对可疑颅骨骨折患者螺旋CT检查方法的选择

Checking method of multislice computed tomography in patients with suspected skull fracture

目的比较普通CT轴位骨窗扫描、CT骨窗薄层重建、及颅骨三维成像对颅骨线性骨折的诊断情况。方法收集2013年7月至2014年10月本院颅脑外伤含有线性骨折并进行普通CT轴位扫描、颅骨CT三维成像检查的病例各50例,并对颅脑普通CT轴位扫描进行骨窗薄层重建。分为层厚为10 mm、6 mm、3 mm、1.5 mm轴位骨算法、骨窗图像4组及颅骨CT三维成像,共5组,由两位经验丰富的CT诊断医生使用盲评法为其对骨折线的显示情况打分。结果 10 mm、6 mm、颅骨CT三维成像与3mm、1.5 mm组差异有统计学意义,而3 mm、1.5 mm组间差异没有统计学意义。层厚为10 mm、6 mm的图像可以显示部分线性骨折线,部分骨折线显示不清或未见显示。层厚为3 mm、1.5 mm的图像基本可以显示所有线性骨折线,但是在波及范围的确定和三维立体观感的建立上不如颅骨CT三维重建的图像。结论层厚为3 mm CT骨窗薄层重建作为外伤怀疑颅骨骨折患者的最适合初检方案。

Objective To compare three methods of ordinary CT axial scan, reconstruction of bone window CT thin layer with the skull of three-dimensional imaging in the diagnosis of linear skull fracture. Methods Fifty cases of traumatic brain injury with linear skull fracture were collected with ordinary CT axial scan and another 50 cases with three dimensional skull CT ima- ging from July 2013 to October 2014 in our hospital, and craniocerebral axial were constructed into bone window thin layer. The cases were divided into five groups of 10 ram, 6 ram, 3 mm and 1.5 mm （axial bone algorithm, bone window images） and skull CT three-dimensional ima- ges, then the fracture line was scored by two experienced CT diagnosis physicians with blind e- valuation method. Results Differences between 10 ram, 6 ram, skull CT three-dimensional imaging groups and 3 mm and 1.5 mm groups were statistically significant, difference between 3 mm and 1.5 mm groups was not statistically significant. Some linear fracture line were showed in 10 ram, 6 mm layer thickness images, while parts of fracture lines were not. All lin- ear fracture line were showed in 3 mm and 1.5 mm layer thickness images, but skull three di- mensional CT reconstruction images had superior definition of fracture line courses, size and the dimensionality information. Conclusion CT could be the most suitable early detection solution for suspected patients with skull fracture caused by trauma.