64层螺旋CT增强扫描在急诊胸部创伤中的初步应用

目的：探讨64层螺旋CT增强扫描在急诊胸部创伤中的诊断价值及临床意义。方法：18例急诊胸部创伤患者均行胸部64层螺旋CT平扫及增强扫描。采用最大密度投影（MIP）、曲面重建（CPR）和容积再现技术（VR）对胸部大血管进行重建、分析。将CT诊断结果与手术、随访复查结果进行比较。结果：18例中,CT平扫显示胸部主要损伤有：肺挫伤10例（55.56%）,血胸及肋骨骨折各9例（50%）,气胸8例（44.44%）,锁骨骨折6例（33.33%）。CT增强扫描诊断心脏大血管损伤7例,其中锁骨下动脉假性动脉瘤3例,胸主动脉假性动脉瘤2例,胸主动脉夹层和心包破裂各1例。CT增强扫描结果与手术、临床随访结果相吻合。结论：64层螺旋CT增强扫描是全面而准确地诊断急诊胸部创伤的重要影像技术,可以对CT平扫不能确定的心脏、大血管的损伤情况作出明确判断,对临床救治方案的早期确定具有重要的指导意义。

The preliminary application of contrast-enhanced 64-slice MSCT in emergency chest trauma

Objective： To assess the role of contrast-enhanced 64-slice multislice computed tomography （MSCT） in the diaguosis and treatment of emergency chest trauma patients. Methods： Eighteen patients （16 males and 2 females）, age range from 15 to 63 years, of emergency chest trauma were underwent with plain scan and enhancement scan of 64-slice MSCT aider the injury. Thoracic great vessels were reconstructed and analyzed by maximum intensity projection （MIP）, curved planar reformation （CPR） and volume rendering （VR）. The diagnoses of CT were compared with the corresponding operation or follow-up. Results： On 64-slice MSCT plain scan, major injuries were lung contusions （n=10, 55.56 %）, haemothorax （n=9, 50 %）, rib fractures （n=9, 50 %）,pneumothorax （n=8, 44.44 %） and clavicle fractures （n=6, 33.33 %）. 7 cases heart and thoracic great vessels injuries were diagnosed by contrast-enhanced CT scan, which including subclavian artery pseudoaneurysm （n=3）, thoracic aorta pseudoaneurysm （n=2）, dissection of thoracic aorta （n=l） and pericardium rupture （n=l）. There had a good overall correlation between results of CT and operation or follow-up. Conclusion： The contrast-enhanced 64-slice MSCT scan is the important image modality for overall and accurate diagnosis of emergency chest trauma patients. It cans assessment the injury of heart and thoracic great vessels that CT plain scan uncertain. It has great value in guiding surgical planning early.