16层螺旋CT对可疑颅骨骨折的诊断价值

Diagnosis of suspected skull fracture with 16-slice spiral CT in patients with traumatic brain injury

关键词:  颅骨骨折  CT平扫  受试者工作曲线  灵敏度  特异度

Key words:  skull fracture  CT scan  receiver operating curve  sensitivity  specificity

摘要:

目的 探究16层螺旋CT对可疑颅骨骨折的诊断价值。方法 对2015年1月至2016年12月16岁以上颅脑外伤患者80例进行回顾性分析，纳入的对象为CT诊断为可疑颅骨骨折且行手术治疗的患者，患者在术前行头颅CT检查，以术中探查结果作为金标准，绘制头颅CT诊断颅骨骨折的受试者工作曲线（ROC），确定其特异度、灵敏度，分析其诊断颅骨骨折的能力。 结果16层头颅CT诊断可疑颅骨骨折的ROC曲线下面积（AUC）为0.89，具有较高的诊断价值（P=0.038，95%CI： 0.816～0.964）。当骨折线宽度为1.29mm时，诊断结果特异度为71.7%，灵敏度为96.3%，Youden指数为1.68。亚组分析表明，头颅CT对年龄偏大者诊断价值较高(P=0.03)。结论 头颅CT可用于颅脑外伤可疑颅骨骨折的急诊筛查，尤其是年龄偏大者，但对于颅骨骨折的确诊仍需要术中探查来明确。

Abstract:

Objective To evaluate the application of 16-slice spiral head CT in diagnosis of suspected skull fractures in patients with craniocerebral trauma. Methods Clinical data of 80 patients with suspected skull fractures undergoing 16-slice spiral CT examination from January 2015 to December 2016 were retrospectively reviewed. With the surgical results as the gold standard, the diagnostic value of CT scan for skull fractures was analyzed by receiver operating characteristic curve (ROC). Results The area under the ROC curve of cranial CT was 0.89 （95%CI： 0.816-0.964,P=0.038）. When the width of fracture line was 1.29mm, the specificity, sensitivity and Youden index for diagnosis was 71.7%, 96.3% and 1.68, respectively. Subgroup analysis showed that cranial CT had higher diagnostic value for patients with older ages (P=0.03). Conclusion Cranial CT can be used for emergency screening of suspected skull fractures in patients with craniocerebral trauma, especially in older patients, but the diagnosis needs to be confirmed by intraoperative exploration.