胸部创伤的X线—CT诊断

探讨闭合性及开放性胸部创伤的ＣＴ表现及诊断价值，笔者对６９全胸部创伤者进行临床，Ｘ线平片，ＣＴ扫描诊断，对Ｘ线平片与ＣＴ片进行了对比分析。结果 ＣＴ表现为肺挫伤５１例，肺撕裂伤１２例，Ｘ线平片分别漏，误诊２１例和７例。结论ＣＴ能明确创伤病变的部位，性质，程度，敏感性和特异性高，为临床诊断及处理提供较单纯Ｘ线平片更多的信息及可靠的依据，为胸部创伤最重要的检查方法之一。     

胸部闭合性损伤诊断中CT与X线临床价值比较

目的探讨CT与X线用于胸部闭合性损伤诊断临床价值差异。方法对X线检查胸部闭合性损伤患者175例临床影像学资料进行分析,比较两种检查方式不同类型胸部闭合性损伤临床诊断符合率。结果血气胸、肺不张、肺挫伤及创伤性湿肺等CT检查临床诊断符合率均显著高于X线（P〈0.05）;但两种检查方式骨折、肺撕裂伤及纵隔气肿临床诊断符合率比较差异无统计学意义（P〈0.05）。结论 CT在诊断肺实质损伤及血气胸方面家价值优于X线,适用于受伤较重患者;而X线骨折诊断准确率高,且操作简便、价格低廉,可作为临床首选影像学检查方式。     

胸部创伤的X线诊断分析

近年来,随着交通及其他意外事故的频繁发生,胸部创伤患者日渐增多。胸部在直接或间接暴力作用下,均可发生损伤的可能。因此,X线检查对其有着重要意义,现将我院近几年来资料完整的胸部创伤患者100例结合文献分析讨论,以期提高对胸部创伤各种影像表现的认识与理解。     

胸部创伤84例X线平片,CT影像分析

胸部创伤是外伤中较常见的急诊，死亡率约占所有创伤的25％[1]。在直接或间接的暴力下，均可发生肺实质损伤。在很多病例中临床尚未出现明显症状之前，X线平片、CT即可显示阳性改变，因此，X线平片、CT对胸部损伤有较大的诊断价值。现将我院1993～1995年临床资料完整的胸部创伤84例分析如下。116床资料1．1一般情况本组男71例，女卫3例；年龄5～75岁，平均41岁。车祸60例，砸伤16例，挤压伤4例，跌落伤4例。84例均有完整的X线胸片，其中4＆例同时作了胸部CT扫描。84例中单纯肋骨骨折10例，全身复合伤74例。22例出现低氧血症，4例并发成…     

胸部创伤的X线和CT影像对比研究

目的 :探讨X线和CT对胸部创伤的诊断价值和特征。材料和方法 :回顾性分析 69例胸部创伤X线平片及CT表现。结果 :肺挫伤 43例 ,肺不张及肺萎陷 2 1例 ,骨折合并气胸 2 4例 ,胸腔积血 3 5例 ,皮下气肿和纵隔气肿 2 1例 ,其它合并损伤 :颅脑挫伤 13例 ,肝破裂 2例 ,脾破裂 2例 ,胸椎骨折 4例 ,锁骨骨折 3例 ,肩胛骨骨折 2例。结论 :CT能明确创伤病变的部位、性质、程度 ,敏感性和特异性高 ,能清晰显示X线平片难以发现的少量胸腔积液和积气 ,对危重及复合伤患者可减少搬动 ,并能较快完成检查 ,是胸部创伤最重要的检查方法之一。     

SARS的胸部X线与CT诊断

目的 评价X线平片和CT检查在严重急性呼吸综合征(SARS)的诊断价值。方法 回顾性分析29例临床诊断SARS的患者，对发病后的一系列胸片和CT影像进行分析。结果 X线表现：发热后1周内胸片显示单侧或双侧肺局灶性斑片状模糊影，然后迅速扩大到其他肺野，部分呈片团状弥漫分布，部分融合呈大片状，中心密度高，周边密度低，可见支气管气像。按病变高峰期侵犯肺的范围将病变分为轻、中、重度，轻度5例，中度10例，重度14例。CT表现：发病1～10d有4例CT扫描显示两肺多发斑片状实变影，边缘模糊，部分融合成大片状，可见支气管气像。发病10～30d有9例进行CT检查，表现为两肺大部或弥漫磨玻璃样改变，肺间质增厚，呈粗大网状，夹杂斑块状肺实变影，胸膜下区可见小叶过度充气征象；发病30d后，有19例进行检查，2例CT表现正常，17例主要表现为两肺局灶或广泛性不同程度的肺间质增厚影像。结论 SARS同时存在急性肺炎和急性间质性肺炎的影像改变，在治疗过程中，一系列胸片检查有助于掌握病情的变化，CT检查能较准确地评价肺部病变。     

64层螺旋CT 与X线摄影对胸廓骨折的诊断价值

目的：探讨64层螺旋C T对胸廓骨折的诊断中的应用价值。方法对收治的32例胸廓骨折患者采用螺旋C T扫描及三维重建图。结果32例患者中胸骨柄骨折4例,胸骨体骨折2例,肩胛骨骨折9例,胸腰椎骨折13例,肋骨骨折4例。X线平片未发现2例肋骨骨折,在Seimens Definition AS （128）64层螺旋CT的Syngo ．via工作站上结合VR、MIP、MPR薄层原始图像看到的2例肋骨骨折（2／32）,这2例肋骨骨折征象表现为骨皮质中断,断端有错位,由于细微的骨折薄层图像不易观察,故结合多方位重建观察;另外,X线平片未发现3例肩胛骨骨折,在SEIM ENS Definition AS （128）64层螺旋CT的Syngo ．via工作站上结合VR、MIP、MPR薄层原始图像看到的3例肩胛骨骨折（3／32）。结论64层螺旋CT检查提高了胸廓骨折的发现率,为治疗方案提供指导性意见。     

Multislice CT in thoracic trauma

The introduction of CT imaging in the 1970s revolutionized all aspects of medical care, perhaps nowhere more so than in the evaluation of acutely injured patients. Just as single-slice helical scanning was a great advance over conventional CT, the capabilities of MSCT are proving to be dramatically superior to single-slice methods. Improved contrast bolus imaging, thinner slices, and isotropic voxels should enable the trauma radiologist to identify both major organ system disruption and subtle injuries more promptly. Multiplanar and three-dimensional reconstructions, a forte of MSCT, facilitate rapid communication of disease states with surgeons and others involved in the care of injured patients. In many centers, whole-body CT is beginning to supplant plain films of the chest and spine in the evaluation of severe trauma victims; the cost-effectiveness of such methods is still under evaluation.     

Diagnostic Imaging in pediatric thoracic trauma

Thoracic trauma accounts for approximately 14% of blunt force traumatic deaths, second only to head injuries. Chest trauma can be blunt (90% of cases) or penetrating. In young patients, between 60 and 80% of chest injuries result from blunt trauma, with over half as a consequence of impact with motor vehicles, whereas in adolescents and adults, penetrating trauma has a statistically more prominent role. Pulmonary contusions and rib fractures are the most frequent injuries occurring. Chest X-ray is the first imaging modality of choice to identify patients presenting with life-threatening conditions (i.e., tension pneumothorax, huge hemothorax, and mediastinal hematoma) and those who require a CT examination. Multi-Slice Computed Tomography is the gold standard to evaluate chest injuries. In fact, the high spatial resolution, along with multiplanar reformation and three-dimensional (3D) reconstructions, makes MDCT the ideal imaging method to recognize several chest injuries such as rib fractures, pneumothorax, hemothorax, lung contusions and lacerations, diaphragmatic rupture, and aortic injuries. Nevertheless, when imaging a young patient, one should always keep into account the ALARA concept, to balance an appropriate and low-dose technique with imaging quality and to reduce the amount of ionizing radiation exposure. According to this concept, in the recent years, the current trends in pediatric imaging support the rising use of alternative imaging modalities, such as US and MRI, to decrease radiation exposure and to answer specific clinical questions and during the observation period also. As an example, ultrasound is the first technique of choice for the diagnosis and treatment of pleural and pericardial effusion; its emerging indications include the evaluation of pneumothoraces, costocondral and rib fractures, and even pulmonary contusions.     

胸部钝性外伤的CT表现

随着胸部钝性外伤病例的日益增多,影像学检查在该病的诊断和处理中发挥着越来越大的作用,CT有利于各种胸部外伤的快速确诊,特别是多层螺旋CT和各种容积重组方法又增加了人们对胸部外伤及其相关病变的新认识。综述肺、纵隔、大血管、膈肌和骨性胸廓等胸部各脏器和组织在钝性外伤时的CT表现。     

胸部钝性外伤的CT表现

随着胸部钝性外伤病例的日益增多,影像学检查在该病的诊断和处理中发挥着越来越大的作用,CT有利于各种胸部外伤的快速确诊,特别是多层螺旋CT和各种容积重组方法又增加了人们对胸部外伤及其相关病变的新认识.综述肺、纵隔、大血管、膈肌和骨性胸廓等胸部各脏器和组织在钝性外伤时的CT表现.     

Modern CT diagnosis of acute thoracic and abdominal trauma

PURPOSE: To evaluate a modified algorithm in the diagnostic management of polytraumatized patients by using whole body multislice CT (MSCT) as primary diagnostic tool. MATERIAL AND METHODS: Between June 1999 and October 2000 532 polytraumatized patients were referred to the emergency department. 336 polytraumatized patients were primarily evaluated using whole body MSCT according to the "Innsbruck Emergency Algorithm." MSCT is performed immediately after cardiovascular stabilization of the patient. During the initial stabilization period free intraabdominal fluid is excluded or demonstrated by abdominal ultrasound. Time-consuming conventional radiographs are omitted with exception of an optimal chest X-ray. In patients with suspected or obvious arterial injuries or fractures the multislice-CT-dataset is used to perform 2D and 3D reconstructions in order to optimize visualization of additional skeletal and vascular injuries. RESULTS: By means of whole body MSCT it was possible to detect all injuries. The diagnostic advantage of whole body MSCT as compared to conventional X-ray was analyzed in 111 consecutive polytraumatized patients with an injury severity score (ISS) of 34.77. The early use of MSCT shortened the time for diagnostic work-up substantially (approximately 50%). CONCLUSION: Whole body multislice-CT used as primary diagnostic tool in the management of polytraumatized patients allows for a fast, accurate and comprehensive diagnostic work-up.     

CT evaluation of thoracic infections after major trauma

Thirty-seven septic patients with major multisystem trauma were evaluated by computed tomography (CT) to identify possible thoracic sources of infection. CT was 72% accurate in the diagnosis of empyema and 95% accurate in the diagnosis of lung abscess. While CT proved useful in demonstrating these sites of thoracic infections in septic trauma victims, the presence of concurrent thoracic pathology, particularly loculated hemothorax or hemopneumothorax and traumatic lung cysts with hemorrhage or surrounding parenchymal consolidation, introduced sources of diagnostic error. CT also proved helpful in guiding appropriate revisions of malpositioned and occluded thoracostomy tubes.     

CT在颈椎损伤中的诊断价值

目的：探讨CT扫描在颈椎损伤中的诊断价值。方法：回顾性分析32例颈椎损伤的CT与平片检查资料。结果：骨折28例（其中6例伴脱位）,单纯脱位4例,合并伤10例。结论：CT对颈椎损伤的检出率明显高于平片,能清晰显示其损伤的细节,并对判断失稳及椎管狭窄的程度均有重要价值。     

急诊胸部创伤CT检查的价值探讨

急诊胸部创伤常见于交通事故、工伤事故、暴力伤等,部分患者可同时合并有复合性的其他急性创伤,如颅脑、腹部、四肢创伤等。因病情急,临床在作体格检查时受限,常规胸片因系被动体位,难以达到优质片要求,加之常规胸片的局限性使其有些征象不易检出。而胸部CT检查不需要变换体位,     

X线、CT及MRI对骨肉瘤的诊断价值

目的:探讨X线平片、CT和MRI检查在骨肉瘤的临床诊断价值.方法:回顾分析18例经穿刺或手术病理证实的骨肉瘤的X线、CT和MRI表现,并加以总结.结果:本组18例,X线平片检查漏、误诊3例(其中2例表现阴性);18例中,CT检查显示骨肉瘤的瘤骨、骨质破坏优于X线平片11例;18例中,10例行MRI检查,均表现为骨髓腔内正常的骨髓高信号被肿瘤组织所取代,肿瘤周围骨髓和软组织内均可见水肿区,6例可见骨膜反应,3例中央发生坏死囊变.结论:X线检查简便、易行,其空间分辨率高,是诊断骨肉瘤的首选方法.CT对显示结构复杂、重叠部位较多的骨肉瘤病灶有明显优势.MRI扫描在判断肿瘤的范围方面有较大优势,并能为临床定制治疗方案及预后判断提供准确的依据.X线平片、CT和MRI检查三者结合应用,有利于提高对骨肉瘤的诊断准确性.