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Effectiveness of Chest CT in Children: CT Findings in Relation to the Clinical Question
Michael Esser1, Ilias Tsiflikas1, Mareen Sarah Kraus1
1Diagnostic and Interventional Radiology, Universitätsklinikum Tübingen, Tübingen, Germany.
Insights
Pediatric chest CT scans are highly effective in specialized centers, providing conclusive results in over 97% of cases. Improving pre-CT clinical evaluation is key to enhancing efficiency and preventing unnecessary imaging.
Area of Science:
- Radiology
- Pediatric Imaging
- Diagnostic Accuracy
Background:
- Chest computed tomography (CT) is a vital imaging modality in pediatric care.
- Assessing the diagnostic yield of CT based on clinical context is essential for optimizing resource utilization.
- Understanding the effectiveness and efficiency of pediatric chest CT requires analysis of findings relative to suspected diagnoses.
Purpose of the Study:
- To evaluate the effectiveness and efficiency of pediatric chest CT.
- To correlate CT findings with suspected diagnoses, analyzing positive, negative, and inconclusive results.
- To determine the diagnostic value of CT in relation to specific clinical questions in children.
Main Methods:
- Retrospective analysis of 2019 pediatric chest CT examinations from a university hospital.
- Inclusion of 973 patients with detailed clinical data, including referring department and suspected diagnosis.
- Assessment of whether CT answered the clinical question, confirmed/ruled out suspected diagnoses, and identified additional findings.
Main Results:
- Chest CT provided conclusive results in 97.6% of pediatric examinations.
- The suspected diagnosis was confirmed in 70% of scans; 20% were negative for the suspected condition and additional findings.
- Clinically significant additional findings were detected in 56% of cases, highlighting CT's role beyond the initial query.
Conclusions:
- Pediatric chest CT demonstrates excellent effectiveness in specialized centers, with a high rate of conclusive results.
- CT effectively identifies relevant findings beyond the primary clinical concern, particularly in complex cases.
- Enhanced pre-CT clinical evaluation is crucial for improving the efficiency of pediatric chest CT, especially for suspected pneumonia.
Purpose:
To estimate the effectiveness and efficiency of chest CT in children based on the suspected diagnosis in relation to the number of positive, negative, and inconclusive CT results.
Materials And Methods:
In this monocentric retrospective study at a university hospital with a division of pediatric radiology, 2019 chest CT examinations (973 patients; median age: 10.5 years; range: 2 days to 17.9 years) were analyzed with regards to clinical data, including the referring department, primary questions or suspected diagnosis, and CT findings. It was identified if the clinical question was answered, whether the suspected diagnosis was confirmed or ruled out, and if additional findings (clinically significant or minor) were detected.
Results:
The largest clinical subgroup was the hematooncological subgroup (n = 987), with frequent questions for inflammation/pneumonia (66 % in this subgroup). Overall, CT provided conclusive results in 97.6 % of all scans. In 1380 scans (70 %), the suspected diagnosis was confirmed. In 406/2019 cases (20 %), the CT scan was negative also in terms of an additional finding. In 8 of 9 clinical categories, the proportion of positive results was over 50 %. There were predominantly negative results (110/179; 61 %) in pre-stem cell transplant evaluation. In the subgroup of trauma management, 81/144 exams (57 %) showed positive results, including combined injuries (n = 23). 222/396 (56 %) of all additional findings were estimated to be clinically significant.
Conclusion:
In a specialized center, the effectiveness of pediatric chest CT was excellent when counting the conclusive results. However, to improve efficiency, the clinical evaluation before imaging appears crucial to prevent unnecessary CT examinations.
Key Points:
· Pediatric chest CT in specialized centers has a high diagnostic value.. · CT identifies relevant changes besides the working hypothesis in clinically complex situations.. · Pre-CT clinical evaluation is crucial, especially in the context of suspected pneumonia..
Citation Format:
· Esser M, Tsiflikas I, Kraus MS et al. Effectiveness of Chest CT in Children: CT Findings in Relation to the Clinical Question. Fortschr Röntgenstr 2022; 194: 281 - 290.
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