寰枢椎急性创伤常用检查技术的应用价值分析

Evaluation of common inspection techniques for acute atlantoaxial trauma

目的探讨寰枢椎急性创伤患者临床常用的三种检查技术:数字断层融合(DTS)、CT和直线数字化X线摄影(DR)的应用价值。方法从重庆医科大学附属第一医院放射科影像归档和通信系统上存储的既往寰枢椎急性创伤病例影像中,选取2013年3月至2017年12月50例寰枢椎DTS影像(计入DTS组)、50例寰枢椎CT平扫影像(计入CT组)和50例寰枢椎DR张口位影像(计入DR组),由2名高年资放射医师进行诊断,再与临床结果进行对照;比较三组的诊断准确率、急性创伤病变检出率、影像质量评分和有效辐射剂量。结果DR组仅在扭伤、跌伤等轻微病因引起的寰枢椎急性创伤的诊断准确率上与DTS组和CT组比较差异无统计学意义(P>0.05),但对车祸等暴力性病因引起的急性创伤的诊断准确率和总诊断率上均低于DTS组和CT组,差异有统计学意义(P<0.05)。DTS技术对寰椎/枢椎骨折、寰枢关节脱位的检出率均稍弱于CT技术,明显优于DR技术,差异有统计学意义(P<0.05)。CT组和DTS组的影像质量评分[(4.60±0.11)分和(4.16±0.15)分]均高于DR组[(2.80±0.18)分],差异有统计学意义(P<0.05)。CT组的有效辐射剂量[(2.330±0.020)mSv/人次]最高,DTS组[(0.614±0.076)mSv/人次]次之,DR组[(0.025±0.003)mSv/人次]最低,两两比较差异均有统计学意义(P<0.05)。结论DR技术在扭伤、跌伤等轻微病因引起的急性创伤中应用尚可,但在其他大多数寰枢椎急性创伤的应用价值不高;DTS可作为大多数寰枢椎急性创伤的首选检查方案,CT诊断准确率和有效辐射剂量最高,建议作为复杂病例的进一步检查方法。

Objective To evaluate and compare the 3 common inspection techniques for acute atlantoaxial trauma: tomosynthesis (DTS), digital radiology (DR) and computed tomography (CT). Methods The imaging data from March 2013 through December 2017 were retrieved from the Picture Archiving and Communication Systems (PACS) of The First Affiliated Hospital of Chongqing Medical University concerning the patients with acute atlantoaxial trauma.Selected for this study were 50 DTS images (DTS group), 50 CT images (CT group) and 50 DR images (DR group).The image diagnoses for the 3 groups were conducted by 2 senior radiologists and their judgments were compared with the definite clinical diagnoses.The 3 groups were compared in terms of diagnostic accuracy, diagnostic rate of acute atlantoaxial trauma, image quality and effective radiation dosage. Results DR was insignificantly different from DTS or CT in diagnostic accuracy for the acute atlantoaxial trauma which had been caused by mild violence like spraining and falling (P>0.05), but significantly inferior to both DTS and CT in diagnostic accuracy and diagnostic rate of the acute atlantoaxial trauma which had been caused by severe violence like traffic accident (P<0.05).In detection of atlas/axial fracture and atlantoaxial dislocation, DTS was slightly weaker than CT but significantly better than DR (P< 0.05).The image quality scores for CT group (4.60±0.11) and DTS group (4.16±0.15) were significantly higher than that for DR group (2.80±0.18)(P<0.05).In average effective radiation dosage, CT group (2.33±0.020 mSv/time) was the highest, followed by DTS group (0.61±0.076 mSv/time) and DR group (0.025±0.003 mSv/time), showing significant differences between any two (P<0.05). Conclusions DR technique may be used for inspection of the atlantoaxial acute trauma caused by mild violence like spraining and falling, but has little value for inspection of most cases of atlantoaxial acute trauma.DTS technique may be the first choice for inspection of most atlantoaxial acute trauma.CT should be applied as a further inspection for complex cases because of its highest diagnostic accuracy and highest effective radiation dosage.