CAJ | 학술논문

目的探讨MSCT MPR方法诊断创伤性膈肌破裂(traumatic diaphragmatic rupture,TDR)的价值.方法 21例手术证实TDR,15例排除TDR的胸腹部创伤患者术前MSCT图像,由3名高年资医师先后对MSCT横断面和MPR图像行盲法回顾分析,以发现横膈异常升高、膈肌中断缺损及"颈圈征"作为TDR诊断依据.对照手术结果计算MSCT横断面及MPR诊断TDR的敏感度、特异度、阳性预测值、阴性预测值和准确度;MSCT横断面和MPR对膈肌中断缺损、"颈圈征"的辨认率差异及其诊断TDR的敏感度、特异度差异采用McNemar检验.结果 MSCT横断面诊断TDR的敏感度、特异度、阳性预测值、阴性预测值和准确度分别为71%(15/21)、80%(12/15)、83%(15/18)、67%(12/18)和75%(27/36);MPR分别为86%(18/21)、93%(14/15)、95%(18/19)、82%(14/17)和89%(32/36).21例TDR中,MSCT显示膈肌中断、缺损横断面12处(9例),采用MPR重组方法除显示上述12处外,还进一步显示8处(6例),共20处(15例),差异无统计学意义(P=0.125).MSCT横断面显示"颈圈征"6例,MPR方法显示14例,二者差异有统计学意义(P=0.021).MSCT横断面上观察膈肌中断缺损诊断TDR的敏感度、特异度分别为43%(9/21)和80%(12/15),MPR分别为71%(15/21)和93%(14/15),差异均无统计学意义(P值分别为0.125和0.500).MSCT横断面上观察"颈圈征"诊断TDR的敏感度、特异度分别为29%(6/21)和100%(15/15),MPR分别为67%(14/21)和100%(15/15),敏感度差异有统计学意义(P=0.021),特异度差异无统计学意义(P=1.000).结论 MSCT诊断TDR具有良好的敏感度、特异度和准确度;MPR是横断面诊断TDR的重要补充,有助于提高TDR诊断水平.
목적 탐토MSCT MPR방법진단창상성격기파렬(traumatic diaphragmatic rupture,TDR)적개치.방법 21례수술증실TDR,15례배제TDR적흉복부창상환자술전MSCT도상,유3명고년자의사선후대MSCT횡단면화MPR도상행맹법회고분석,이발현횡격이상승고、격기중단결손급"경권정"작위TDR진단의거.대조수술결과계산MSCT횡단면급MPR진단TDR적민감도、특이도、양성예측치、음성예측치화준학도;MSCT횡단면화MPR대격기중단결손、"경권정"적변인솔차이급기진단TDR적민감도、특이도차이채용McNemar검험.결과 MSCT횡단면진단TDR적민감도、특이도、양성예측치、음성예측치화준학도분별위71%(15/21)、80%(12/15)、83%(15/18)、67%(12/18)화75%(27/36);MPR분별위86%(18/21)、93%(14/15)、95%(18/19)、82%(14/17)화89%(32/36).21례TDR중,MSCT현시격기중단、결손횡단면12처(9례),채용MPR중조방법제현시상술12처외,환진일보현시8처(6례),공20처(15례),차이무통계학의의(P=0.125).MSCT횡단면현시"경권정"6례,MPR방법현시14례,이자차이유통계학의의(P=0.021).MSCT횡단면상관찰격기중단결손진단TDR적민감도、특이도분별위43%(9/21)화80%(12/15),MPR분별위71%(15/21)화93%(14/15),차이균무통계학의의(P치분별위0.125화0.500).MSCT횡단면상관찰"경권정"진단TDR적민감도、특이도분별위29%(6/21)화100%(15/15),MPR분별위67%(14/21)화100%(15/15),민감도차이유통계학의의(P=0.021),특이도차이무통계학의의(P=1.000).결론 MSCT진단TDR구유량호적민감도、특이도화준학도;MPR시횡단면진단TDR적중요보충,유조우제고TDR진단수평.
Objective To investigate the diagnostic value of multiplanar reformation (MPR)reconstruction for the detection of traumatic diaphragmatic rupture (TDR) in multi-slice CT examination.Methods Thirty six cases with thoracoabdominal trauma, including 21 cases with and 15 cases without TDR confirmed by surgery, received multi-slice CT examination. They were enrolled in this study. Three experienced radiologists retrospectively analyzed the axial and MPR images. The diagnostic criteria for TDR included abnormally elevated hemidiaphragm, diaphragmatic discontinuity, the "collar sign" or "dependent viscera "sign. Referenced to surgical results, the sensitivity, specificity, positive predictive value, negative predictive value and accuracy of axial and MPR images in detection of TDR were calculated. The McNemar was used to investigate the differences between axial and MPR images in the detection of diaphragmatic discontinuity and "collar sign", and the differences between axial and MPR images of these two signs in TDR diagnosis. Results The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of axial images in detection of TDR were 71% ( 15/21 ), 80% ( 12/15 ), 83% ( 15/18 ),67% ( 12/18 ) and 75% ( 27/36 ), respectively; of MPR images, they were 86% ( 18/21 ), 93%(14/15), 95% ( 18/19 ), 82% ( 14/17 ) and 89% ( 32/36), respectively. By axial images, twelve diaphragmatic defects or interrupts were identified in nine cases, and "collar sign" was identified in six cases. By MPR, 20 diaphragmatic defects or interrupts were identified in 15 cases ( P = 0.125 ), and "collar sign" was identified in 14 cases (P =0.021 ). The sensitivity and specificity of diaphragmatic defects or interrupts for TDR diagnosis in axial images were 43% (9/21) and 80% ( 12/15 ), respectively;in MPRimages, they were71% (15/21) (P=0.125)and93% (14/15) (P=0.500), respectively.The sensitivity and specificity of "collar sign" for TDR diagnosis in axial images were 29% (6/21) and 100% ( 15/15), respectively; in MPR images, they were 67% ( 14/21 ) (P =0. 021 ) and 100% (15/15)( P = 1.000), respectively. Conclusions MSCT presented good sensitivity, specificity and accuracy for the diagnosis of TDR. MPR images were useful supplements for axial images in TDR diagnosis which improved the diagnosis.