家兔闭合性胸部创伤早期影像学检查的诊断价值

Early radiological diagnostic value of closed chest trauma in rabbits

目的 探讨放射性核素显象、胸部 CT和 X线检查对家兔闭合性胸部创伤的早期诊断价值。 方法 建立单侧胸部撞击伤动物模型 ,采用单光子发射计算机断层显象 (SPECT)、胸部 CT和 X线片对闭合性胸部创伤进行早期诊断 ,并与病理解剖结果进行对照观察。 结果 伤后 30分钟伤侧肺感兴趣区致伤部位 /心脏部位 (ROI2 /ROI1 )比值立即升高 ,至伤后 6小时达到高峰 ;对侧肺相对应部位 /心脏部位 (ROI3/ROI1 )比值缓慢升高 ,至伤后 6小时达到高峰 ,但仍小于伤侧肺 ,双侧肺之间比较差别具有显著性意义 (P<0 .0 1)。 结论 胸部 X线片检查仍是诊断胸部创伤最基本的方法 ,但对严重的胸部创伤和多发伤患者应尽早做胸部 CT检查 ,SPECT对肺挫伤有较高的诊断价值。CT对肺挫伤的诊断敏感性优于 X线片 ,但对渗出和水肿则不如 SPECT灵敏、准确。因此 ,对严重胸部创伤、多发伤患者 ,急诊检查应采用 CT。

Objective To explore the early diagnostic value of single photon emission computed tomography(SPECT), thoracic computed tomography(CT),and chest X-ray for closed chest trauma. Methods To establish the animal model of unilateral chest impact trauma,to adopt SPECT, thoracic CT, and chest X-ray for early diagnosis of closed chest trauma,and to compare these findings with postmortem examination. Results Thirty minutes after blunt chest trauma, the region of interesting (ROI) between traumatized lung and the heart (ROI_2/ROI_1) immediately increased to the peak six hours after trauma; on the contralateral lung, the ratio (ROI_3/ROI_1) increased slowly and reached the peak after six hours, these ratio was still smaller than that of the traumatized lung. These differences were significant (P<0.01). Conclusions Chest X-ray is still the most fundamental diagnostic method of chest trauma,but it was thought that the patients of severe chest trauma and multiple injuries should be examined early by thoracic CT. Radionuclide imaging have more diagnostic value than chest X-ray on pulmonary contusion. The diagnostic sensibility to pulmonary contusion of thoracic CT is superior to conventional radiograph,but thoracic CT is inferior to SPECT on exploring exudation and edema of pulmonary contusion. Thoracic CT is superior to conventional radiograph on diagnosis of chest trauma,therefore patients of severe chest trauma and multiple injuries should be adopted to thoracic CT examination at emergency room in order to be diagnosed as soon as possible.