多层螺旋CT在鼻部外伤诊断中的应用及法医学鉴定价值

The application value of MSCT in the diagnosis and forensic identification of nasal trauma

目的探讨多层螺旋CT(multi-slice spiral CT,MSCT)在鼻部外伤诊断中的应用,以提高鼻骨骨折诊断的准确性。方法对154例鼻部外伤患者进行MSCT扫描,利用工作站的重组软件对图像进行多平面重建(MPR),包括轴位、冠位、矢状位以及容积再现(VR)、最大密度投影法(MIP)及三维重建技术(3D)进行重建并对检查结果进行分析。结果在各种重建技术中,MPR+图像锐化最优,MPR则可任意方向、任意角度重建,以最佳角度显示骨折及周围软组织情况,尤其是冠状位显示骨折最直观清晰,而锐化使图像的性噪比更差,反而使骨窗的分辨率大大提高,图像更清晰,结合其他重建技术,对鼻骨骨折的诊断具有重要价值。结论在鼻部外伤诊断中,利用各种重建技术,对于鼻骨骨折往往能作出正确的诊断,但同时应注意与各种变异、畸形及陈旧骨折相鉴别,避免漏诊误诊,提高诊断率,为患者及法医学鉴定提供准确的诊断依据。

Objective To investigate the application of multiple-slice spiral CT in the diagnosis of nasal trauma, to improve the accuracy of diagnosis of nasal bone fracture. Methods MSCT scans were performed in 154 cases of nasal trauma patients using reconstruction software workstation for multiple planar reconstruction of the image （MPR）, including axial, coronal, sagittal view and volume reproduction （VR）, maximum intensity projection （MIP） and three-dimensional reeonstmetion teehnique （3D） and the ,esuhs were analyzed. Results By comparion of various reconstruction techniques, MPR＋ image sharpening optimal , MPR could be in any direction, any angle ,eeonstruetion, display fracture and snft tissue arnund the best angle, especially the coronal fractures showed the most intuitive and clear, and tire sharpening of the signal-In-noise ratio of the image was poor, but the bone window image resolutinn was greatly improved. Clearly, in combination with other reeonstruction techniques, had important value in the diagnosis of nasal bone fraeture. Conclusion In tire diagnosis of nasal trauma, using various reconstruction teehniques for nasal bone fracture can oflen make tire correct diagnosis, bul also should pay attention to and all kinds of variation, deformity and old fracture identification, avoid misdiagnnsis, improve the diagnosis rate for forensic patients and provide basis for accurate diagnosis.