标准差]，女性587名）和1151名接受CXR检查的参与者（平均年龄59岁±18[标准差]，女性561名）进行了评估。使用ULDCT时，急诊科影像学诊断肺炎的几率是CXR的1.55倍（95%CI：1.33 - 1.80），TP显著更多（比值1.50；95%CI：1.26 - 1.76），FN更少（0.61；95%CI：0.37 - 0.99），但FP更多（1.75；95%CI：1.19 - 2.58）；其他下呼吸道感染（LRTI）也观察到类似模式。ULDCT观察到的肺淤血较少（0.45；95%CI：0.34 - 0.61），TP较少（0.50；95%CI：0.34 - 0.73），FP也较少（0.40；95%CI：0.24 - 0.65）。PPV无显著差异。使用ULDCT时，放射科医生对肺炎（ULDCT组121/324，37%；CXR组48/208，23%）、LRTI（84/192，44%；18/63，29%）及无确诊疾病（350/382，92%；447/544，82%）的诊断更有把握。
与CXR相比，ULDCT在检测肺炎和LRTI时TP更多，但FP也更多，而在检测肺淤血时TP和FP均较少。PPV相当。
问题 在急诊科就诊的患者中，超低剂量CT（ULDCT）在识别非创伤性肺部疾病方面是否比胸部X线摄影（CXR）更准确？ 发现 在急诊科出现非创伤性肺部症状的患者中，ULDCT检测到的肺部感染更多，而CXR检测到的肺淤血更多。 临床意义 在急诊科患者中，ULDCT在检测肺炎和其他LRTI方面优于CXR，而CXR在检测肺淤血方面更优。在特定患者群体中，ULDCT可作为CXR的替代方法。
