螺旋CT高分辨扫描及多平面重建对颅底骨折的诊断

The basal skull fracture diagnosis with helical HRCT scanning and multiple planar reconstruction

目的通过螺旋CT高分辨扫描及多平面重建(mutipleplanarreconstruction,MPR)技术与常规扫描诊断颅底骨折的对照比较,进一步探讨螺旋CT高分辨扫描及MPR技术对颅底骨折的诊断价值。方法对65例临床怀疑颅底骨折的脑外伤病人除进行头颅常规CT扫描外,又对其颅底进行高分辨扫描及MPR。结果65例脑外伤病人颅底高分辨CT扫描及MPR发现颅底骨折58例194处,其中线样骨折76处,粉碎骨折118处;而常规CT扫描发现颅底骨折52例111处,其中线样骨折49处,粉碎骨折62处,6例颅底骨折被漏诊,83处骨折不能明确显示。薄层高分辨及MPR图像能清晰显示骨折线,并且每个病例有多幅图像支持诊断,与颅底常规CT扫描比较差异有非常显著性意义(χ2=40.82,p<0.005)。结论对颅脑外伤病人进行CT检查时,增加颅底薄层高分辨扫描及MPR,能提高颅底骨折的检出率,减少漏诊。对临床硬脑膜修补的筛选、预防颅内感染具有重要的指导意义。

Objective To evaluate the diagnosis value of thin-section helical HRCT scanning and multiple planar reconstruction( MPR) technique in the detection of basal skull fractures compared with conventional CT scanning. Methods Conventional head CT scanning and thin-section helical HRCT scanning with MPR of basal skull were underwent in 65 cases clinically suspected basal skull fractures. Results For the 65 cases of cranial trauma,58 cases with 194 fracture lines were demonstrated by thin-section HRCT scanning of skull basal and MPR, which included linear fractures 76 and smashing fractures 118. while conventional CT scanning could only show 52 cases with 111 fracture lines including linear fracture 49,smashing fracture 62 and 6 cases of basal skull fractures were leak-diagnosed,83 fractures could not be demonstrated. Thin-section HRCT image and MPR could clearly show fracture lines and there were several images of the same case supporting the diagnosis. This technique compared with conventional CT scanning contained very obvious difference in the detection of basal skull fractures(χ2=40.82,p<0.005). Conclusion When cranial trauma patients are proceeding CT scan, adding thin-section HRCT scanning and MPR can increase the finding rate of basal skull fractures and reduce leak-diagnosis, which have an important guide significance for clinic selection of patients for dural repair and preventing from intracranial infection.