Gavant M L, Menke P G, Fabian T, Flick P A, Graney M J, Gold R E
Department of Radiology, University of Tennessee, Memphis, USA.
Radiology. 1995 Oct;197(1):125-33. doi: 10.1148/radiology.197.1.7568809.
To determine the effectiveness of helical computed tomography (CT) as a screening device to detect traumatic aortic rupture.
Helical CT was used to examine 1,518 patients with nontrivial blunt trauma. Of these patients, 127 (8.37%) with abnormal CT scans of the mediastinum or aorta underwent thoracic aortography--89 patients solely for evaluation of mediastinal hematoma depicted at CT. Imaging abnormalities were correlated with surgical or clinical outcome.
Twenty-one aortic injuries were identified that ranged from subtle intimal flaps to complete aortic disruption. Helical CT was more sensitive than aortography (100% versus 94.4%, respectively) but less specific (81.7% versus 96.3%, respectively) in detection of aortic injuries in patients who underwent both examinations. The association between CT findings and outcome was phi = 0.62 (chi2 = 49.1, 1 df, P < .01) and between aortography and outcome was phi = 0.85 (chi2 = 92.2, 1 df, P < .001). The P value of the difference between the phi coefficients was .10.
Helical CT of the chest is effective for screening critically injured patients with possible blunt thoracic aortic injuries.
确定螺旋计算机断层扫描（CT）作为检测创伤性主动脉破裂筛查手段的有效性。
采用螺旋CT对1518例非轻微钝性创伤患者进行检查。其中，127例（8.37%）纵隔或主动脉CT扫描异常的患者接受了胸主动脉造影——89例患者仅用于评估CT显示的纵隔血肿。将影像异常与手术或临床结果进行关联分析。
共识别出21例主动脉损伤，范围从细微的内膜瓣到完全性主动脉破裂。在同时接受两种检查的患者中，螺旋CT检测主动脉损伤的敏感性高于主动脉造影（分别为100%和94.4%），但特异性较低（分别为81.7%和96.3%）。CT检查结果与结果之间的关联系数phi为0.62（χ2 = 49.1，自由度为1，P <.01），主动脉造影与结果之间的关联系数phi为0.85（χ2 = 92.2，自由度为1，P <.001）。phi系数差异的P值为0.10。
胸部螺旋CT对筛查可能存在钝性胸主动脉损伤的重症患者有效。
