CT不同重建技术对视神经管骨折诊断效能及漏误诊原因分析  

Different CT Reconstruction Techniques for Optical Canal Fractures: Analysis of Diagnostic Efficiency and Causes for Missed Diagnosis and Misdiagnosis

作　　者：邵举薇[1] 向述天[1] 杨亚英[2] 苏伟[1] 

机构地区：[1]云南省第二人民医院昆明医科大学第四附属医院放射科,昆明650021 [2]昆明医科大学第一附属医院影像科,昆明650031

出　　处：《临床误诊误治》2016年第4期97-101,共5页Clinical Misdiagnosis & Mistherapy

摘　　要：目的分析CT不同重建技术对视神经管(optic canal,OC)骨折的诊断效能及漏误诊原因,以提高诊断正确率。方法回顾性分析2012年4月—2014年3月经临床及CT检查诊断OC骨折65例的临床资料。结果本组行单纯轴位高分辨率CT(HRCT)扫描漏诊19例,轴位扫描加曲面重建(cueved planar reformation,CPR)漏诊14例,轴位扫描加容积再现技术(volume rendering technique,VRT)漏诊16例,轴位扫描加二维多平面重建(multiplanar reformat,MPR)全部确诊。5例误诊均因轴位扫描所致,其中将颈内动脉钙化斑块误认为骨折碎片4例、前床突骨嵴状突起误认为管内骨折碎片1例。诊断效能显示,轴位扫描加MPR的诊断灵敏度及特异度均为100.00%,单纯轴位扫描诊断特异度为0;受试者工作曲线下面积分析显示,轴位扫描加MPR对OC骨折诊断的准确性最佳。结论 OC骨折需行轴位HRCT扫描结合MPR、CPR、VRT等后处理技术共同诊断,以轴位HRCT扫描加MPR诊断效能最佳。Objective To analyze CT signs of optic canal（ OC） fractures and causes of missed diagnosis and misdiagnosis so as to improve the accuracy of diagnosis. Methods A retrospective study was conducted for 60 cases with OC fractures and 5 cases misdiagnosed as OC fractures during April 2012 and March 2014. Results The direct CT signs of OC fractures included continuous interruption of bone cortex,OC collapse,narrowed canal cavity,and displacement of fragments.The indirect signs included herniation of the orbital fat involving sphenoidal and ethmoidal sinus,thickening mucous membrane of sphenoidal and ethmoidal sinus,and localized hematoma of mucous membrane. Out of 60 cases,17 cases showed linear fractures; 12 cases showed depressed fractures; 8 cases showed embedded fractures; 20 cases showed smashing fractures; 3cases showed mixed fractures. In 60 cases,HRCT pure axial view resulted in missed diagnosis of 19 cases,axial view in combination with CPR resulted in missed diagnosis of 14 cases,axial view in combination with VRT resulted in missed diagnosis of16 cases. HRCT axial view resulted in misdiagnosis of 5 cases as OC fractures,wherein 4 cases misdiagnosed as fragments actually had calcification of internal carotid and 1 misdiagnosed as canal fragment actually had ridge protruding of anterior clinoid process. The diagnostic efficiency showed that the axial view ＋ MPR provided sensitivity of 0,the pure axial view provided specificity of 0,while the other three methods provided specificity of 100%. The AUC of receiver operating characteristic（ ROC） curve showed that HRCT axial view in combination with MPR had the best diagnostic accuracy of OC fractures. Conclusion OC fracture should be diagnosed by HRCT axial view in combination with post-processing techniques such as MPR,CPR and VRT. HRCT axial view in combination with MPR has the best diagnostic accuracy. Application of multiple techniques can further reduce the rate of missed diagnosis and misdiagnosis.

关 键 词：视神经管骨折 视神经疾病 视神经损伤 体层摄影术 螺旋计算机 漏误诊 

分 类 号：R779.6[医药卫生—眼科]