64层螺旋CT三维容积再现图像在肋骨骨折诊断中应用价值

Application value of 64-slice spiral CT three-dimensional volume rendering in diagnosis of rib fracture

目的分析64层螺旋CT三维容积再现图像在肋骨骨折诊断中应用价值。方法选择如皋市人民医院2015年1月至2018年3月胸外伤疑似肋骨骨折且影像学检查资料完整的患者61例,其中男性41例,女性20例;年龄24~66岁,平均年龄46.6岁。行X射线检测、CT扫描和图像重建。比较X射线诊断与64层螺旋CT三维容积再现图像在肋骨骨折诊断时确诊率及漏诊情况。结果 61例经临床及影像学证实共124处骨折,其中多发骨折患者占65.6%;骨折部位多在腋段,占60.5%(75/124)。螺旋CT三维容积再现确诊58例119处骨折,X射线诊断确诊45例96处骨折;螺旋CT三维容积再现确诊率明显高于X射线诊断[96.0%(119/124) vs 77.4%(96/124)],差异有显著统计学意义(P=0.000 <0.01)。X射线诊断漏诊16例28处(占22.6%),其中膈下肋骨7处,腋段肋骨11处,肋骨弓部5处,靠近肋软骨5处。螺旋CT三维容积再现漏诊3例5处(占4.03%),其中3处靠近肋软骨,2处靠近肋胸椎。64层螺旋CT三维容积再现尚发现患者合并锁骨骨折4处,颈椎及胸椎骨折4处,肺挫伤7例,胸腔积液5例。结论应用64层螺旋CT三维容积再现图像技术提高了肋骨骨折的确诊率,诊断隐匿性肋骨骨折及并发症时效果更优,值得在临床推广使用。

Objective To analyze the application value of 64-slice spiral CT three-dimensional volume rendering in the diagnosis of rib fracture. Methods From January 2015 to March 2018, a total of 61 cases suspected rib fracture patients were enrolled, included 41 males and 20 females, aged 24-66 years old with mean of 46.6 years old. The X-ray detection, CT scan and image reconstruction were performed. The diagnosis and misdiagnosis rate of rib fracture were compared between Xray and 64-slice spiral CT three-dimensional volume rendering images. Results A total of 124 fractures were confirmed by clinical and imaging in 61 cases, of which the multiple fractures accounted for 65.6 %. The fractures were mostly in axillary segment, accounting for 60.5 %(75/124). There were 119 fractures diagnosed in 58 cases by spiral CT three-dimensional volume rendering, and 96 fractures in 45 cases by X-ray. The diagnosis rate of spiral CT three-dimensional volume rendering was significantly higher than that of X-ray[96.0 %(119/124) vs 77.4 %(96/124)], and the difference was statistically significant(P = 0.000 < 0.01). The misdiagnosis of X-ray happened in 28 cases(22.6 %), in which 7 of subphrenic ribs, 11 of axillary segment, 5 of arch ribs and 5 of cartilage ribs. Three cases with 5 fractures(4.03 %) were missed by spiral CT three-dimensional volume rendering, in which 3 of costal cartilage and 2 of costal thoracic vertebra. In addition, 64-slice spiral CT three-dimensional volume rendering showed 4 of collarbone fracture, 4 of cervical and thoracic fractures, 7 of pulmonary contusion and 5 of pleural effusion. Conclusion It is demonstrated that 64-slice spiral CT three-dimensional volume rendering improves the diagnosis rate of rib fracture, and shows more efficiency in occult rib fractures and complications, which is worth in clinical promotion.