Davies A M, Fowler J, Tyrrell P N, Millar J S, Leahy J F, Patel K, Hill J S
Department of Radiology, Birmingham General Hospital, UK.
Br J Radiol. 1993 Jan;66(781):37-43. doi: 10.1259/0007-1285-66-781-37.
The purpose of this study was to determine the proportion of significant abnormalities detected on anteroposterior (AP) and lateral radiographs of the lumbar spine when viewed separately, in a series of cases where the prevalence of abnormalities had been artificially increased. Five radiologists of varying experience were required to report separately on the AP and lateral films of 300 cases in which randomly included were 30 cases with metastatic disease, a disc infection or an inflammatory spondylitis. At a later date, unaware of their initial observations, the radiologists repeated the exercise reviewing all the films together. As might be expected the false positive rate was relatively high, particularly in the least experienced radiologists' responses. Nevertheless the overall results indicate that the majority of early inflammatory spondylitis cases will be missed on a solitary lateral film as will many of the metastases. Conversely, fractionally more of the disc infections were observed on the lateral film than on the AP. Further analyses in terms of sensitivity, specificity, positive and negative predictive values are presented. The authors conclude that it is preferable to reduce the overall number of lumbar spine examinations performed, by adherence to accepted guidelines, than to prejudice the detection of significant, albeit rare, abnormalities by restricting the routine series of radiographs.
本研究的目的是在一系列人为增加异常患病率的病例中，确定分别观察腰椎前后位（AP）和侧位X线片时发现的显著异常的比例。要求五位经验各异的放射科医生分别报告300例病例的AP片和侧位片情况，其中随机纳入了30例患有转移性疾病、椎间盘感染或炎性脊柱炎的病例。之后，在不知道他们最初观察结果的情况下，放射科医生一起复查所有片子并再次报告。不出所料，假阳性率相对较高，尤其是经验最少的放射科医生的报告中。然而，总体结果表明，大多数早期炎性脊柱炎病例以及许多转移瘤病例在单独的侧位片上会被漏诊。相反，在侧位片上观察到的椎间盘感染病例比在AP片上略多。本文还给出了敏感性、特异性、阳性预测值和阴性预测值方面的进一步分析。作者得出结论，遵循公认的指南减少腰椎检查的总体数量，比通过限制常规X线片系列而损害对显著（尽管罕见）异常的检测更为可取。
