多层螺旋CT肋软骨成像及在诊断肋软骨损伤中的价值

The imaging and diagnostic value of costicartilage injuries on multislice CT

目的探讨多层螺旋CT(MSCT)肋软骨成像方法及其在肋软骨损伤诊断中的价值。方法利用西门子Sensation4多层螺旋CT机按照胸部常规扫描条件对胸部外伤组36例和对照组100例患者进行容积扫描,然后进行薄层低对比及高对比图像重组,并将重组图像导入CT三维(3D)工作站,利用多平面重组成像(MPR)、最大密度投影(MIP)、表面阴影法成像(SSD)及容积成像技术(VRT)对图像进行后处理,由2名CT诊断医生一起对各种后处理图像进行观察和分析。结果所有受检者的MSCT后处理图像均能显示肋软骨。正常肋软骨表现为周围密度均匀、形态规则、表面光滑;肋软骨损伤6例10处,表现为肋软骨密度不均匀或者其中有裂隙,2例呈粉碎状。MIP、SSD、VRT3种成像模式间图像质量差异无统计学意义(χ2=1.356,P=0.716),MIP、SSD、VRT成像模式与MPR成像模式间图像质量比较差异均有统计学意义(UMIP:MPR=12.981,USSD:MPR=12.652,UVRT:MPR=12.937,P值均=0.000)。结论MSCT是1种无创伤性显示肋软骨形态的最佳影像学方法,其相关CT表现可望成为临床诊断肋软骨损伤的“金标准”。

Objective To investigate the imaging methods of multi-slice CT （MSCT） in costicartilage and the diagnostic value in the costicartilage injuries. Methods There were 100 cases in normal group and 36 cases in group of chest injuries. All cases were performed in volume scan according to conventional chest scan by SIEMENS Sensation 4 MSCT, then performed in thin slice low and high contrast image reconstructions. After that, all the source images were input into CT 3D workstations,costicartilage were imaged by postprocessing software such as multiplanar reconstructions （MPR）, maximum intensity projection（MIP）, surface shade display （SSD） and volume rendering technique （VRT）. All the pictures were observed and analyzed by two radiologists. Results All postprocessed images that obtained from the MSCT could show the costicartilage clearly. Normal costicartilage displayed uniform density, regular shape and smooth surface; there were 6 injuries in l0 cases with costicartilage injuries, which displayed no uniformity density or cranny in costicartilage and showed cranny in 2 cases. No significant difference of image quality was found among the three imaging modes of MIP, SSD, VRT （ X^2 = 1. 356, P = 0. 716 ）. Significant differences were found between MPR and other three imaging modes（ UMIP：MPR = 12. 981, USSD：MPR = 12. 652, UVRT：MPR = 12. 937, P =0. 000）. Conclusion So far, the MSCT is the best noninvasive imaging method to show the shape of costicartilage, it may be considered as a clinical “gold standard” in the diagnosis of costicartilage injury.