多层螺旋CT不同重建方法在诊断肋骨骨折中的对比研究

目的 探讨多层螺旋CT不同后处理功能在诊断肋骨骨折中的价值.方法 对48例X线平片疑有骨折的病例行及MSCT容积扫描及多种图像后处理,观察几种不同图像对骨折显示的效果.结果 48例中,X线平片显示肋骨骨折65处,MSCT检查及后处理图象显示肋骨骨折217处.8例正常X线平片在MSCT上显示有12处肋骨骨折,7例X线平片有17处可疑骨折的被MSCT检查后确诊7处、排除10处.另外,MSCT还同时发现胸骨骨折2例,胸椎骨折3处,肩胛骨骨折1处,血气胸12例,肺挫伤15例,纵隔血肿2例;而X线平片仅发现血气胸10例,肺挫伤5例.X线平片和MSCT同时发现锁骨骨折7处.图像显示横断面扫描可发现细小骨折但缺乏立体信息;VR和SSD重建立体感强,可多角度、多方位观察骨折移位及关节脱位;MPR显示骨折线的走行和移位更有优势且能同时显示周围软组织病变.结论 MSCT检查肋骨骨折明显优于常规X线平片,其几种后处理功能各有优势,应将横轴位与MPR、SSD、VR的一种或几种相结合,可为临床及法医鉴定提供可靠的依据.

Different reconstructions of multi-slice spiral CT in diagnosing rib fractures: a comparative study

Objective To probe role of post-imaging treatment of multi-slice spiral CT in diagnosing rib fracture. Methods MSCT scanning and a variety of reconstructions of the images were performed for 48 patients suspicious of rib fractures indicated by X- ray in order to bring out differences in displaying the fractures. Results 65 rib fractures in 48 patients were found with X-ray films while 217 rib fractures with MSCT. 12 fractures were found out by MSCT from 8 X-ray films that did not display fractures. 17 doubtful fractures on the X-ray films were confirmed as fractures (7 fractures) or excluded (10 fractures) by MSCT. Moreover, many hidden fractures or lesions were detected by MSCT as: 2 fractures in sternum, 3 fractures in thoracic vertebra, 1 fracture in scapula, 12 cases of pneumohemothorax, 15 cases of lung contusion, and 2 cases of mediastinal hematoma. In contrast, X-ray films detected merely 10 cases of pneumohemothorax and 5 cases of lung contusion. Both X-ray film and MSCT found 7 fractures in clavicle. Transverse scanning was able to find out fine fractures however lacking three-dimensional information. VR and SSD reconstruction enjoy a strong 3D sense, helping to observe fracture displacement and joint dislocation with multi-angle and multi-position. MPR was better in displaying ways of fracture lines and dislocation in addition to showing lesions in surrounding soft tissues. Conclusion MSCT is superior to conventional X-ray exam in detecting rib fractures, its post-imaging treatment has varied advantages. If a transverse scanning is combined with one or several procedures as MPR or SSD or VR, more reliable images can be obtained for the purpose of clinical or forensic use.