使用计算机断层扫描半自动肺容积定量法预测创伤性肺实质损伤中危及生命的咯血。

IF 4.1 2区医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

Insights into Imaging Pub Date : 2024-11-15 DOI:10.1186/s13244-024-01849-8

Wen-Ruei Tang, Chao-Chun Chang, Chen-Yu Wu, Chih-Jung Wang, Tsung-Han Yang, Kuo-Shu Hung, Yi-Sheng Liu, Chia-Ying Lin, Yi-Ting Yen

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引用次数: 0

摘要

目的：胸部计算机断层扫描（CT）可诊断和评估肺挫伤的严重程度。然而，在严重肺挫伤病例中，总肺容积比可能无法准确预测严重程度。本研究调查了因胸部钝伤导致肺挫伤或撕裂伤的患者在到达急诊科时出现的危及生命的咯血与胸部 CT 成像数据之间的关联：回顾性审查了2018年至2022年间在创伤中心接受治疗的277例肺挫伤或撕裂伤患者的病历。根据胸部 CT 图像计算各肺叶局部肺挫伤体积与肺叶体积之比。Hounsfield单位（HU）范围内的最大比值被定义为五个肺叶中HU范围内的最高比值：患者年龄中位数为 41 岁，68.6% 为男性。39名患者发生了危及生命的咯血。-500HU至100HU最大比值的接收者操作特征曲线下面积为96.52%。临界值为 45.49%。多变量分析显示，-500 HU 至 100 HU 的最大胸部 CT 比值≥ 45.49% 的患者死亡率较高（调整后的赔率 [aOR]：104.66，95% 置信区间）：104.66，95% 置信区间 [CI]：21.81-502.16，P 结论：胸部 CT 在 -500 HU 至 100 HU 的最大比值≥ 45.49%、血气胸和胸部 AIS 高分与胸部钝性创伤患者危及生命的大咯血有关：本研究提供了一个从胸部 CT 图像中得出的客观指数，用于预测危及生命的咯血发生率。这一信息有助于筛选出需要加强监测的高危患者，以便及早干预，改善预后：要点：急诊科 CT 有助于预测肺挫伤患者危及生命的咯血。最大 CT 比率≥ 45.49%（-500 HU 至 100 HU，任一肺叶）与危及生命的咯血有关。胸部简易损伤量表评分较高和血气胸也可预测危及生命的大咯血。

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Predicting life-threatening hemoptysis in traumatic pulmonary parenchymal injury using computed tomography semi-automated lung volume quantification.

Objectives: Chest computed tomography (CT) can diagnose and assess the severity of pulmonary contusions. However, in cases of severe lung contusion, the total lung volume ratio may not accurately predict severity. This study investigated the association between life-threatening hemoptysis and chest CT imaging data on arrival at the emergency department in patients with pulmonary contusions or lacerations due to blunt chest injury.

Methods: The records of 277 patients with lung contusions or lacerations treated at a trauma center between 2018 and 2022 were retrospectively reviewed. The ratio of the local lung contusion volume to lobe volume in each lobe was calculated from chest CT images. The maximal ratio in the Hounsfield unit (HU) range was defined as the highest ratio value within the HU range among five lobes.

Results: The median patient age was 41 years, and 68.6% were male. Life-threatening hemoptysis occurred in 39 patients. The area under the receiver operating characteristic curve for the maximal ratio at -500 HU to 100 HU was 96.52%. The cutoff value was 45.49%. Multivariate analysis showed a high maximal chest CT ratio ≥ 45.49% at -500 HU to 100 HU (adjusted odds ratio [aOR]: 104.66, 95% confidence interval [CI]: 21.81-502.16, p < 0.001), hemopneumothorax (aOR: 5.18, 95% CI: 1.25-21.47, p = 0.023), and chest abbreviated injury scale (AIS, aOR: 5.58, 95% CI: 1.68-18.57, p = 0.005) were associated with life-threatening hemoptysis.

Conclusions: Maximal chest CT ratios ≥ 45.49% at -500 HU to 100 HU, hemopneumothorax, and high chest AIS scores are associated with life-threatening hemoptysis in patients with blunt chest trauma.

Critical relevance statement: The present study provides an objective index derived from chest CT images to predict the occurrence of life-threatening hemoptysis. This information helps screen high-risk patients in need of more intensive monitoring for early intervention to improve outcomes.

Key points: Emergency department CT helps predict life-threatening hemoptysis in patients with lung contusions. Maximal CT ratios ≥ 45.49% (-500 HU to 100 HU, either lung lobe) are associated with life-threatening hemoptysis. High chest abbreviated injury scale scores and hemopneumothorax also predict life-threatening hemoptysis.

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来源期刊

Insights into Imaging Medicine-Radiology, Nuclear Medicine and Imaging

CiteScore

7.30

自引率

4.30%

发文量

182

审稿时长

13 weeks

期刊介绍： Insights into Imaging (I³) is a peer-reviewed open access journal published under the brand SpringerOpen. All content published in the journal is freely available online to anyone, anywhere! I³ continuously updates scientific knowledge and progress in best-practice standards in radiology through the publication of original articles and state-of-the-art reviews and opinions, along with recommendations and statements from the leading radiological societies in Europe. Founded by the European Society of Radiology (ESR), I³ creates a platform for educational material, guidelines and recommendations, and a forum for topics of controversy. A balanced combination of review articles, original papers, short communications from European radiological congresses and information on society matters makes I³ an indispensable source for current information in this field. I³ is owned by the ESR, however authors retain copyright to their article according to the Creative Commons Attribution License (see Copyright and License Agreement). All articles can be read, redistributed and reused for free, as long as the author of the original work is cited properly. The open access fees (article-processing charges) for this journal are kindly sponsored by ESR for all Members. The journal went open access in 2012, which means that all articles published since then are freely available online.