Diagnostic accuracy of ultra-low-dose chest CT vs chest X-ray for acute non-traumatic pulmonary diseases.

IF 4.7 2区医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING European Radiology Pub Date : 2025-08-01 Epub Date: 2025-01-29 DOI:10.1007/s00330-024-11223-3

Maadrika M N P Kanglie, Inge A H van den Berk, Tjitske S R van Engelen, Shandra Bipat, Patrick M M Bossuyt, Jan M Prins, Jaap Stoker

{"title":"Diagnostic accuracy of ultra-low-dose chest CT vs chest X-ray for acute non-traumatic pulmonary diseases.","authors":"Maadrika M N P Kanglie, Inge A H van den Berk, Tjitske S R van Engelen, Shandra Bipat, Patrick M M Bossuyt, Jan M Prins, Jaap Stoker","doi":"10.1007/s00330-024-11223-3","DOIUrl":null,"url":null,"abstract":"Objectives: To compare the diagnostic accuracy of ULDCT to CXR for detecting non-traumatic pulmonary diseases at the emergency department (ED) and to study diagnostic confidence levels.Methods: Secondary analysis of the prospective OPTIMACT trial (2418 ED participants randomly allocated to ULDCT or CXR). Diagnoses at imaging at the ED were compared to the reference diagnosis on day 28. Ratios of positive diagnoses, true positives (TP), false positives (FP), false negatives (FN), and positive predictive values (PPV) were assessed with 95% confidence intervals (CI). The diagnostic confidence levels of the radiologists were studied.Results: One thousand one hundred sixty-one ULDCT participants (mean age, 59 years ± 18 [standard deviation], 587 female) and 1151 CXR participants (mean age, 59 years ± 18 [standard deviation], 561 female) were evaluated. With ULDCT, pneumonia was 1.55 times (95% CI: 1.33-1.80) more often diagnosed at imaging at the ED, with significantly more TP (ratio 1.50; 95% CI: 1.26-1.76) and fewer FN (0.61; 95% CI: 0.37-0.99) but more FP (1.75; 95% CI: 1.19-2.58); a similar pattern was observed for other lower respiratory tract infections (LRTI). Pulmonary congestion was less often observed with ULDCT (0.45; 95% CI: 0.34-0.61), with fewer TP (0.50; 95% CI: 0.34-0.73), and FP (0.40; 95% CI: 0.24-0.65). PPVs were not significantly different. With ULDCT, radiologists were more often certain in diagnosing pneumonia (ULDCT 121/324, 37% vs CXR 48/208, 23%), LRTI (84/192, 44% vs 18/63, 29%), and no established disease (350/382, 92% vs 447/544, 82%).Conclusion: Compared to CXR, ULDCT led to more TP but also more FP in detecting pneumonia and LRTI, while fewer TP and FP were found for pulmonary congestion. PPVs were comparable.Key points: Question Is ultra-low dose CT (ULDCT) more accurate than chest X-ray (CXR) for identifying non-traumatic pulmonary diseases in patients presenting at the ED? Findings ULDCT detects more pulmonary infections in patients presenting at the ED with non-traumatic pulmonary complaints, while CXR detects more pulmonary congestion. Clinical relevance ULDCT is superior to CXR in detecting pneumonia and other LRTI in ED patients, while CXR is superior in detecting pulmonary congestion. ULDCT can be an alternative for CXR in a selected group of patients.","PeriodicalId":12076,"journal":{"name":"European Radiology","volume":" ","pages":"4836-4845"},"PeriodicalIF":4.7000,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"European Radiology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1007/s00330-024-11223-3","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/1/29 0:00:00","PubModel":"Epub","JCR":"Q1","JCRName":"RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING","Score":null,"Total":0}

引用次数: 0

Abstract

Objectives: To compare the diagnostic accuracy of ULDCT to CXR for detecting non-traumatic pulmonary diseases at the emergency department (ED) and to study diagnostic confidence levels.

Methods: Secondary analysis of the prospective OPTIMACT trial (2418 ED participants randomly allocated to ULDCT or CXR). Diagnoses at imaging at the ED were compared to the reference diagnosis on day 28. Ratios of positive diagnoses, true positives (TP), false positives (FP), false negatives (FN), and positive predictive values (PPV) were assessed with 95% confidence intervals (CI). The diagnostic confidence levels of the radiologists were studied.

Results: One thousand one hundred sixty-one ULDCT participants (mean age, 59 years ± 18 [standard deviation], 587 female) and 1151 CXR participants (mean age, 59 years ± 18 [standard deviation], 561 female) were evaluated. With ULDCT, pneumonia was 1.55 times (95% CI: 1.33-1.80) more often diagnosed at imaging at the ED, with significantly more TP (ratio 1.50; 95% CI: 1.26-1.76) and fewer FN (0.61; 95% CI: 0.37-0.99) but more FP (1.75; 95% CI: 1.19-2.58); a similar pattern was observed for other lower respiratory tract infections (LRTI). Pulmonary congestion was less often observed with ULDCT (0.45; 95% CI: 0.34-0.61), with fewer TP (0.50; 95% CI: 0.34-0.73), and FP (0.40; 95% CI: 0.24-0.65). PPVs were not significantly different. With ULDCT, radiologists were more often certain in diagnosing pneumonia (ULDCT 121/324, 37% vs CXR 48/208, 23%), LRTI (84/192, 44% vs 18/63, 29%), and no established disease (350/382, 92% vs 447/544, 82%).

Conclusion: Compared to CXR, ULDCT led to more TP but also more FP in detecting pneumonia and LRTI, while fewer TP and FP were found for pulmonary congestion. PPVs were comparable.

Key points: Question Is ultra-low dose CT (ULDCT) more accurate than chest X-ray (CXR) for identifying non-traumatic pulmonary diseases in patients presenting at the ED? Findings ULDCT detects more pulmonary infections in patients presenting at the ED with non-traumatic pulmonary complaints, while CXR detects more pulmonary congestion. Clinical relevance ULDCT is superior to CXR in detecting pneumonia and other LRTI in ED patients, while CXR is superior in detecting pulmonary congestion. ULDCT can be an alternative for CXR in a selected group of patients.

查看原文

微信好友朋友圈 QQ好友复制链接

本刊更多论文

超低剂量胸部CT与胸部x线对急性非创伤性肺部疾病的诊断准确性

目的：比较ULDCT与CXR在急诊科（ED）非创伤性肺部疾病诊断中的准确性，并研究诊断置信度。方法：对前瞻性OPTIMACT试验（2418名ED受试者随机分配到ULDCT或CXR组）进行二次分析。第28天在急诊科的影像学诊断与参考诊断进行比较。以95%置信区间（CI）评估阳性诊断、真阳性（TP）、假阳性（FP）、假阴性（FN）和阳性预测值（PPV）的比率。研究了放射科医生的诊断置信水平。结果：共纳入1161例ULDCT参与者（平均年龄59岁±18岁[标准差]，女性587例）和1151例CXR参与者（平均年龄59岁±18岁[标准差]，女性561例）。使用ULDCT，肺炎在急诊科的诊断率为1.55倍（95% CI: 1.33-1.80）， TP显著高于急诊科(比值1.50；95% CI: 1.26-1.76)，较小的FN (0.61；95% CI: 0.37-0.99)，但FP更高(1.75；95% ci: 1.19-2.58)；其他下呼吸道感染（LRTI）也观察到类似的模式。肺充血在ULDCT中较少观察到(0.45；95% CI: 0.34-0.61)， TP较少(0.50；95% CI: 0.34-0.73), FP (0.40；95% ci: 0.24-0.65)。ppv无显著性差异。使用ULDCT，放射科医生对肺炎的诊断更确定（ULDCT 121/324, 37%, CXR 48/208, 23%）， LRTI(84/192, 44%, 18/63, 29%)，无确诊疾病（350/382,92%,447/544,82%）。结论：与CXR相比，ULDCT对肺炎和LRTI的TP和FP检出率较高，而对肺充血的TP和FP检出率较低。ppv具有可比性。超低剂量CT （ULDCT）在诊断急诊科非创伤性肺部疾病方面是否比胸部x线（CXR）更准确？结果：在急诊科就诊的非创伤性肺部疾病患者中，ULDCT检出更多肺部感染，而CXR检出更多肺充血。ULDCT在诊断ED患者肺炎及其他LRTI方面优于CXR，而CXR在诊断肺充血方面优于CXR。在选定的患者组中，ULDCT可作为CXR的替代方法。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文去求助

来源期刊

European Radiology 医学-核医学

CiteScore

11.60

自引率

8.50%

发文量

874

审稿时长

2-4 weeks

期刊介绍： European Radiology (ER) continuously updates scientific knowledge in radiology by publication of strong original articles and state-of-the-art reviews written by leading radiologists. A well balanced combination of review articles, original papers, short communications from European radiological congresses and information on society matters makes ER an indispensable source for current information in this field. This is the Journal of the European Society of Radiology, and the official journal of a number of societies. From 2004-2008 supplements to European Radiology were published under its companion, European Radiology Supplements, ISSN 1613-3749.