压痛点标记在细微肋骨骨折MSCT检查中的价值

Diagnostic value of marking tender point in rib micro-fracture using MSCT

目的探讨胸廓压痛点放置标记在肋骨细微骨折MSCT检查中的价值。方法对49例临床怀疑外伤性肋骨骨折而X线平片诊断阴性的患者行胸部CT平扫,扫描前对压痛点进行标记。扫描后将CT图像处理成包含标记和无标记图像各一份,由两名放射诊断医师对图像进行诊断分析,同时记录诊断耗时。以两名副主任医师共同确认是否骨折作为标准,比较有、无标记时两名医师诊断符合率、诊断结论的一致性及诊断耗时的差异。结果两名医师在有标记时的诊断符合率(92.22%、94.44%)均高于无标记时(65.56%、63.33%)(2值分别为4.316、5.876,P值均<0.05),尤其是对于无错位骨折。有压痛点标记时两名医师作出每例正确诊断的耗时为(167.66±98.37)s、(140.83±47.43)s,明显低于无压痛点标记时(323.21±154.8)s、(288.88±93.33)s,(t值分别为4.576、8.913,P值均<0.01);有标记时两名医师的诊断结论一致性(Kappa值为0.949)高于无标记时(Kappa值为0.583)。结论压痛点放置标记物能明显提高细微肋骨骨折的MSCT诊断准确率和诊断效率,且不同医师间诊断结论的一致性得到显著提高。

Objective To avaluate application of marking tender point in the diagnosis of rib micro‐fracture using MSCT . Methods 49 patients ,suspected of rib fracture clinically and having nagative findings on X‐ray plain films ,were chosen to take MSCT scanning with tender point marked .CT images including and exluding marker were obtained after scans ,and were analyzed respectively by two junior radiologists .With consensus of two senior radiologists serving as the standard of rib fracture ,the diagnostic accuracy ,diagnostic consistency ,and time consumed for diagnosis based on CT images inclu‐ding and exluding marker were compared .Results The diagnostic accuracy of two radiologists based on CT images inclu‐ding marker （92 .22% and 94 .44% ） was significantly higher than that based on CT images exluding marker（65.56% and 63 .33% ;χ2 = 4 .316 and 5 .876 ;P = 0 .037 and 0 .015） ,especially for non‐dislocated fractures .The time consumed for di‐agnosis based on CT images including marker （167 .66 ± 98 .37） s and （140 .83 ± 47 .43） s was significantly reduced com‐pared with the time consumed based on CT images exluding marker（323 .21 ± 154 .8） s and （288 .88 ± 93 .33） s ;t = 4 .576 and 8 .913 ;P = 0 .000 and 0 .000） .The diagnostic consistency of two radiologists based on CT images including marker was significantly better than that based on CT images exluding marker（Kappa = 0 .949 vs 0 .583） .Conclusion Marking tender point can improve diagnostic accuracy ,time efficiency ,and consistency for the diagnosis of rib micro‐fracture using MSCT .