Seow A, Kazerooni E A, Pernicano P G, Neary M
Department of Radiology, University of Michigan Hospital 48109-0326, USA.
AJR Am J Roentgenol. 1996 Feb;166(2):313-6. doi: 10.2214/ajr.166.2.8553937.
Expiratory films are regarded as being superior to inspiratory films for pneumothorax detection, yet this has not been proved. In the current study, we compared inspiratory versus expiratory chest radiographs for pneumothorax detection.
Eighty-five paired inspiratory and expiratory radiographs with pneumothoraces and 93 pairs without pneumothoraces were randomly arranged and reviewed independently by three radiologists. A score of 1-5 was assigned for each hemithorax (5 = definite pneumothorax, 1 = definitely no pneumothorax). Results were compared for inspiration and expiration using receiver operating characteristic (ROC) analysis.
The average area under the ROC curves for all readers was .973 for inspiration and .972 for expiration (nonsignificant). McNemar's test and an alpha level of .05 also yielded no significant difference in sensitivity and specificity. Four of the 85 cases were scored as definite pneumothorax on inspiration and as definitely not on expiration by all readers, and three of the 85 cases were scored as definite pneumothorax on expiration and as definitely not on inspiration.
Inspiratory and expiratory upright films are equally sensitive for pneumothorax detection. Given the limitations of expiratory films, inspiratory films are recommended as the initial examination of choice for pneumothorax detection.
呼气位胸片被认为在检测气胸方面优于吸气位胸片，但这尚未得到证实。在本研究中，我们比较了吸气位与呼气位胸部X线片对气胸的检测情况。
85对有气胸的吸气位和呼气位胸片以及93对无气胸的胸片被随机排列，由三位放射科医生独立阅片。每个半侧胸腔给予1至5分（5分 = 明确气胸，1分 = 肯定无气胸）。使用受试者操作特征（ROC）分析比较吸气和呼气时的结果。
所有阅片者吸气时ROC曲线下的平均面积为0.973，呼气时为0.972（无显著差异）。McNemar检验和α水平为0.05时，敏感性和特异性也无显著差异。85例中有4例在吸气时被所有阅片者判定为明确气胸，呼气时判定为肯定无气胸，85例中有3例在呼气时被判定为明确气胸，吸气时判定为肯定无气胸。
吸气位和呼气位立位胸片在检测气胸方面同样敏感。鉴于呼气位胸片的局限性，推荐吸气位胸片作为气胸检测的首选初始检查。
