Zingas A P
Department of Radiology, Wayne State University School of Medicine, Detroit, Michigan.
Crit Care Clin. 1994 Apr;10(2):321-39.
In one's attempt to arrive at the most accurate diagnosis in the critically ill, the selection of the most efficacious and rapid imaging modality can be problematic to clinicians, especially if the clinical presentation is confusing. The selection most often, is between US and CT. In general, US is advantageous in that it can be performed at bedside and is a faster and less costly examination. Its main disadvantages are interference from intestinal gaseous distention, restricted field of view from surgical dressings or wounds, and operator-dependence for accuracy. With the newer and faster CT scanners, CT is gaining an increasingly important role in the evaluation of the critically ill, despite the need for patient transport to the radiology department. It is more effective in displaying and localizing abnormalities and more helpful for drainage guidance than US. The potential benefit of CT should outweight the risk of transport of the unstable patient, and because of CT's high cost, appropriate timing of the study and expected diagnostic benefit should be taken into consideration. Norwood reported that CT was not positive for abscess prior to the eighth postoperative day, only 55% of examinations aided in or altered the pre-examination diagnosis, and more than 70% were of no benefit to the patient. An organized approach is essential in solving complex diagnostic problems if one is to enhance patient care and efficacious use of personnel and resources. This can be accomplished best by direct communication between clinicians and radiologists before and after the examination. Radiologists who understand the clinical problems and are familiar with all diagnostic modalities should be consulted for the selection of the modality best suited to answering the question at hand. Similarly, critically ill patients should benefit most if clinicians and radiologists review the examination results together in light of the clinical presentation for more accurate and meaningful diagnosis.
在试图对危重症患者做出最准确诊断时，选择最有效、最快速的成像方式对临床医生来说可能是个难题，尤其是当临床表现令人困惑时。通常，选择往往在超声（US）和计算机断层扫描（CT）之间。一般来说，超声的优势在于它可以在床边进行，检查速度更快且成本更低。其主要缺点是受肠道气体扩张的干扰、手术敷料或伤口对视野的限制以及准确性依赖于操作人员。随着更新、更快的CT扫描仪的出现，尽管需要将患者转运至放射科，但CT在危重症评估中发挥着越来越重要的作用。与超声相比，它在显示和定位异常方面更有效，对引流指导也更有帮助。CT的潜在益处应超过不稳定患者转运的风险，并且由于CT成本高昂，应考虑检查的适当时机和预期的诊断益处。诺伍德报告称，术后第八天之前CT对脓肿的诊断并不准确，只有55%的检查有助于或改变了检查前的诊断，超过70%的检查对患者没有益处。如果要加强患者护理以及有效利用人力和资源，采用有条理的方法对于解决复杂的诊断问题至关重要。这最好通过临床医生和放射科医生在检查前后的直接沟通来实现。对于选择最适合回答手头问题的成像方式，应咨询了解临床问题并熟悉所有诊断方式的放射科医生。同样，如果临床医生和放射科医生根据临床表现共同审查检查结果以做出更准确、更有意义的诊断，危重症患者将受益最大。
