Luker G D, Glazer H S, Eagar G, Gutierrez F R, Sagel S S
Mallinckrodt Institute of Radiology, St Louis, MO 63110.
Radiology. 1994 Dec;193(3):813-9. doi: 10.1148/radiology.193.3.7972830.
To determine the effect of the interpretation of plain chest radiographs on the time to definitive diagnosis of aortic dissection.
The authors evaluated chest radiographs from 75 patients in whom chest radiography was performed before aortic dissection was diagnosed. The radiographs and available comparison images were retrospectively reviewed to identify cases in which aortic dissection should have been suggested before the diagnosis was made.
Radiographic reports suggested that only 19 patients (25%) had an aortic dissection or thoracic aortic aneurysm or needed additional imaging of the aorta. No statistically significant correlation existed between interpretation of the chest radiographs and delay to diagnosis, type of dissection, availability of previously obtained images, or presence of characteristic clinical symptoms. Retrospective analysis showed that the chest radiographs of 36 patients (48%) contained sufficient findings to suggest the diagnosis. In five patients, failure to prospectively suggest dissection was associated with a delay to diagnosis of more than 24 hours.
Although prospective interpretation of the chest radiograph shortened the delay to definitive diagnosis for only a limited number of patients, retrospective analysis suggests that the delay can be shortened for additional patients.
确定胸部X线平片解读对主动脉夹层明确诊断时间的影响。
作者评估了75例在诊断主动脉夹层之前进行胸部X线检查的患者的胸部X线片。回顾性分析这些X线片及可用的对照影像，以确定在诊断之前本应提示主动脉夹层的病例。
X线报告显示，仅19例患者（25%）患有主动脉夹层或胸主动脉瘤，或需要对主动脉进行额外成像。胸部X线片的解读与诊断延迟、夹层类型、既往获得影像的可用性或特征性临床症状的存在之间不存在统计学显著相关性。回顾性分析显示，36例患者（48%）的胸部X线片包含足以提示诊断的发现。在5例患者中，未能前瞻性提示夹层与诊断延迟超过24小时相关。
虽然胸部X线片的前瞻性解读仅对有限数量的患者缩短了明确诊断的延迟时间，但回顾性分析表明，其他患者的延迟时间也可缩短。
