非裂孔性膈疝膈肌破口形态MSCT多平面重组观察

Break Patterns of Non-hiatus Diaphragmatic Hernia:MSCT MPR Evaluation

目的探讨非裂孔性膈疝膈肌破口多层螺旋CT(MSCT)多平面重组(mutiple planar-reconstraction,MPR)成像方法及其形态特征。资料与方法回顾分析53例非裂孔性膈疝患者的影像资料,其中Bochdalek疝18例,Morgagni疝8例(4例经手术证实),创伤性膈疝(traumatic diaphragmatic hernia,TDH)21例(均经手术证实),医源性膈疝(iatrogenic diaphragmatic hernia,IDH)6例(2例经手术证实)。53例均行MSCT容积扫描,采用MPR倾斜横断位直接显示和冠状或矢状位重组测量横断位定点描绘(简称测量法)间接显示两种方法,观察膈肌破口大小、形态特征及显示情况并作比较。结果各类非裂孔性膈疝破口形态主要有类圆形和椭圆形/梭形两类。MPR倾斜横断位及测量法分别显示Bochdalek疝12例(66.7%)和14例(77.8%),Morgagni疝4例(50%)和5例(62.5%),TDH17例(80.9%)和18例(85.7%),IDH6例(100%)和6例(100%);总显示率分别为73.6%和81.1%(χ2=1.08,P>0.05)。非创伤类膈疝破口形态主要为椭圆形/梭形,创伤类膈疝(IDH属于创伤类膈疝)主要为类圆形(P<0.05)。TDH破口长短径显著大于其他各类膈疝(P<0.05)。10例两种方法均未能显示较完整膈疝破口形态。结论 MPR倾斜横断位和测量法能直接或间接显示绝大多数各类非裂孔性膈疝膈肌破口形态特征,可为临床评估病情、指导手术提供比较直观的影像资料。

Objective To explore the break patterns of non-hiatus diaphragmatic hernia using MSCT MPR imaging methods.Materials and Methods Fifty-three cases of non-hiatus diaphragmatic hernia,includeing Bochdalek hernia（18 cases）,Morgagni hernia（8 cases）,traumatic diaphragmatic hernia（TDH,21 cases）,iatrogenic diaphragmatic hernia（IDH,6 cases）underwent MSCT volume scanning.The size and morphology of diaphragmatic hernia were displayed directly on MPR axial images and indirectly measured on coronal and sagittal reconstruction images.Results The display rate of direct and indirect method were 73.6% and 81.1% respectively（χ2=1.08,P0.05）.The break patterns of non-hiatus diaphragmatic hernia were round or oval type.The oval type was mainly occurred in non-traumatic diaphragmatic hernia,while round type was mainly occurred in traumatic diaphragmatic hernia（P0.05）.The short and long diameter of TDH were significantly greater than that of the other types of diaphragmatic hernia（P0.05）.Conclusion The size and morphology of break patterns of non-hiatus diaphragmatic hernia can be displayed by MPR axial images directly and measurement indirectly.The MSCT MPR images provide more information for assessment and guiding surgery of the disease.