鼻骨骨折螺旋CT3D成像与X线片对比研究

目的 评价螺旋CT扫描三维重建成像与X线摄片对比对鼻骨骨折法医学鉴定的价值。方法 使用SOMATOM BALANCE 1s螺旋CT机，对32例复杂鼻部外伤者2mm／2mm扫描，常规进行最大密度投影法(MIP)、多平面重建(MPR)、表面覆盖法(SSD)、容积成像(VR)方式。全貌显示受伤鼻骨骨折影像，并与常规鼻骨摄片比较。结果 螺旋CT三维成像纠正3例X线照片的假阳性和6例诊断骨折类型不准确。结论 螺旋CT三维重建对诊断复杂鼻骨骨折块数目、移位，以及骨折类型优于X线摄片。     

MSCT及图像后处理在鼻骨骨折法医鉴定中的应用

目的探讨多层螺旋CT(MSCT)及图像后处理在鼻骨骨折法医学鉴定中的应用价值。方法采用MSCT对134例被鉴定人进行薄层扫描并行多平面重建(MPR)和表面遮盖成像(SSD)。比较MSCT与常规X线诊断结果。结果线型骨折55(41.04%)例,粉碎型骨折46例(34.33%),凹陷型骨折27例(20.15%),未见骨折6例(4.48%)。X线平片及CR片漏、误诊48例(35.82%)。MSCT正确诊断133例(99.25%)。两者诊断结果存在显著差异(χ2=45.0816,P<0.001)。结论MSCT及后处理图像应作为鼻骨骨折法医鉴定的主要依据。     

骨折鉴定中MSCT及图像后处理的诊断与应用

目的探讨多层螺旋CT(MSCT)及其图像后处理功能在骨折法医鉴定中的诊断与应用价值。方法对366例法医鉴定者行薄层扫描并进行表面遮盖成像(SSD),透明化X线模拟投影(see-through)和多平面重建(MPR)处理。对所得图像进行诊断和分型。结果准确诊断并对134例鼻骨、98例眼眶和21例颅骨骨折进行分型。正确显示36例肋骨骨折、4例肩胛骨骨折、24例脊柱骨折和27例四肢骨及关节骨折。利用透明化X线模拟投影等技术鉴别陈旧性骨折18例。结论MSCT及图像后处理在骨折法医鉴定中具有重要实用价值,可为伤害等级鉴定提供有力的法医学依据。     

多层螺旋CT及后处理技术在眼眶骨折法医鉴定中的应用

目的探讨MSCT及后处理技术在眼眶骨折法医鉴定中的应用价值。方法采用MSCT对98例法医鉴定者进行薄层扫描并行多平面重建(MPR)和表面遮盖成像(SSD)处理。比较MSCT与常规CT诊断结果。结果爆裂骨折51例(52.04%),直接骨折32例(32.65%),复合骨折11例(11.22%),未见骨折4(4.09%)例。常规CT漏、误诊32例(32.65%)。98例患者经MSCT检查明确诊断。二者诊断结果存在显著统计学差异(χ2=66.00,P<0.001)。结论MSCT及后处理技术在眼眶骨折法医鉴定中具有较高的实用价值。     

骨折法医鉴定中多层螺旋CT（MSCT）重建技术的应用分析

目的探讨MSCT及后处理功能在法医鉴定中的应用方法。方法对366例法医鉴定者行MSCT薄层扫描并表面遮盖成像(SSD),透明化X线模拟投影(see-through)和多平面重建(MPR)处理。分析技术参数和应用方法。结果采集层厚1~3mm,重建间隔0.5~1mm。SSD重建366例,其中细小骨折显示欠佳,4例眼眶重建出现“假孔”。21例关节分解后关节面显示清晰。透明化X线模拟投影重建18例,准确鉴别新鲜与陈旧骨折。MPR重建366例,显示骨折326例。结论选择适宜的后处理技术并联合应用可更好的显示骨折,为法医鉴定提供高质量图像。     

用MSCT沿鼻骨斜面多平面重组技术鉴定鼻骨线性骨折

目的探讨多层螺旋CT(MSCT)沿鼻骨斜面多平面重组(MPR)技术在鼻骨线性骨折法医学鉴定中的应用价值。方法以MSCT轴位平扫和沿鼻骨斜面多平面重组(MPR),对98例头面部外伤患者进行检查。结果 MSCT轴位平扫诊断:鼻骨正常和线性骨折(单侧或双侧)分别为29例和69例,阳性率70.4%。MSCT沿鼻骨斜面多平面重组(MPR)复诊:鼻骨正常的和线性骨折分别为19例和79例,阳性率80.6%。结论采用MSCT沿鼻骨斜面多平面重组技术可发现常规MSCT轴位平扫未能检见的鼻骨线性骨折,对法医学鉴定具有更高的应用价值。     

多层螺旋CT后处理技术在胸廓骨折中的作用

外伤导致的骨折,法医损伤程度鉴定时常需要根据骨折的具体情况进行评定。以往主要是通过普通X线平片诊断,但病变有时易被临近组织遮挡,造成漏诊及误诊。传统CT的横轴位扫描图像缺乏整体观,给司法鉴定带来一定困难。因此特别需要立体全方位观察。多层螺旋CT(MSCT)的多层面重建(MPR)和三维重建具有上述特征[1],可多角度、多层面反映骨折特征。特别对胸廓组成骨骨折断端无明显移位,而易漏诊的肋骨和胸骨骨折有更大的优越性。1对象与方法1.1对象本组共40例患者,男31例,女9例,年龄20~60岁,平均44岁。胸骨损伤14例,均为前胸壁遭受猛烈撞击伤…     

多层螺旋CT、普通CT和X线在骨折法医学鉴定中的应用

目的比较多层螺旋CT（MSCT）、普通CT与X线3种检查法,评价它们在骨折法医鉴定中的应用价值。方法对366例受检者（已接受其他影像学检查）行MSCT薄层扫描并行SSD,透明化X线模拟投影和MPR处理。统计分析MSCT、CT常规与X线检查在各部位骨折中的诊断正确率和漏、误诊率并行χ2检验。结果鼻骨、肋骨、四肢及关节、眶骨、颅骨骨折MSCT诊断正确率明显高于普通CT或X线（P〈0.01）。MSCT与普通CT对脊柱骨折的诊断正确率无统计学差异（P〉0.05）。MSCT、普通CT与X线的总体诊断正确率分别为99.45%、70.27%和59.17%。常规CT、X线与MSCT诊断结果间存在显著统计学差异（P〈0.001）。结论MSCT对骨折的显示更准确,可作为法医鉴定的重要辅助检查手段。     

多层螺旋CT及后处理技术在眼眶骨折法医鉴定中的应用

目的 探讨MSCT及后处理技术在眼眶骨折法医鉴定中的应用价值。方法 采用MSCT对98例法医鉴定者进行薄层扫描并行多平面重建(MPR)和表面遮盖成像(SSD)处理。比较MSCT与常规CT诊断结果。结果 爆裂骨折51例(52．04％)，直接骨折32例(32．65％)，复合骨折11例(11．22％)，未见骨折4(4．09％)例。常规CT、误诊32例(32.65％)。98例患者经MSCT检查明确诊断。二者诊断结果存在显著统计学差异(x^2=66．00，P&lt;0．001)。结论 MSCT及后处理技术在眼眶骨折法医鉴定中具有较高的实用价值。     

螺旋CT三维成像在肋骨骨折法医学鉴定中的应用

肋骨骨折在法医学检案中比较常见,临床上一般经X线检查(拍片、胸透)结合临床症状即可确诊。但在少数情况下,X线检查却不能发现肋骨骨折征象或难以确诊骨折,以致造成漏诊,给法医学鉴定带来困难。螺旋CT的问世普及,以及三维重建技术被应用于临床,为肋骨骨折的诊断提供了一种新的客观检查手段。现就实践中的鉴定案例,结合文献探讨螺旋CT三维成像技术在肋骨骨折法医学鉴定中的应用价值。1资料与方法本文共收集10例肋骨骨折,男性7例,女性3例,年龄在22～67岁,平均年龄为35岁。致伤物均为钝器,全部为直接外力作用于胸、背部所致。采用美国Marcon…     

Image-guided virtual autopsy findings of gunshot victims performed with multi-slice computed tomography and magnetic resonance imaging and subsequent correlation between radiology and autopsy findings

Because the use of radiology in modern forensic medicine has been, until today, mostly restricted to conventional X-rays, which reduces a 3D body to a 2D projection, a detailed 3D documentation of a gunshot's wound ballistic effects was not possible. The aim of our study was to evaluate whether the progress in imaging techniques over the last years has made it possible to establish an observer-independent and reproducible forensic assessment using multi-slice computed tomography (MSCT) and magnetic resonance imaging (MRI) technologies for the documentation and analysis of gunshot wounds. The bodies of eight gunshot victims were scanned by MSCT and by MRI; the data of these imaging techniques were post-processed on a workstation, interpreted and subsequently correlated with the findings of classical autopsy. With the spiral CT and MRI examinations and the subsequent 2D multi-planar reformation (MPR) and 3D shaded surface display (SSD) reconstruction, the entire gunshot-created complex skull fractures and brain injuries (such as wound channels and deeply-driven bone splinters) could be documented in complete and graphic detail. CT and MRI also documented vital reaction to the gunshot by demonstrating air emboli in the heart and blood vessels and the classic pattern of blood aspiration to the lung. Gunshot residues deposited within and under the skin were visible. In conclusion, we think that the radiological methods of MSCT and MRI have the potential to become a routine "virtual autopsy" tool in the future. Bullets and relevant histological samples from specific sites then might be won in image-guided minimally invasive fashion via percutaneous biopsy. The rapid application of developing radiological methods may lead to new horizons in forensic documentation and intravital as well as postmortem examination.     

Role of preoperative 3-dimensional computed tomography reconstruction in depressed skull fractures treated with craniectomy: a case report of forensic interest

Patients affected by cranial trauma with depressed skull fractures and increased intracranial pressure generally undergo neurosurgical intervention. Because craniotomy and craniectomy remove skull fragments and generate new fracture lines, they complicate forensic examination and sometimes prevent a clear identification of skull fracture etiology. A 3-dimensional reconstruction based on preoperative computed tomography (CT) scans, giving a picture of the injuries before surgical intervention, can help the forensic examiner in identifying skull fracture origin and the means of production.We report the case of a 41-year-old-man presenting at the emergency department with a depressed skull fracture at the vertex and bilateral subdural hemorrhage. The patient underwent 2 neurosurgical interventions (craniotomy and craniectomy) but died after 40 days of hospitalization in an intensive care unit. At autopsy, the absence of various bone fragments did not allow us to establish if the skull had been stricken by a blunt object or had hit the ground with high kinetic energy. To analyze bone injuries before craniectomy, a 3-dimensional CT reconstruction based on preoperative scans was performed. A comparative analysis between autoptic and radiological data allowed us to differentiate surgical from traumatic injuries. Moreover, based on the shape and size of the depressed skull fracture (measured from the CT reformations), we inferred that the man had been stricken by a cylindric blunt object with a diameter of about 3 cm.     

螺旋CT三维重建在肋骨骨折法医临床鉴定中的应用

目的探讨螺旋CT三维重建评价肋骨骨折在法医临床中应用价值。方法收集肋骨骨折35例,分别采用X线摄片、CT扫描及螺旋CT三维重建检查。结论35例检查都取得清晰的立体图像,且可以消除周围组织结构,单独观察肋骨骨折情况。结果:螺旋CT三维重建在肋骨骨折的诊断、法医临床学中有较高的价值。     

颅骨骨折断面细微结构的观察研究

作者利用扫描电子显微镜,对颅骨骨折断面上微细结构的形态学特征进行了观察与研究,发现在颅骨骨折断面上有微细的骨折裂线,向断面深部的骨质中延伸,其宽度为5至100um不等,主要分布在颅骨外板内,或外板与板障的交界处.分布于板障内的微细裂线可造成骨小梁横行、纵行和螺旋形骨折.骨折时,骨基质中的胶原纤维束可被分离或断裂,各胶原纤维层可分开.骨内血管可被骨折裂线横断或纵形撕裂,损伤的血管可被从哈佛氏管中拉出.生前骨折时,在微细裂线的深方可清楚见到纤维蛋白网和红细胞相互粘集,死后骨折则未见到此现象.本文还探讨了颅骨骨折发生的机理和推断生前骨折的可能性.     

Study on the microstructures of skull fracture

The authors observed the edges of skull fractures under the scanning electron microscope. Many microfractures can be found along the main fracture lines. The width of the microfractures varies from 5 to 100 microns. They may be located either in the external compact bone or between the outer compact bone and dipl?e, or in the dipl?e. Those within the dipl?e form transverse, longitudinal or spiral fractures of bony trabeculae. Collagenous fibre bunches in the bony matrix may be divided or broken and the different layers of collagenous fibre may be separated. The blood vessels inside the skull may be crosscut or longitudinally torn by the fracture lines. Sometimes the torn blood vessels may be drawn out of the Haversian canals. In antemortem fractures, the fibrin networks and red blood cells can be easily found in the depths of those cracks. The possible mechanism of formation of the microfractures and the possibility of differentiation between ante- and post-mortem fractures are discussed.