Liu C, Chen Z, Xu J, Wu G
Department of Radiology, QingPu Branch of Zhongshan Hospital Affiliated to Fudan University, Qingpu District, ShangHai, China.
Department of Radiology, Qingpu District Hospital of Traditional Chinese Medicine, Qingpu District, ShangHai, China.
Clin Radiol. 2022 Apr;77(4):283-290. doi: 10.1016/j.crad.2022.01.035. Epub 2022 Feb 12.
To evaluate the value and limitations of computed tomography (CT) diagnosis of rib fractures, and to discuss the characteristics of missed rib fractures.
One hundred and sixty chest trauma patients who underwent both early CT (within 48 h) and follow-up CT (14 days later) were enrolled. For early CT examinations, the diagnosis of rib fractures was divided into routine assessment and verification assessment. The detection rates of rib fractures in both patterns were calculated, and the characteristics of missed rib fractures were analysed, based on the imaging results of the twice CT examinations as the reference standard.
A total of 584 fracture sites were confirmed. The overall detection rate of rib fractures in the routine assessment method was 72.4%. In the verification assessment, the detection rates of rib fractures of four observation strategies (axial images, multiplanar reconstruction [MPR], axial images + volume reconstruction [VR] and MPR + VR) were 76.2%, 79.1%, 78.6%, 80.8%, respectively. The incidence of occult fractures was 19.2% (112/584). In both assessment methods, the detection rates of rib fractures at the costochondral junction were the lowest (60%, 65%, respectively); the detection rates ranged from 63.6% to 74.7% for non-displaced rib fractures, but 100% for displaced rib fractures. Most (78.9%) missed rib fractures were accompanied by visible fractures on the same or adjacent first to second rib.
Most missed rib fractures are occult on early CT, which is attributable to the limitations of the CT technique. The number of displaced rib fractures on early CT is a more stable and reliable clinical indicator.
评估计算机断层扫描（CT）诊断肋骨骨折的价值及局限性，并探讨漏诊肋骨骨折的特点。
纳入160例胸部创伤患者，这些患者均接受了早期CT（48小时内）及随访CT（14天后）检查。对于早期CT检查，肋骨骨折的诊断分为常规评估和验证评估。计算两种模式下肋骨骨折的检出率，并以两次CT检查的影像结果作为参考标准，分析漏诊肋骨骨折的特点。
共确认584处骨折部位。常规评估方法中肋骨骨折的总体检出率为72.4%。在验证评估中，四种观察策略（轴位图像、多平面重建[MPR]、轴位图像+容积重建[VR]和MPR+VR）的肋骨骨折检出率分别为76.2%、79.1%、78.6%、80.8%。隐匿性骨折的发生率为19.2%（112/584）。在两种评估方法中，肋软骨交界处肋骨骨折的检出率最低（分别为60%、65%）；无移位肋骨骨折的检出率为63.6%至74.7%，但移位肋骨骨折的检出率为100%。大多数（78.9%）漏诊肋骨骨折在同一或相邻的第一至第二肋骨上伴有可见骨折。
大多数漏诊的肋骨骨折在早期CT上表现为隐匿性，这归因于CT技术的局限性。早期CT上移位肋骨骨折的数量是一个更稳定可靠的临床指标。
