计算机断层扫描作为疑似钝性主动脉损伤患者的筛查检查。
Computed tomography as a screening exam in patients with suspected blunt aortic injury.
作者信息
Durham R M, Zuckerman D, Wolverson M, Heiberg E, Luchtefeld W B, Herr D J, Shapiro M J, Mazuski J E, Salimi Z, Sundaram M
机构信息
Department of Surgery, St. Louis University Health Sciences Center, MO 63110-0250.
出版信息
Ann Surg. 1994 Nov;220(5):699-704. doi: 10.1097/00000658-199411000-00015.
BACKGROUND
Chest computed tomography (CT) screening of patients with blunt trauma for thoracic aortic injury is controversial. This study was undertaken to determine whether CT could exclude aortic injury and be used to select patients for aortography.
METHODS
Computed tomography and aortography were used to evaluate 155 patients with blunt trauma. Computed tomography scans were reviewed separately by four attending radiologists who were unaware of the patients' clinical course and angiographic findings.
RESULTS
Eight of 155 patients had aortic injuries requiring operation. Computed tomography scans in five patients were read as positive by all reviewers. One scan was read as positive by three reviewers and as negative by one. Two scans were read as positive by two radiologists and as negative by two. After poor scans were excluded, the combined sensitivity of CT for detecting aortic injury was 88%, specificity was 54%, positive predictive value was 9%, and negative predictive value 99%.
CONCLUSIONS
The sensitivity of CT scan for indicating the need for aortography is observer dependent. As CT manifestations of aortic injury are often subtle, CT does not reliably exclude aortic injury.
背景
胸部计算机断层扫描（CT）用于钝性创伤患者的胸主动脉损伤筛查存在争议。本研究旨在确定CT能否排除主动脉损伤并用于选择进行主动脉造影的患者。
方法
采用计算机断层扫描和主动脉造影对155例钝性创伤患者进行评估。4名主治放射科医生分别对计算机断层扫描结果进行了回顾，他们对患者的临床病程和血管造影结果并不知情。
结果
155例患者中有8例主动脉损伤需要手术治疗。所有审阅者均将5例患者的计算机断层扫描结果读为阳性。1例扫描结果被3名审阅者读为阳性，1名读为阴性。2例扫描结果被2名放射科医生读为阳性，2名读为阴性。排除质量差的扫描结果后，CT检测主动脉损伤的综合敏感度为88%，特异度为54%，阳性预测值为9%，阴性预测值为99%。
结论
CT扫描提示是否需要进行主动脉造影的敏感度取决于观察者。由于主动脉损伤的CT表现往往不明显，CT不能可靠地排除主动脉损伤。
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