Effectiveness of Chest CT in Children: CT Findings in Relation to the Clinical Question

 

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Abstract

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

Zusammenfassung

Ziel Abschätzung der klinischen Wertigkeit der Thorax-CT bei Kindern auf Grundlage der Verdachtsdiagnose und positiven, negativen und inkonklusiven CT-Befunde.

Material und Methoden In dieser retrospektiven monozentrischen Studie an einer Universitätsklinik mit Abteilung für Kinderradiologie wurden 2019 Thorax-CTs (973 Patienten; Altersmedian 10,5 Jahre; Spannweite: 2 Tage bis 17,9 Jahre) hinsichtlich klinischer Daten analysiert, einschließlich Zuweiserinformationen, primärer Fragestellungen oder Verdachtsdiagnosen und CT-Befunde. Es wurde festgehalten, ob die klinische Fragestellung beantwortet wurde, ob die Verdachtsdiagnose bestätigt oder ausgeschlossen wurde und ob Nebenbefunde (klinisch signifikant oder irrelevant) festgestellt wurden.

Ergebnisse Die größte klinische Untergruppe bestand aus hämatoonkologischen Fällen (n = 987) mit häufiger Fragestellung eines pulmonalen Infektfokus (66 % in dieser Gruppe). Insgesamt lieferte die CT in 97,6 % aller CTs konklusive Resultate. In 1380 CTs (70 %) wurde die Verdachtsdiagnose bestätigt. In 406/2019 Fällen (20 %) wurde weder ein primärer Befund noch ein Nebenbefund festgestellt. In 8 von 9 klinischen Kategorien war der Anteil der positiven Ergebnisse über 50 %. Vorwiegend negative Ergebnisse (110/179; 61 %) traten bei Patienten vor Stammzelltransplantation auf. In der Gruppe der Traumapatienten lieferten 81/144 der Untersuchungen (57 %) positive Ergebnisse, einschließlich mehrerer kombinierter Verletzungen (n = 23). 222/396 aller Nebenbefunde (56 %) wurden als klinisch relevant eingestuft.

Schlussfolgerung Die pädiatrische Thorax-CT in spezialisierten Zentren hat eine hohe diagnostische Aussagekraft im Hinblick auf konklusive Untersuchungsergebnisse. Zur Verbesserung der Effizienz der Methode und Prävention unnötiger CT-Untersuchungen ist die klinische Beurteilung prä-CT entscheidend.

Kernaussagen: 

• Die pädiatrische Thorax-CT in spezialisierten Zentren hat eine hohe diagnostische Aussagekraft.

• Die CT kann in klinisch komplexen Situationen relevante Veränderungen neben der Arbeitshypothese erkennen.

• Die klinische Beurteilung prä-CT ist unentbehrlich, insbesondere bei Verdacht auf eine Pneumonie.

Publication History

Received: 12 April 2021

Accepted: 27 July 2021

Article published online:
14 October 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

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