多层螺旋CT初查漏诊肋骨骨折30例分析

Analysis of missed rib fractures in 30 cases by MSCT in the initial

目的通过对胸部外伤初查CT漏诊肋骨骨折的病例分析,探讨轴位像和容积再现(VR)图像在肋骨骨折的诊断价值及其局限性。方法搜集我院2016年7月至2019年10月初查CT漏诊的肋骨骨折30例(共39根),采用16层螺旋CT胸部扫描,层厚为5.0 mm或7.5 mm,由2位中级以上诊断医师对轴位像和VR图像采用双盲法分析,如有分歧协商解决。结果30例初查CT共诊断肋骨骨折93根,复查CT诊断肋骨骨折132根,初查漏诊39根,漏诊率29.5%(39/132);部分病例短期(3周)内复查仍漏诊肋骨骨折7根,漏诊率为5.3%(7/132)。初查漏诊的39根肋骨,复查时轴位像和VR像均提示骨折28根、仅轴位像提示骨折6根、仅VR像提示骨折5条。结论多层螺旋CT(MSCT)初查时存在漏诊肋骨骨折的可能性,短期(3周)内复查CT仍然存在漏诊的可能性,根据临床需要复查CT是必要的。轴位像VR像在诊断肋骨骨折时具有一定的互补性,联合应用诊断的准确率更高。

Objective To explore the value and limitation of axial image and volume rendering(VR)image in the diagnosis of rib fracture by analyzing the cases'missed diagnosis of rib fracture on CT of chest trauma.Methods Thirty cases(39 in total)with rib fracture missed by CT in our hospital from July 2016 to October 2019 were collected.Sixteen slice spiral CT was used to scan the chest.The thickness of the slice was 5.0 mm or 7.5mm.The axial image and VR image were analyzed by two mid-level or above diagnostic doctors with double blind method.If there was any difference,it was resolved through consultation.Results There were 93 ribs fracture diagnosed by preliminary CT,132 ribs fracture diagnosed by recheck CT,39 ribs fracture missed diagnosis,the missed diagnosis rate was 29.5%(39/132);7 ribs fracture still missed diagnosis in a short time(3 weeks),the missed diagnosis rate was 5.3%(7/132).In the 39 ribs missed in the initial examination,28 fractures were indicated by axial image and VR image,6 fractures were indicated by axial image only,and 5 fractures were indicated by VR image only.Conclusion There is possibility of missed diagnosis of rib fracture in MSCT initial examination,and there is still possibility of missed diagnosis in short-term(3 weeks)re-examination of CT.It is necessary to reexamine CT according to clinical needs.Axial image and VR image are complementary in the diagnosis of rib fracture,and the accuracy of combined diagnosis is higher.