鼻区骨折影像学检查的漏误诊分析

目的对比鼻区骨折X线摄片和CT检查中漏误诊发生率，以提高鼻区骨折诊断的正确性。方法收集同时经鼻骨侧位X线摄片和MSCT检查诊断为鼻区骨折的影像资料150例，回顾分析其X线和MSCT表现及漏误诊原因。结果鼻骨侧位X线片显示鼻骨骨折102例，其中线性骨折35例，线性骨折伴移位41例，粉碎性骨折26例，漏诊35例，误诊32例。CT诊断鼻骨骨折137例（其中线性骨折36例，线性骨折伴移位55例，粉碎性骨折46例），复合性骨折88例，单纯鼻旁骨骨折13例；横轴面图像漏诊6例，误诊8例，冠状面图像漏诊8例，误诊9例，横轴面结合冠状面图像误诊1例。结论鼻部外伤患者仅作鼻骨侧位X线摄片容易漏诊，MSCT薄层扫描结合MPR、VR成像能全面观察鼻区细微结构和骨折改变。

Imaging analysis for missed and mistaken diagnosis of nasal fractures

Objective To improve the diagnostic accuracy of nasal fractures by X-ray and CT examination. Methods 150 cases with nasal trauma were examined by lateral X-ray and multi-slice CT （MSCT）. The imaging manifestations were retrospectively reviewed. Results The linear fracture, linear fracture with displacement and smashed fracture of nasal bones was respectively showed in 35 cases, 41 cases and 26 cases by lateral X-ray radiogram. Thirty-five fractures were missed and thirty-two fractures were mistaken by X-ray. 137 cases with nasal bone fractures were diagnosed by MSCT, which included linear fracture （n=36 cases）, linear fracture with displacement （n=55 cases） and smashed fracture （n=46 cases）. Among all patients, 88 cases with compound fractures and 13 cases with single paranasal bone fractures were diagnosed by MSCT. The 6 cases fractures were missed on the transverse imageing, and 8 cases on the coronal imaging. The mistaken diagnosis was in 8 cases by only transverse images, and 9 cases by the coronal images, and one cases on the both transverse and coronal images. Conclusion Traumatic nasal bone fractures could be missed and mistaken diagnosis by only lateral X-ray. The diagnostic accuracy could be improved by MSCT examination with Multi-plane Rendering （MPR） and Volume-Rendering （VR） perfectly.