创伤性膈疝膈肌破口形态MSCT成像研究

MSCT in the diagnosis of the rupture crevasse in traumatic diaphragmatic hernia

目的:研究创伤性膈疝(TDH)膈肌破口MSCT成像方法及其形态特征。材料与方法:回顾分析27例TDH影像资料,其中顿伤性膈疝21例(均手术证实),医源性膈疝6例(2例手术证实)。27例均行MSCT容积扫描,采用多平面重组(MPR)倾斜法、投影法及线段法观察膈肌破口显示情况、形态特征并作比较。结果:27例膈肌破口倾斜法显示21例(77.8%),投影法和线段法冠矢状位显示相同,分别为24例(88.9%)、20例(74.1%),平均77.2%。27例中共26例次破口形态显示不清,其中右侧11例次36.7%(11/30),左侧15例次(14.3%,15/105),t=6.51,P<0.05。破口形态主要有类圆形和椭圆形/梭形两类,其中显示为类圆形倾斜法16例(59.3%),投影法20例次(45.5%),线段法26例次(59.1%);显示为椭圆形/梭形倾斜法11例(40.7%)、投影法24例次(54.5%)和线段法18例次(40.9%)。结论:MSCT MPR能直接或间接显示绝大多数TDH膈肌破口形态,倾斜法和线段法显示情形相似,较投影法更客观真实。

Objective： To investigate MSCT morphologic characteristics of the diaphragmatic crevasse in traumatic diaphragmatic hernia（TDH）.Materials and Methods： The MSCT features of 27 patients with TDH were analyzed retrospectively,which included 21 cases of blunt diaphragmatic hernia（BDH）（all confirmed by surgery） and 6 cases of iatrogenic diaphragmatic hernia（IDH）（2 surgically confirmed）.Twenty-seven patients all underwent MSCT scanning,slantwise,projective and linear methods of MPR reconstruction were adopted to observe and compare diaphragmatic crevasse for its display and morphological characteristics.Result： Diaphragm crevasse can display in 21 cases of the 27 cases with slantwise methods of MPR（77.8%）,besides 24 cases（88.9%） with projective methods and 20 cases（74.1%） with linear methods,average 77.2%,without difference in coronal or sagittal sites of the last two methods.Of the 27 cases with TDH,the shape of the crevasse was not clearly displayed,11 ones could not show right side（36.7%,11/30）,15 ones could not display left side（14.3%,15/105）,t=6.51,P0.05.Form of diaphragmatic crevasse is mainly classic round,oval or spindle,of which,16 cases（59.3%）,20 cases（45.5%）,26 cases（59.1%） displayed classic round by tilted method,projective method and linear method in turn,likewise 11 cases（40.7%）,24 cases（54.5%）,18 cases（40.9%） were displayed oval or spindle by three methods above mentioned in turn.Conclusion： The morphological characteristics of break in the most of TDH can be displayed directly or indirectly,the demonstrative situation of tilted method and linear method is similar;and more objective than that of the projective ones.