多层螺旋CT对创伤性膈损伤的诊断价值

摘要

Objective To determine the usefulness of multi-slice CT (MSCT) with multiple planar reconstruction (MPR) images in the diagnosis of traumatic diaphragm injuries (TDIs).Methods Thirty three patients of TDIs were reviewed retrospectively in this study,including 28 men and 5 women,aged from 1 ～76 years.Thirty three cases respectively underwent MSCT examinations.Sagittal and coronal MPRs were performed in all cases.The clinical data and MSCT appearances (such as the diaphragmatic discontinuity sign,the collar sign,the bread sign,and intra-thoracic location of herniated abdominal contents) were analyzed.Results Of 33 cases,2 cases were simple contusion,31 cases were blunt trauma injuries (left 26 cases,right 5 cases),The herniation intruding into the thoracic cavity consisted mainly of stomach or fluid gas bowel loops (left 25 cases,right 1 case),liver (only right 3 cases) and abdominal fat (left 16 cases,right 2 cases).The sensitivity of MSCT detecting the abnormality of the diaphragm was 100％.On MSCT images,21 cases (67.7％) showed diaphragmatic discontinuity sign,10 cases (32.2％) showed diaphragm thickening sign,and collar sign and bread sign were seen in 5 cases (16.1％) respectively.Compared with transverse CT scan,MPRs performed better for demonstrating the diaphragmatic discontinuity sign (19 cases vs 8 cases,P ＜ 0.05.Conclusion M SCT examinations are useful in the diagnosis of TDIs,especially when MSCT sagittal and coronal MPR images are obtained.%目的 探讨创伤性膈损伤的多层螺旋CT(MSCT)表现特征及诊断价值.方法 回顾性分析笔者医院创伤性膈损伤患者33例,其中男性28例,女性5例,患者年龄1～76岁,33例均行MSCT检查且行冠、矢状位多平面重建(MPR)处理,分析患者临床资料与MSCT表现特征及诊断价值,影像学表现包括膈肌连续性中断征、膈肌增厚征、项圈征、面包征及膈疝部位及内容物等.结果 33例中,2例为单纯挫伤,31例为钝性损伤(左侧26例,右侧5例),膈疝内容物分别为胃或含液气肠袢(左侧25例,右侧1例)、肝脏(仅右侧3例)及腹腔脂肪(左侧16例,右侧2例)；MSCT提示膈肌异常的敏感度为100％,21例(67.7％)可见膈肌连续性中断征,10例(32.2％)可见膈肌增厚征,项圈征与面包征各5例(16.1％).与横断面相比,MPR能更好地显示膈肌连续性中断征(P＜0.05).结论 MSCT检查对诊断创伤性膈损伤有重要价值,尤其是MPR技术对诊断有很大帮助.