CT應取代常規素片檢查頸脊椎創傷


  2003 年5月6日-根據一項在5月6日於聖地牙哥所舉行的美國放射學會年會中所發表的報告指出,電腦斷層掃描 (CT) 應該取代常規素片X光攝影,進行頸椎創傷的檢測。這項回顧報告顯示,CT的檢測不僅更加準確也更加快速,而且較為便宜。
  
  本研究的主要作者哈佛醫學院Mykol Larvie博士表示,美國每年有成千上萬的人進行頸椎(C-脊椎) 檢測,但是發現異常的數量並不多,因此引起有關CT與常規素片檢測費用的爭論。
  
  根據1992 年到2001 年的統計,進行常規素片以檢測頸椎創傷的數量已經逐漸減少,而脊髓CT檢測的數量卻增加。在2001年,一共進行了1,131次常規素片及1,908次CT掃瞄,常規素片的陽性率為0.50%,而CT 掃瞄則為5.85%。
  
  使用常規素片檢測發生的偽陽性比率高於CT掃瞄,5常規素片檢測的敏感性是60%,其陽性預測值僅為21%,因為偽陽性的發生率是陽性的3.7倍。
  
  雖然CT的設備和維修費用比常規素片高,但是頸椎CT影像的直接費用卻比常規素片影像低了16%。
  
  Larvie博士表示,CT的總直接費用比常規素片更低,因為CT檢測的時間較短。這是第一項研究證實CT可以完全地取代常規素片,並提出可節省更多成本的結果。

CT Should Replace Plain Films<

By Laurie Barclay, MD
Medscape Medical News

May 6, 2003 — Computed tomography (CT) should replace plain film radiography for imaging suspected cervical spine trauma, according to a presentation on May 6 during the American Roentgen Ray Society annual meeting in San Diego. A retrospective review showed that CT was more accurate, faster to obtain, and less expensive.

"There are hundreds of thousands of cervical spine (C-spine) examinations performed in the U.S. each year; very few of them have abnormal findings," says lead author Mykol Larvie, PhD, from Harvard Medical School in Boston, Massachusetts. "This has sparked controversy over the cost of using CT rather than plain film radiography to examine possible C-spine injuries."

From 1992 to 2001, the number of plain films done for suspected cervical spine trauma decreased, while the number of spinal CT examinations increased. In 2001, there were 1,131 plain films and 1,908 CT scans done for this indication, with true-positives in 0.50% of 5-view plain films and in 5.85% of CT scans.

False-positive findings were more common in plain films than in CT scans. Sensitivity of the 5-view plain film examination was 60% with a positive predictive value of only 21%, because the incidence of false-positives was 3.7 times greater than that of true-positives.

Despite higher equipment and maintenance costs for CT than for plain film radiography, the direct cost of cervical spine CT imaging was 16% lower than for plain film imaging.

"Overall direct costs are lower because CT takes significantly less time than a plain film examination," Dr. Larvie says. "This is the first study to show that CT can completely replace plain films, and result in a cost savings."

ARRS 103rd Annual Meeting: Abstract 174. May 6, 2003.

Reviewed by Gary D. Vogin, MD

    
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