Ahn J M, Lee K S, Goo J M, Song K S, Kim S J, Im J G
Department of Radiology, Samsung Medical Center, Seoul, Korea.
J Thorac Imaging. 1996 Fall;11(4):265-71. doi: 10.1097/00005382-199623000-00004.
The objective of this study was to compare chest radiography with computed tomography (CT) in the prediction of a specific diagnosis in adult patients with anterior mediastinal masses. Chest radiographs and CT scans of 128 patients with anterior mediastinal masses were randomized and analyzed retrospectively by two independent observers. The observers listed the three most likely diagnoses in order of probability and recorded the degree of confidence in their first-choice diagnosis. Findings from chest radiographs and CT scans were recorded by each observer and used for a stepwise discriminant analysis between diagnoses. Results showed that the correct first-choice diagnosis, regardless of the degree of confidence, was made in 36% of chest radiographs and 48% of CT scans (p < 0.05). The correct diagnosis was included among top three diagnoses in 59% and 72% of the studies, respectively (p < 0.001). A high confidence diagnosis (level 1) was reached in 9% and 34% of each study, respectively, (p < 0.001), and was correct in 58% and 80% of the studies, respectively. Interobserver agreement (k statistics) on the correct first-choice diagnosis was 0.45 and 0.53, respectively. Interpretations of the CT scans were most often accurate in the confident diagnosis of benign germ cell tumors (n = 10, 100%), thymolipomas (n = 3, 100%), and omental hernia (n = 2, 100%). Seven of 15 radiographic findings and 11 of 22 CT findings were discriminant. We conclude that although CT is better then chest radiography in determining the pathologic diagnosis of an anterior mediastinal mass, CT is still poor at making that prediction with confidence. However, several anterior mediastinal masses could be diagnosed accurately by CT.
本研究的目的是比较胸部X线摄影与计算机断层扫描（CT）在预测成年前纵隔肿块患者特定诊断方面的效果。对128例前纵隔肿块患者的胸部X线片和CT扫描进行随机分组，并由两名独立观察者进行回顾性分析。观察者按可能性顺序列出三种最可能的诊断，并记录对其首选诊断的置信程度。每位观察者记录胸部X线片和CT扫描的结果，并用于诊断之间的逐步判别分析。结果显示，无论置信程度如何，胸部X线片和CT扫描中分别有36%和48%做出了正确的首选诊断（p<0.05）。在各项研究中，正确诊断分别在59%和72%的研究中被列为前三种诊断之一（p<0.001）。在各项研究中，分别有9%和34%的情况达到了高置信度诊断（1级）（p<0.001），且在这些研究中分别有58%和80%是正确的。观察者间对正确首选诊断的一致性（k统计量）分别为0.45和0.53。CT扫描的解读在良性生殖细胞肿瘤（n = 10，100%）、胸腺脂肪瘤（n = 3，100%）和网膜疝（n = 2，100%）的置信诊断中最常是准确的。15项X线表现中的7项和22项CT表现中的11项具有判别性。我们得出结论，虽然在确定前纵隔肿块的病理诊断方面CT比胸部X线摄影更好，但CT在做出有把握的预测方面仍然很差。然而，几种前纵隔肿块可以通过CT准确诊断。
