Abstract:

Objective　To analyze the clinical values of multi-slice CT (MSCT) with multiplanar reformation (MPR) and volume rendering (VR) in the diagnosis of subtle and occult fractures. Methods　The clinical data of 126 patients with suspected fractures in plain X-ray examination and confirmed as subtle and occult fractures by MSCT scan in Xianning Central Hospital from January 2020 to January 2021 were retrospectively analyzed. Of the 126 patients, 66 were male and 60 female, and they were 16-63 years old, with a total of 145 suspected fracture joints. The MPR and VR were used to diagnose subtle and occult fractures, and the effects of the different techniques in the diagnosis of occult fractures were compared. The count data were expressed as cases or percentages, and the χ² and McNemar tests were performed. The sensitivity, specificity, and accuracy of MSCT in the diagnosis of subtle and occult fractures were calculated. Results　A total of 115 occult fracture sites and 30 fracture-free sites out of 145 osteoarticular injuries in the 126 cases were confirmed by surgery and post-operative follow up. The fractures were consisted of 26 pelvic and hip fractures, 20 knee fractures, 21 spine fractures, 31 ankle fractures, 11 elbow fractures, and 6 wrist fractures. With the results of surgery and post-operative follow-up as the gold standard, the McNemar test indicated that the sensitivity, specificity, and accuracy of MSCT in the diagnosis of occult fractures were 98.26% (113/115), 100.00% (30/30), and 98.62% (143/145), respectively. The accuracy rate of MPR in identifying occult fractures was 94.78%(109/115), with 6 missed diagnoses; the accuracy rate of VR in identifying occult fractures was 99.13% (114/115), with 1 missed diagnosis; the values of MPR and VR in the diagnosis of occult fractures yielded no statistical difference (P>0.05). Both MPR and VR were able to correctly identify the un-fractured area, and the accuracies of the two techniques in the diagnosis of occult fractures were not statistically different (χ²=3.684, P>0.05). Conclusion　MSCT scan and its post-processing techniques MPR and VR can effectively show subtle and occult fractures and are of great value in the diagnosis of subtle and occult fractures.

Key words: Multi-slice CT, Multiplanar reformation, Volume , rendering, Subtle fractures, Occult fractures, Diagnostic value

摘要： 目的　研究多层螺旋CT（multi-slice CT，MSCT）扫描多层面重组（multiplanar reformation，MPR）以及容积再现（volume rendering，VR）在诊断细微及隐匿性骨折中的应用价值。方法　回顾性分析咸宁市中心医院2020年1月至2021年1月126例疑似骨折但普通X线检查阴性，行MSCT扫描证实为细微及隐匿骨折患者的相关临床资料，其中男66例，女60例，年龄16～63岁，疑似骨折关节共145处，分别应用MSCT MPR以及VR重建诊断细微及隐匿骨折，比较不同重建方法在诊断隐匿性骨折中的效果。计数资料以例或百分比形式表示，采用χ²检验，采用McNemar检验，计算MSCT在诊断隐匿性骨折中的灵敏度、特异度及准确度。结果　126例患者经手术及术后随访共证实145个骨关节损伤中隐匿性骨折115个，无骨折部位30个。骨折关节部位包括：骨盆及髋关节26个，膝关节20个，脊柱21个，踝关节31个，肘关节11个，腕关节6个。以手术及术后随访结果为金标准，McNemar检验提示，MSCT诊断隐匿性骨折的灵敏度、特异度以及准确度分别为98.26%（113/115）、100.00%（30/30）、98.62%（143/145）。MPR识别隐匿骨折的正确率为94.78%（109/115），漏诊6处；VR识别隐匿性骨折的正确率为99.13%（114/115），漏诊1处；MPR及VR均能正确识别未骨折处，两种重建方法诊断隐匿性骨折的正确率比较，差异无统计学意义（χ²=3.684，P>0.05）。结论　MSCT扫描及其后处理技术MPR、VR均能有效显示微小及隐匿性骨折，在诊断微小及隐匿性骨折中具有重要价值。

关键词: 多层螺旋CT, 多层面重组, 容积再现, 细微骨折, 隐匿骨折, 诊断价值