两次法多层螺旋CT后处理诊断肋骨骨折在司法鉴定中的运用  

Application of two-stage multi-row spiral CT post-treatment in the diagnosis of rib fracture in judicial identification

作　　者：刘少强[1] 郭少华[1] 卢绍辉[1] 颜峰平[2] 王俊[1] 张娣 陈惠[1] 张乐 LIU Shao-qiang;GUO Shao-hua;LU Shao-hui;YAN Feng-ping;WANG Jun;ZHANG Di;CHEN Hui;ZHANG Le(Department of CT-MR,The First Affiliated Hospital of Gannan Medical University,Ganzhou,Jiangxi 341000;Forensic Centre of Gannan Medical University,Ganzhou,Jiangxi 341000)

机构地区：[1]赣南医学院第一附属医院CT-MR室,江西赣州341000 [2]赣南医学院司法鉴定中心,江西赣州341000

出　　处：《赣南医学院学报》2021年第9期948-950,970,共4页JOURNAL OF GANNAN MEDICAL UNIVERSITY

基　　金：江西省教育厅科技项目(GJJ170860)。

摘　　要：目的:探讨两次法多层螺旋CT后处理诊断急性肋骨骨折的价值。方法:选择32例急性外伤怀疑肋骨骨折的患者行两次(外伤时、外伤后20~30天)多排螺旋CT扫描,分别行肋骨表面三维容积成像(VR)、最高密度投影(MIP)、每一根肋骨薄层重建(CPR)、病变部位局部放大VR、MIP、CPR成像,对照第二次CT检查有新鲜骨痂形成或新增骨硬化处的肋骨,对第一次CT扫描进行回顾性重建。结果:32例患者共发现194根230处肋骨骨折。完全性肋骨骨折97处,不完全性肋骨骨折133处。完全性肋骨骨折与第一次检查吻合,没有误诊与漏诊。不完全性肋骨骨折133处,两次检查进行对照,首次CT漏诊19处,首次CT不能确定急性骨折21处,排除了陈旧性骨折与假像11处。结论:两次法多层螺旋CT后处理利用骨痂的出现明确首次CT急性骨折的存在并排除假像,诊断准确率可达100%。Objective:To evaluate the value of two-stage multi-slice spiral CT post-treatment in the diagnosis of acute rib fracture.Methods:A total of 32 cases with suspected rib fracture underwent two multi-slice spiral CT scans(20~30 days after trauma).Three-dimensional volume imaging(VR),highest density projection(MIP),thin-layer reconstruc⁃tion(CPR)of each rib,local enlargement of lesion site were performed.Results:In the 32 cases,a total of 194 ribs with 230 fractures were found.There were 97 complete rib fractures and 133 incomplete rib fractures.Complete rib frac⁃ture was anastomosed with the first examination without misdiagnosis and missed diagnosis.Incomplete rib fracture 133,two examinations were compared,the first CT missed 19,the first CT could not determine the acute fractures(21 frac⁃tures),excluding old fracture and false image(11 fractures).Conclusion:Two-step multi-slice spiral CT post-treat⁃ment can make sure the presence of callus CT of the first acute fracture,and eliminate the false image,the accuracy of the second contrast diagnosis can reach 100%。

关 键 词：两次法 CT后处理 肋骨骨折 司法鉴定 

分 类 号：R814.4[医药卫生—影像医学与核医学]