1 Department of Radiology, Geneva University Hospital, Rue Gabrielle-Perret-Gentil 4, 1211 Geneva 14, Switzerland.
AJR Am J Roentgenol. 2013 Oct;201(4):W639-47. doi: 10.2214/AJR.12.9813.
The purpose of this study was to analyze fracture patterns and related effects of laryngeal trauma and to assess the value of 2D multiplanar reformation (MPR) and 3D reconstruction.
Among 4222 consecutively registered trauma patients who underwent emergency MDCT, 38 patients had presented with laryngeal trauma. Axial, 2D MPR, 3D volume-rendered, and virtual endoscopic images were analyzed retrospectively by two blinded observers according to predefined criteria. Laryngeal fractures, soft-tissue injuries, and airway compromise were evaluated and correlated with clinical, endoscopic, surgical, and follow-up findings.
Fifty-nine fractures (37 thyroid, 13 cricoid, nine arytenoid) were present in 38 patients. They were isolated in 21 (55%) patients. The other 17 (45%) patients had additional injuries to the neck, face, brain, chest, or abdomen. Laryngeal fractures were bilateral in 31 (82%) patients and were associated with hyoid bone fractures in nine (24%) patients. Arytenoid luxation was present in eight cartilages. Axial imaging missed 7 of 59 (12%) laryngeal fractures, six of eight (75%) arytenoid luxations, and four of nine (44%) hyoid bone fractures. Additional 2D MPR imaging missed 5 of 59 (8%) laryngeal fractures, five of eight (62.5%) arytenoid luxations, and two of nine (22%) hyoid bone fractures, whereas 3D volume-rendered images depicted them all. Virtual endoscopy and 3D volume rendering added diagnostic accuracy with respect to the length, width, shape, and spatial orientation of fractures in 22 of 38 (58%) patients; arytenoid luxation in six of eight (75%) luxations; and the evaluation of airway narrowing in 19 of 38 (50%) patients. Three-dimensional volume rendering was not of additional value in evaluation of the cricoid cartilage.
The use of 2D MPR and 3D volume rendering with or without virtual endoscopy improved assessment of thyroid and hyoid bone fractures, arytenoid luxations, and laryngotracheal narrowing, providing helpful data for optimal management.
本研究旨在分析喉外伤的骨折模式及相关影响，并评估二维多平面重建（MPR）和三维重建的价值。
在连续登记的 4222 例创伤患者中，有 38 例患者出现喉外伤。对轴向、二维 MPR、三维容积再现和虚拟内窥镜图像进行回顾性分析，由两名盲法观察者根据预设标准进行分析。评估喉骨折、软组织损伤和气道阻塞，并与临床、内窥镜、手术和随访结果相关联。
38 例患者中有 59 处骨折（37 处甲状软骨、13 处环状软骨、9 处杓状软骨）。21 例（55%）患者为单发骨折，17 例（45%）患者伴有颈部、面部、脑、胸部或腹部的其他损伤。31 例（82%）患者的喉骨折为双侧，9 例（24%）患者伴有舌骨骨折。8 个软骨中有 8 个杓状软骨脱位。轴向成像漏诊了 59 处喉骨折中的 7 处（12%）、8 处杓状软骨脱位中的 6 处（75%）和 9 处舌骨骨折中的 4 处（44%）。额外的二维 MPR 成像漏诊了 59 处喉骨折中的 5 处（8%）、8 处杓状软骨脱位中的 5 处（62.5%）和 9 处舌骨骨折中的 2 处（22%），而三维容积再现图像则全部显示了这些骨折。虚拟内窥镜和三维容积重建增加了 38 例患者中 22 例（58%）骨折的长度、宽度、形状和空间方位、8 例（75%）杓状软骨脱位和 38 例（50%）患者气道狭窄的评估的诊断准确性。三维容积重建对环状软骨的评估没有额外的价值。
使用二维 MPR 和三维容积重建（有或无虚拟内窥镜）可改善对甲状软骨和舌骨骨折、杓状软骨脱位以及喉气管狭窄的评估，为最佳治疗提供有帮助的数据。
