薄层螺旋CT扫描在肋骨骨折法医学鉴定中的应用分析

Application of Thin-slice Spiral CT Scan in Forensic Identification of Rib Fractures

目的明确薄层螺旋CT扫描及其图像后处理功能对肋骨骨折的诊断价值。方法取2018年在本鉴定所进行肋骨骨折摄片复查的被鉴定人为研究对象,年龄为41~80岁,共计125例,所有对象均在本鉴定所进行薄层螺旋CT扫描,根据现场CT影像学检查进行图像后处理并作出诊断,采用卡方检验对相关数据进行分析。结果本所复查的案例中,64例与原诊断不一致,发现漏诊149根肋骨骨折,时间跨度从伤后1个月至2年以上。距损伤时间越久,越难以发现漏诊。曲面重组(CPR)、容积再现(VR)、最大密度投影(MIP)对不同时间段陈旧性肋骨骨折的诊断率具有明显差异,MIP检出率最高,其次为VR,CPR则最低,各方法检出率比较,差异有统计学意义(P﹤0.01)。结论对于伤后不同时间段复查肋骨骨折,不同的CT成像方式各有其优势。

Objective To clarity the diagnostic value of thin-slice spiral CT scan and its post-processing function for rib fracture.Methods The subjects were 125 appraised persons aged 41 to 80 who underwent radiographic reexamination of rib fracture in this appraisal institute in 2018.All appraised persons underwent thin-slice spiral CT scanning in this appraisal institute.The diagnosis was made according to the on-site CT imaging examination,and the related data were analyzed by chi-square test.Results Among the cases reviewed by our institute,64 were inconsistent with the original diagnosis.It is founded that 149 rib fractures were missed.The time span ranged from one month to more than two years after injury.The longer the time,the more difficult it is to detect missed diagnosis.Curved planar reconstruction(CPR),volume rendering(VR)and maximum intensity projection(MIP)have significant differences in the diagnosis of old rib fractures in different time periods.The detection rate of MIP is the highest,followed by VR and CPR,and the detection rate of each method is the lowest.The difference is statistically significant(P<0.01).Conclusion Different CT imaging methods have their own advantages for the review of rib fracture at different time after injury.