创伤患者急诊CT检查中的非创伤性相关病变

Non- trauma associated incidental findings in emergency CT examinations in patients with trauma

目的探讨创伤性急诊CT检查中非创伤相关病变的漏诊及其临床相关性分类。方法回顾分析我科2014—06—01～2015—11—30因多发伤进行夜间急诊CT检查的患者影像资料，由2名副主任医师进行双盲法独立阅片，仔细观察有无非创伤性相关病变，与初诊存档报道对照确定是否漏诊，并参考CT结肠成像报道和数据系统（C—RADS）模型对病变临床相关性进行分类。结果本组共306例患者，发现非创伤性相关病变者125例（40．8％），病变159个。43个在初诊存档诊断报道中未提示，漏诊率27．0％，其中E4（可能重要的发现）漏诊率9．3％（4／43）。在病变的临床相关性分类中，3个E1（正常变异）1．9％，87个E2（无临床意义）54．7％，58个E3（重要性不确定）36．5％，11个E46．9％。结论提高对创伤急诊CT检查中非创伤性相关病变的认识与重视，才能避免或减少主观性造成的漏诊；同时参考C—RADS模型对非创伤病变进行临床相关性分类，有助于值班医生对病变轻重的初步判断。

Objective To investigate the non -detection of non -trauma associated incidental findings （IFs） and clinical relevance classification of them in emergency CT examinations in patients with trauma. Methods We conducted a retrospective analysis of emergency CT scan images of 306 traumatic patients whose were referred to our department at night, between June 1st 2014 and November 30th 2015. The images were independently evaluated by two radiologists, and the incidental findings were observed that compared with the primary archived reports to determine the non - detection rate. The clinical relevance of incidental findings were classified by the modified CT Colonography Reporting and Data System（C - RADS）. Results A total of 159 IFs were found in 125 of 306 traumatic patients undergoing spiral CT examinations （40.8%）. A total of 3 out of them （ 1.9% ） were categorized E1 （anatomic variant）, 87 （54.7%） were categorized E2 （clinically unimportant finding）, 58 （36.5%） were categorized E3 （ likely unimportant finding）, and 11 （ 6.9% ） were categorized E4 （ potentially important finding）. A total of 43 of 125 findings were not mentioned in the archived reports for a non - detection rate of 27.0% , and the non - detection rate of E4 was 9.3% （4/43）. Conclusion It is important to pay attention to the diagnosis of non - trauma associated incidental findings in the traumatic patients, possibly, to avoid or reduce the non - detection of incidental findings. Using the C - RADS model for the clinical relevance classification of non - trauma associated incidental findings is helpful to judgment the severity of lesions.