Winer-Muram H T, Rubin S A, Ellis J V, Jennings S G, Arheart K L, Wunderink R G, Leeper K V, Meduri G U
Department of Diagnostic Radiology, University of Tennessee, Memphis.
Radiology. 1993 Aug;188(2):479-85. doi: 10.1148/radiology.188.2.8327701.
This study was done to evaluate the diagnostic accuracy of bedside chest radiography for pneumonia, adult respiratory distress syndrome (ARDS), or both in patients receiving mechanical ventilation. The series consisted of 40 patients; diagnostic accuracy was defined as the area under the receiver operating characteristic curve. Overall diagnostic accuracy for ARDS was 0.84. Overall diagnostic accuracy for pneumonia was 0.52. Review of previous radiographs and knowledge of clinical data did not enhance diagnostic accuracy for ARDS or pneumonia. Diagnostic accuracy for pneumonia was minimally reduced when ARDS was present. There was an increase in false-negative results because the diffuse areas of increased opacity in ARDS obscured the radiographic features of pneumonia. The authors conclude that chest radiography is of limited value for the diagnosis of pneumonia in patients receiving mechanical ventilation. The high false-negative and false-positive ratings for pneumonia resulted in a low diagnostic accuracy. The high diagnostic accuracy for ARDS was primarily due to the well-defined radiographic appearance of ARDS and few false-positive ratings.
本研究旨在评估床边胸部X线摄影对接受机械通气患者肺炎、成人呼吸窘迫综合征（ARDS）或两者的诊断准确性。该系列研究包括40例患者；诊断准确性定义为受试者工作特征曲线下面积。ARDS的总体诊断准确性为0.84。肺炎的总体诊断准确性为0.52。回顾既往X线片及了解临床数据并不能提高ARDS或肺炎的诊断准确性。当存在ARDS时，肺炎的诊断准确性略有降低。由于ARDS中弥漫性密度增高区域掩盖了肺炎的X线特征，假阴性结果有所增加。作者得出结论，胸部X线摄影对接受机械通气患者肺炎的诊断价值有限。肺炎的高假阴性和假阳性率导致诊断准确性较低。ARDS的高诊断准确性主要归因于ARDS明确的X线表现及较少的假阳性率。
