DR和MSCT在创伤性膈肌破裂诊断中的价值

目的:比较DR、MSCT在创伤性膈肌破裂(TDR)诊断中的价值,为外科手术治疗提供可靠影像依据。方法:收集2013年1月至2015年1月两年间经DR、MSCT诊断并且手术确诊25例TDR患者的影像资料。由2位高年资医师采用双盲法分析,以发现横隔异常升高、隔肌中断缺损、膈肌活动度、“颈圈征”、膈肌破口位置、大小及疝囊内容物为诊断依据;并与手术结果对照计算DR、MSCT在诊断TDR的准确率。结果:25例患者中DR、MSCT轴位在显示横隔异常升高及MSCT后处理技术在隔肌中断缺损、疝囊内容物与手术结果均具有较好一致性,准确率100%。与手术结果相比MSCT轴位在膈肌破口位置、大小准确率20%、隔肌中断缺损准确率48%、颈圈征准确率55.56%、疝囊内容物准确率55.56%。与手术结果相比MSCT后处理技术在膈肌破口位置、大小准确率92%、颈圈征77.78%。DR在膈肌活动度、疝囊内容物上有一定价值,与手术结果相比准确率分别为52%和24%,在隔肌中断缺损、颈圈征、膈肌破口位置、大小存在一定局限性。结论:MSCT后处理技术在诊断TDR具有较高准确率,为临床提供精准的影像信息和最佳的手术方案,应作为首选影像学检查方法。 

TheValue of DR and MSCT in Diagnosis of Traumatic Diaphragm Rupture

Objective:To compare thevalue ofDR with MSCT in diagnosis of traumatic diaphragm rupture (TDR), and provide reliable imaging basis for the surgical treatment. Methods: collected the TDR image data of 25 confirmed cases by surgery who received DR and MSCT diagnosis from January 2013 to January 2015. Analyze the collected materials with double-blind method by two senior doctors to find the followingcharacteristicas diagnostic basis: abnormal evaluation of the diaphragm, diaphragm defect, mobility ofdiaphragmaticmuscles, collar feature,place and size of the rupture and the contents ofhernial sac.Thencalculatethe diagnostic accuracy of DR and MSCTreferringto the results of surgery. Results: among all the 25 cases, the surgical result and DR &MSCT diagnosis result have consistency.And the diagnosisaccuracyof abnormal evaluation of the diaphragm displayed on the axial images of DR & MSCT and diaphragm defect, the contents ofhernial sacdisplayed on MSCT post-processing is 100%. Compared with surgical results, the axial MSCT diagnosis accuracy of place and size of the rupture is 20%;diaphragm defect,48%;collar feature,55.56%,hernial sac,55.56%. Compared with surgical results, the MSCT post-processing diagnosis accuracy is showed below, place and size of the rupture, 92%; collar feature 77.78. DR diagnosis has some value on mobility ofdiaphragmaticmuscles and the contents of hernial sac, and the diagnosis accuracy were 52% and 24%. But it is not so ideal on diaphragm defect, collar feature and place and size of the rupture. Conclusion: MSCT post-processing technique demonstrates high diagnosticaccuracy;it can provide accurate imaging information and optimal operation plan. So it should be the preferred imaging diagnosis method in traumatic diaphragm rupture (TDR).