MSCT轴位扫描结合冠状面MPR与矢状面MPR图像在诊断胸部骨折患者中应用

Application of MSCT Axial Scanning Combined with Coronal and Sagittal MPR Images in the Diagnosis of Thoracic Fractures

目的多层螺旋CT(MSCT)轴位扫描结合冠状面多平面重组(MPR)与矢状面MPR图像在诊断胸部骨折患者中应用。方法分析我院2012年5月至2013年5月经病理学诊断证实为胸部骨折的35例患者的常规轴位CT图像、冠状面MPR及矢状面MPR图像,以病理检查结果为准,观察胸骨骨折类型及检出率,胸骨骨折患者胸部创伤的检查。结果 35胸骨骨折患者中,斜形骨折7例、横断骨折27例、粉碎性骨折3例、错位性骨折11例、无错位性骨折23例、错位性横断骨折10例、无错位性横断骨折20例。常规轴位CT检出胸骨骨折25例,检出率为71.43%;斜形骨折、横断骨折、无错位性骨折、无错位性横断骨折均有漏诊,结合冠状面MPR图像,可避免斜形骨折的漏诊;矢状面MPR可清楚的检查出各种骨折类型,检出率均为100%。常规轴位CT发现患者并发椎体骨折6例、多发肋骨骨折19例、锁骨骨折4例,胸腔积液20例,胸骨后纵隔血肿9例,胸骨后纵隔气肿3例,肺挫伤18例。结合冠状面MPR及矢状面MPR图像后,另发现胸骨后纵隔血肿7例(常规轴位CT漏诊)。结论 MSCT轴位扫描结合冠状面MPR与矢状面MPR图像可有效提高多种骨折类型的检出率,尤其是矢状面MPR可避免横断骨折、无错位性骨折、无错位性横断骨折的漏诊,具有较好的临床应用价值。

Objective To explore the application of multi-slice spiral CT（MSCT） axial scanning combined with coronal and sagittal multi-planar reconstruction（MPR） images in the diagnosis of thoracic fractures. Methods The routine axial CT images, coronal and sagittal MPR images of 35 patients with pathologically confirmed thoracic fractures who were admitted in our hospital between May 2012 and May 2013 were analyzed retrospectively. Based on the results of pathological examination, the type and detection rate of the thoracic fractures were observed. All patients with thoracic fractures underwent examination for chest trauma. Results Among the 35 patients with thoracic fractures, there were 7 cases with oblique fractures, 27 cases with transverse fractures, 3 cases with comminuted fractures, 11 cases with dislocation fractures, 23 cases with non-dislocation fractures, 10 cases with dislocation transverse fractures and 20 cases with non-dislocation transverse fractures. Routine axial CT detected 25 cases with thoracic fractures, and the detection rate was 71.43%. There was missed diagnosed patients among patients with oblique fractures, transverse fractures, non-dislocation fractures and non-dislocation transverse fractures. Combined with coronal MPR images, the missed diagnosis of oblique fractures can be avoided. Sagittal MPR can clearly display various types of fractures, and the detection rate was 100%. The routine axial CT found that there were 6 cases complicated with vertebral fractures,19 cases with multiple rib fractures, 4 cases with fracture of the clavicle, 20 cases with pleural effusion, 9 cases with substernal mediastinal hematoma, 3 cases with retrosternal mediastinal emphysema and 18 cases with pulmonary contusion. After combination of coronal and sagittal MPR images, 7 cases with posterior mediastinal hematoma were found（missed diagnosed by axial CT）. Conclusion MSCT axial scan combined with coronaland sagittal MPR images can effectively improve the detection rate of various types of fractures, especially sagittal MPR can avoid missed diagnosis of transverse fractures, non-dislocation fractures and non-dislocation transverse fractures, with high clinical application value.