128层螺旋CT后处理技术在胸骨骨折诊断中的应用

The Application of 128-Sclice Spiral CT Post-processing Technologies in Diagnosis of Sternum Fracture

目的探讨128层螺CT轴位扫描、多平面重建(multiple planar reconstruction,MPR)及容积再现(volume rendering,VR)在胸骨骨折中的诊断及应用价值。方法收集经128层螺旋CT行常规胸部扫描诊断胸骨骨折115例,利用工作站对图像进行MPR、VR后处理,并与轴位图像进行对比分析。结果本组115例胸骨骨折中,胸骨柄骨折48例,胸骨体骨折65例,剑突骨折1例,胸骨柄-体分离性骨折1例。骨折类型:横形骨折46例,斜形骨折50例,粉碎性骨折9例,不全性骨折10例。骨折的检出率:MPR重建检出113例(98%),轴位图像90例(78%),VR图像88例(77%)。MPR重建对胸骨骨折的检出要高于常规CT轴位图像及VR图像(P<0.01),具有统计学意义,而常规CT轴位图像与VR图像对胸骨骨折的检出未见显著差异(P>0.05)。结论 128层螺旋CT后处理技术在诊断胸骨骨折中具有重要的临床价值,尤其是MPR可以清晰显示胸骨骨折的部位、形态,避免胸骨细微骨折的漏诊;同时发现前纵隔血肿、肋骨骨折及创伤性湿肺在胸骨骨折的情况下发生率高。

Objective The paper is to discuss the diagnostic and application values of 128-Sclice Spinal CT axial scan, multiple planar reconstruction（MPR） and volume rendering（VR） in sternum fracture. Methods A total of 115 cases who were diagnosed as sternum fracture with routine chest 128-Slice Spinal CT. Images were processed with reconstruction technologies（MPR and VR） for observation and comparison with axial images. Results The 115 sternum fracture cases cover 48 cases with manubrium fracture, 65 with gladiolus fracture, 1 with processus xiphoideus fracture and 1 with manubrium sterni-body isolated fracture. With respect to fracture type, there are 46 cases with manubrium fracture, 50 with oblique fracture, 9 with comminuted fracture and 10 with incomplete fracture. The fracture detection rates are 98%（n=113） with MPR, 78%（n=90） with axial image and 77%（n=88） with VR. The sternum fracture detection rate of MPR is significantly higher than the rates of axial image and VR（P〈0.01）, while there is no significant different between the sternum fracture detection rates of routine axial image and VR（P〉0.05）. Conclusion 128-Sclice Spiral CT post-processing technologies show important clinical values in diagnosis of sternum fracture. Especially, MPR clearly suggests site and morphology of sternum fracture and avoid misdiagnosis of subtle sternum fracture. In addition, the occurrences of anterior mediastinum hematoma, rib fracture and traumatic wet lung are high in sternum fracture cases.