Dundamadappa Sathish Kumar, Thangasamy Senthur, Resteghini Nancy, Vedantham Srinivasan, Chen Andrew, Takhtani Deepak
University of Massachusetts, 55 Lake Avenue North, Worcester, MA, 01655, USA,
Emerg Radiol. 2015 Aug;22(4):367-72. doi: 10.1007/s10140-015-1300-2. Epub 2015 Feb 20.
Skull fracture is a common finding following head trauma. It has a prognostic significance and its presence points to severe trauma. Additionally, there is a greater possibility of detecting associated small underlying extra-axial hematomas and subtle injuries to the brain parenchyma. In pediatric patients, the presence of multiple open sutures often makes fracture evaluation challenging. In our experience, 3D volume (3DV)-rendered CT images complement routine axial bone window (RBW) images in detection and characterization of fractures. This is a multi-reader, multi-case, paired retrospective study to compare the sensitivity and specificity of RBW and 3DV images in detection of calvarial fractures in pediatric patients. A total of 60 cases (22 with fractures and 38 without) were analyzed. Two experienced neuroradiologists and a radiology trainee were the readers of the study. For all readers, the sensitivity was not statistically different between the RBW and the 3DV interpretations. For each reader, there was a statistically significant difference in the interpretation times between the RBW and the 3DV viewing formats. A greater number of sutural diastasis was identified on 3DV. We propose that 3DV images should be part of routine head trauma imaging, especially in the pediatric age group. It requires minimal post-processing time and no additional radiation. Furthermore, 3DV images help in reducing the interpretation time and also enhance the ability of the radiologist to characterize the calvarial fractures.
颅骨骨折是头部外伤后常见的表现。它具有预后意义，其存在提示严重外伤。此外，更有可能发现相关的潜在小的轴外血肿和脑实质的细微损伤。在儿科患者中，多条开放缝线的存在常常使骨折评估具有挑战性。根据我们的经验，三维容积（3DV）重建的CT图像在骨折的检测和特征描述方面可补充常规轴向骨窗（RBW）图像。这是一项多阅片者、多病例的配对回顾性研究，旨在比较RBW和3DV图像在检测儿科患者颅骨骨折方面的敏感性和特异性。共分析了60例病例（22例有骨折，38例无骨折）。两名经验丰富的神经放射科医生和一名放射科实习医生参与了本研究的阅片工作。对于所有阅片者而言，RBW和3DV解读的敏感性在统计学上无差异。对于每位阅片者，RBW和3DV观察方式之间的解读时间存在统计学显著差异。3DV上发现的缝合线分离更多。我们建议3DV图像应成为常规头部外伤影像学检查的一部分，尤其是在儿科年龄组。它所需的后处理时间最少，且无额外辐射。此外，3DV图像有助于缩短解读时间，还能增强放射科医生对颅骨骨折进行特征描述的能力。
