AKCİĞER KONTÜZYON HACMİ: GERÇEKTEN BİLİYOR MUSUNUZ?

Öz

Amaç Pulmoner kontüzyon, künt göğüs travmasının en yaygın komplikasyonlarından biridir. Bir hekimin pulmoner kontüzyonun boyutunu ve gerçek miktarını belirlemesi bazen çok zordur. Çalışmanın amacı bilgisayarlı tomografi görüntüleri üzerinde Cavalieri prensibi ile manuel planimetri yöntemini kullanarak doğru pulmoner kontüzyon hacmini ölçmektir. Gereç ve Yöntem Çalışma “Acil Tıp Kliniğine”, akciğer kontüzyonu ile başvuran 76 hasta üzerinde yapıldı. Hasta verileri retrospektif olarak tarandı ve akciğer kontüzyonu olan hastaların bilgisayarlı tomografi görüntüleri akciğer kontüzyon hacmini hesaplamak için incelendi. Tüm akciğer kesitlerinde ölçüm yapıldıktan sonra, sistemik randomize örnekleme ile 6-8-10 kesitte akciğer kontüzyon hacmi hesaplandı. Kontüzyon hacmi iki bağımsız gözlemci tarafından manuel planimetri yöntemi kullanılarak hesaplandı. Bulgular Tüm kesit ölçümlerinden elde edilen ortalama kontüzyon hacmi %34.23 ± 17.56 idi. Kontüzyon hacmi 6 kesit ölçümünde %27,98±15,05, 8 kesitte %30,66±16,07 ve 10 kesitte %32,47±16,97 idi. Bland Altman grafiklerini incelediğimizde 10 kesitten elde edilen ortalama farkın 6 ve 8 kesit ölçümlerine göre daha küçük olduğu ve güven aralığının daha dar olduğu görülmektedir. Dolayısıyla 10 kesit ölçümünün yaklaşık %95 doğruluk oranı ile tüm akciğer kontüzyon ölçümlerine en yakın değerlendirmeyi verdiğini söyleyebiliriz. Sonuç Akciğer kontüzyon hacmi, BT'de tüm akciğer alanı ölçümü olmaksızın sistematik rastgele örnekleme ile manuel planimetri yöntemi kullanılarak yüksek gözlemciler arası ve gözlemci içi uyum ile objektif olarak değerlendirilebilir.

Anahtar Kelimeler

• Akciğer kontüzyonu
• Bilgisayarlı tomografi
• Kontüzyon hacmi
• Planimetri yöntemi
• Travma

LUNG CONTUSION VOLUME: DO YOU REALLY KNOW?

Öz

Objective Pulmonary contusion is one of the most common complication of blunt chest trauma. It is sometimes very difficult for a physician to determine the extent and real amount of pulmonary contusion. The aim of the study was to measure the accurate pulmonary contusion volume on computed tomography images by using the manual planimetry method with the Cavalieri principle. Material and Method The study was performed on 76 patients who were admitted to the Emergency Medicine Clinic with lung contusion. Patient data were retrospectively screened and computed-tomography images of patients with lung contusion were examined to calculate lung contusion volume. After measurement in all lung sections, lung contusion volume was calculated in 6-8-10 sections by systemic randomized sampling. The volume of the contusion was calculated by two independent observers using the manual planimetry method. Results The mean volume of contusion obtained from all cross-section measurements was 34.23 ± 17.56%. In 6 sections measurement, contusion volume was 27.98±15.05%, in 8 sections 30.66±16.07% and in 10 sections 32.47±16.97%. When we examined the Bland Altman graphs, it is seen that the mean difference obtained from the 10 sections is smaller than the 6 and 8 sections measurements and the confidence interval is narrower. Therefore, we can say that the 10 sections measurement gives the closest evaluation to all lung contusion measurements with about 95% accuracy ratio. Conclusion Lung contusion volume can be objectively evaluated using the manual planimetry method with systematic random sampling without whole lung area measurement on CT with high interobserver and intraobserver agreement.

Anahtar Kelimeler

• Computed tomography
• contusion volume
• lung contusion
• planimetry method
• trauma

Kaynakça

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