64层螺旋CT三维容积再现图像在肋骨骨折诊断中应用价值
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摘要
目的分析64层螺旋CT三维容积再现图像在肋骨骨折诊断中应用价值。方法选择如皋市人民医院2015年1月至2018年3月胸外伤疑似肋骨骨折且影像学检查资料完整的患者61例,其中男性41例,女性20例;年龄24~66岁,平均年龄46.6岁。行X射线检测、CT扫描和图像重建。比较X射线诊断与64层螺旋CT三维容积再现图像在肋骨骨折诊断时确诊率及漏诊情况。结果 61例经临床及影像学证实共124处骨折,其中多发骨折患者占65.6%;骨折部位多在腋段,占60.5%(75/124)。螺旋CT三维容积再现确诊58例119处骨折,X射线诊断确诊45例96处骨折;螺旋CT三维容积再现确诊率明显高于X射线诊断[96.0%(119/124) vs 77.4%(96/124)],差异有显著统计学意义(P=0.000 <0.01)。X射线诊断漏诊16例28处(占22.6%),其中膈下肋骨7处,腋段肋骨11处,肋骨弓部5处,靠近肋软骨5处。螺旋CT三维容积再现漏诊3例5处(占4.03%),其中3处靠近肋软骨,2处靠近肋胸椎。64层螺旋CT三维容积再现尚发现患者合并锁骨骨折4处,颈椎及胸椎骨折4处,肺挫伤7例,胸腔积液5例。结论应用64层螺旋CT三维容积再现图像技术提高了肋骨骨折的确诊率,诊断隐匿性肋骨骨折及并发症时效果更优,值得在临床推广使用。
Objective To analyze the application value of 64-slice spiral CT three-dimensional volume rendering in the diagnosis of rib fracture. Methods From January 2015 to March 2018, a total of 61 cases suspected rib fracture patients were enrolled, included 41 males and 20 females, aged 24-66 years old with mean of 46.6 years old. The X-ray detection, CT scan and image reconstruction were performed. The diagnosis and misdiagnosis rate of rib fracture were compared between Xray and 64-slice spiral CT three-dimensional volume rendering images. Results A total of 124 fractures were confirmed by clinical and imaging in 61 cases, of which the multiple fractures accounted for 65.6 %. The fractures were mostly in axillary segment, accounting for 60.5 %(75/124). There were 119 fractures diagnosed in 58 cases by spiral CT three-dimensional volume rendering, and 96 fractures in 45 cases by X-ray. The diagnosis rate of spiral CT three-dimensional volume rendering was significantly higher than that of X-ray[96.0 %(119/124) vs 77.4 %(96/124)], and the difference was statistically significant(P = 0.000 < 0.01). The misdiagnosis of X-ray happened in 28 cases(22.6 %), in which 7 of subphrenic ribs, 11 of axillary segment, 5 of arch ribs and 5 of cartilage ribs. Three cases with 5 fractures(4.03 %) were missed by spiral CT three-dimensional volume rendering, in which 3 of costal cartilage and 2 of costal thoracic vertebra. In addition, 64-slice spiral CT three-dimensional volume rendering showed 4 of collarbone fracture, 4 of cervical and thoracic fractures, 7 of pulmonary contusion and 5 of pleural effusion. Conclusion It is demonstrated that 64-slice spiral CT three-dimensional volume rendering improves the diagnosis rate of rib fracture, and shows more efficiency in occult rib fractures and complications, which is worth in clinical promotion.
Objective To analyze the application value of 64-slice spiral CT three-dimensional volume rendering in the diagnosis of rib fracture. Methods From January 2015 to March 2018, a total of 61 cases suspected rib fracture patients were enrolled, included 41 males and 20 females, aged 24-66 years old with mean of 46.6 years old. The X-ray detection, CT scan and image reconstruction were performed. The diagnosis and misdiagnosis rate of rib fracture were compared between Xray and 64-slice spiral CT three-dimensional volume rendering images. Results A total of 124 fractures were confirmed by clinical and imaging in 61 cases, of which the multiple fractures accounted for 65.6 %. The fractures were mostly in axillary segment, accounting for 60.5 %(75/124). There were 119 fractures diagnosed in 58 cases by spiral CT three-dimensional volume rendering, and 96 fractures in 45 cases by X-ray. The diagnosis rate of spiral CT three-dimensional volume rendering was significantly higher than that of X-ray[96.0 %(119/124) vs 77.4 %(96/124)], and the difference was statistically significant(P = 0.000 < 0.01). The misdiagnosis of X-ray happened in 28 cases(22.6 %), in which 7 of subphrenic ribs, 11 of axillary segment, 5 of arch ribs and 5 of cartilage ribs. Three cases with 5 fractures(4.03 %) were missed by spiral CT three-dimensional volume rendering, in which 3 of costal cartilage and 2 of costal thoracic vertebra. In addition, 64-slice spiral CT three-dimensional volume rendering showed 4 of collarbone fracture, 4 of cervical and thoracic fractures, 7 of pulmonary contusion and 5 of pleural effusion. Conclusion It is demonstrated that 64-slice spiral CT three-dimensional volume rendering improves the diagnosis rate of rib fracture, and shows more efficiency in occult rib fractures and complications, which is worth in clinical promotion.
引文
[1] SUN Jing, LI Xiao, ZHAO Tao, et al. Diagnostic value of threedimensional volume rendering in rib fracture using 64-slice spiral CT[J]. Chinese Journal of Medical Imaging, 2013, 21(2):121-123.[孙晶,李晓,赵涛,等. 64层螺旋CT三维容积重建对肋骨骨折的诊断价值[J].中国医学影像学杂志,2013,21(2):121-123.]
[2] ZHENG Jian, XU Xiao-ming, WEI Jiang-ping, et al. One case of rib fracture caused by CT artifact[J]. Chinese Journal of Forensic Science, 2011,(4):S12-S13.[郑剑,许小明,魏江平,等. CT伪影致肋骨骨折误鉴1例[J].中国司法鉴定,2011,(4):S12-S13.]
[3] LIU Cong-bin. The method of diagnosis of rib fracture analysis of the application of multislice CT three-dimensional technology[J]. Journal of Practical Medical Imaging, 2018, 19(2):127-129.[刘从彬.多层螺旋CT三维技术在肋骨骨折诊断中的应用[J].实用医学影像杂志,2018,19(2):127-129.]
[4] MA Ning, CUI Yan. Application value of multi-slice spiral CT in the diagnosis of rib fracture[J]. The Journal of Practical Medicine, 2016, 32(3):505-506.[马宁,崔艳.多层螺旋CT三维技术在肋骨骨折诊断中的应用价值[J].实用医学杂志,2016,32(3):505-506.]
[5] GE Xiao-jun, WU Hao, HUA Yan-qing, et al. Feasibility of ultra low-dose CT in rib fractures[J]. Journal of Clinical Radiology, 2011, 30(6):877-880.[葛虓俊,吴昊,滑炎卿,等.超低剂量CT技术在肋骨骨折中的可行性研究[J].临床放射学杂志,2011,30(6):877-880.]
[6] ZHAI Gui-juan, YU Chun, ZHAO Hui-ping. Application of multi-slice spiral CT three-dimensional reconstruction in the diagnosis of rib fracture[J]. Shandong Medical Journal, 2016,56(30):97-99.[翟桂娟,于淳,赵绘萍.多层螺旋CT三维重建在肋骨骨折诊断中的应用[J].山东医药,2016,56(30):97-99.]
[7] LU Xian-dong, ZHANG Cheng-xiang. Comparative analysis of 16-slice spiral CT 3D reconstruction in diagnosis of traumatic rib fracture with DR plain film[J]. Chongqing Medicine,2011, 40(15):1521-1522.[卢先东,张承祥. 16层螺旋CT三维重建诊断外伤性肋骨骨折与DR平片对照分析[J].重庆医学,2011,40(15):1521-1522.]
[8] WANG Yong. Application value of multi-slice spiral CT in the diagnosis of fine rib fracture[J]. Chinese Journal of Modern Drug Application, 2016, 10(2):76-77.[王勇.多层螺旋CT在肋骨微细骨折诊断中的应用价值[J].中国现代药物应用,2016,10(2):76-77.]
[9] GUO Xin-tao, TIAN Hui-min, JIAO Jian-long, et al. Common complications of senile rib fracture and related factors affecting prognosis[J]. Chinese Journal of Gerontology, 2013,33(12):2777-2779.[国欣涛,田惠民,焦建龙,等.老年肋骨骨折常见并发症及影响预后的相关因素[J].中国老年学杂志,2013,33(12):2777-2779.]
[10] YU Jie, LIU Xu-ming, LIN Da, et al. Optimal examination time for multiple slice spiral CT identification of fine rib fractures[J]. Chongqing Medical, 2015, 44(24):3412-3414.[余捷,刘绪明,林达,等.细微肋骨骨折多层螺旋CT鉴定的最佳检查时间[J].重庆医学,2015,44(24):3412-3414.]
[11] WANG Chun-guo, YANG Ling, ZHANG Bing, et al. Research of the MSCT optimal examination time for the occult rib fracture[J]. Journal of Clinical Radiology, 2016, 35(10):1598-1601.[王春国,杨玲,张炳,等.隐匿性肋骨骨折多层螺旋CT最佳检查时间段的研究[J].临床放射学杂志,2016,35(10):1598-1601.]
[12] ZHANG Jun-sheng, ZHAO Bo. Effect and value of multislice CT in early diagnosis of patients with tibial plateau occult fracture after injury of knee joint[J]. Medical&Pharmaceutical Journal of Chinese People’s Liberation Army, 2018, 30(8):96-99.[张军胜,赵波.多层螺旋CT对膝关节损伤后胫骨平台隐匿性骨折早期诊断的效果及价值[J].解放军医药杂志,2018,30(8):96-99.]
[13] CHEN Hong, HUANG Ying, ZHOU Lin. Application of 64-slice spiral CT in the diagnosis of rib fractures[J]. Journal of Imaging Research and Medical Applications, 2018, 2(19):8-10.[陈红,黄英,周林. 64排螺旋CT在肋骨骨折诊断中的应用分析[J].影像研究与医学应用, 2018,2(19):8-10.]
[14] LI San-bao, TANG Guang-jian, WANG Shan-lin, et al.Multislice spiral CT features of occult fracture of the ribs[J].Chinese Journal of CT and MRI, 2018, 16(6):141-144.[李三保,唐光健,王山林,等.肋骨隐匿性骨折多排螺旋CT征象分析[J].中国CT和MRI杂志,2018,16(6):141-144.]
[2] ZHENG Jian, XU Xiao-ming, WEI Jiang-ping, et al. One case of rib fracture caused by CT artifact[J]. Chinese Journal of Forensic Science, 2011,(4):S12-S13.[郑剑,许小明,魏江平,等. CT伪影致肋骨骨折误鉴1例[J].中国司法鉴定,2011,(4):S12-S13.]
[3] LIU Cong-bin. The method of diagnosis of rib fracture analysis of the application of multislice CT three-dimensional technology[J]. Journal of Practical Medical Imaging, 2018, 19(2):127-129.[刘从彬.多层螺旋CT三维技术在肋骨骨折诊断中的应用[J].实用医学影像杂志,2018,19(2):127-129.]
[4] MA Ning, CUI Yan. Application value of multi-slice spiral CT in the diagnosis of rib fracture[J]. The Journal of Practical Medicine, 2016, 32(3):505-506.[马宁,崔艳.多层螺旋CT三维技术在肋骨骨折诊断中的应用价值[J].实用医学杂志,2016,32(3):505-506.]
[5] GE Xiao-jun, WU Hao, HUA Yan-qing, et al. Feasibility of ultra low-dose CT in rib fractures[J]. Journal of Clinical Radiology, 2011, 30(6):877-880.[葛虓俊,吴昊,滑炎卿,等.超低剂量CT技术在肋骨骨折中的可行性研究[J].临床放射学杂志,2011,30(6):877-880.]
[6] ZHAI Gui-juan, YU Chun, ZHAO Hui-ping. Application of multi-slice spiral CT three-dimensional reconstruction in the diagnosis of rib fracture[J]. Shandong Medical Journal, 2016,56(30):97-99.[翟桂娟,于淳,赵绘萍.多层螺旋CT三维重建在肋骨骨折诊断中的应用[J].山东医药,2016,56(30):97-99.]
[7] LU Xian-dong, ZHANG Cheng-xiang. Comparative analysis of 16-slice spiral CT 3D reconstruction in diagnosis of traumatic rib fracture with DR plain film[J]. Chongqing Medicine,2011, 40(15):1521-1522.[卢先东,张承祥. 16层螺旋CT三维重建诊断外伤性肋骨骨折与DR平片对照分析[J].重庆医学,2011,40(15):1521-1522.]
[8] WANG Yong. Application value of multi-slice spiral CT in the diagnosis of fine rib fracture[J]. Chinese Journal of Modern Drug Application, 2016, 10(2):76-77.[王勇.多层螺旋CT在肋骨微细骨折诊断中的应用价值[J].中国现代药物应用,2016,10(2):76-77.]
[9] GUO Xin-tao, TIAN Hui-min, JIAO Jian-long, et al. Common complications of senile rib fracture and related factors affecting prognosis[J]. Chinese Journal of Gerontology, 2013,33(12):2777-2779.[国欣涛,田惠民,焦建龙,等.老年肋骨骨折常见并发症及影响预后的相关因素[J].中国老年学杂志,2013,33(12):2777-2779.]
[10] YU Jie, LIU Xu-ming, LIN Da, et al. Optimal examination time for multiple slice spiral CT identification of fine rib fractures[J]. Chongqing Medical, 2015, 44(24):3412-3414.[余捷,刘绪明,林达,等.细微肋骨骨折多层螺旋CT鉴定的最佳检查时间[J].重庆医学,2015,44(24):3412-3414.]
[11] WANG Chun-guo, YANG Ling, ZHANG Bing, et al. Research of the MSCT optimal examination time for the occult rib fracture[J]. Journal of Clinical Radiology, 2016, 35(10):1598-1601.[王春国,杨玲,张炳,等.隐匿性肋骨骨折多层螺旋CT最佳检查时间段的研究[J].临床放射学杂志,2016,35(10):1598-1601.]
[12] ZHANG Jun-sheng, ZHAO Bo. Effect and value of multislice CT in early diagnosis of patients with tibial plateau occult fracture after injury of knee joint[J]. Medical&Pharmaceutical Journal of Chinese People’s Liberation Army, 2018, 30(8):96-99.[张军胜,赵波.多层螺旋CT对膝关节损伤后胫骨平台隐匿性骨折早期诊断的效果及价值[J].解放军医药杂志,2018,30(8):96-99.]
[13] CHEN Hong, HUANG Ying, ZHOU Lin. Application of 64-slice spiral CT in the diagnosis of rib fractures[J]. Journal of Imaging Research and Medical Applications, 2018, 2(19):8-10.[陈红,黄英,周林. 64排螺旋CT在肋骨骨折诊断中的应用分析[J].影像研究与医学应用, 2018,2(19):8-10.]
[14] LI San-bao, TANG Guang-jian, WANG Shan-lin, et al.Multislice spiral CT features of occult fracture of the ribs[J].Chinese Journal of CT and MRI, 2018, 16(6):141-144.[李三保,唐光健,王山林,等.肋骨隐匿性骨折多排螺旋CT征象分析[J].中国CT和MRI杂志,2018,16(6):141-144.]