多层螺旋CT对外伤性脾破裂的诊断准确性

Diagnostic accuracy of MSCT for traumatic splenic rupture

目的评价多层螺旋CT对外伤性脾破裂的诊断准确性。方法 55例由临床与手术证实的外伤性脾破裂患者均经多层螺旋CT(MSCT)平扫,其中20例又经对比增强CT扫描。对所有患者的CT表现进行了回顾性分析。结果在55例中,起初CT平扫正确诊断50例(90.9%)外伤性脾破裂。增强扫描的20例全部(100%)得到正确诊断。在CT平扫像上,外伤性脾破裂主要表现为脾脏肿大、形态不规则、密度不均匀、边缘模糊及弧形高密度影,而CT增强扫描显示了脾脏内或表面不规则撕裂口、脾内未强化血肿及假性动脉瘤形成。49例(89.1%)患者伴发腹腔积液。早期或轻微脾破裂时,腹腔积液主要见于左侧结肠旁沟及道格拉斯窝。38例(69.1%)患者合并其他脏器或组织损伤。结论多层螺旋CT在外伤性脾破裂的诊断中,具有安全、快速、准确率高等优势。在患者病情许可的条件下,对比增强扫描可提高诊断准确率及合并症的检出率,并能正确分型,为临床选择治疗方案提供可靠依据。

Objective To evaluate the diagnostic accuracy of multislice spiral CT（MSCT） for traumatic splenic rupture（TSR）.Methods Fifty-five patients with clinically and surgically proved TSR underwent precontrast MSCT scans of the abdomen,of whom,20 cases underwent additional contrast-enhanced MSCT scans.CT findings of all the patients were analyzed retrospectively.Results Among 55 patients,initial plain CT scans correctly diagnosed 50（90.9%） cases.Twenty patients who underwent contrast-enhanced MSCT scans were completely（100%） demonstrated to have TSR.On precontrast CT images,TSR mainly appeared as splenomegaly,irregular shape,nonhomogeneous density and hyperdense shadows with ill-defined margin and curvilinear border,while contrast-enhanced MSCT scans visualized irregular lacerated opening of splenic inside or surface,intrasplenic non-enhanced hematomas and false aneurysms.Except these,49（89.1%） cases associated with ascites.When TSR was early or slight,the most common locations of ascites were left paracolonic sulcus and pelvic Douglas pouch.38（69.1%） cases associated with other organ or tissue injuries.Conclusion MSCT in diagnosing TSR has safe,rapid and high-accuracy advantages.Enhanced CT scan can elevate the diagnostic accuracy of TSR and the detect rate of associated injuries and can perform the correct classification of TSR if the conditions of patients are permissible,simultaneously,it can provide reliable evidence for selecting therapeutic protocol.