目的 探讨多层螺旋CT(MSCT)扫 描及三维重建技术在降低隐匿性骨折漏诊 率中的应用价值。方法 选取2014年7月 至2016年8月我院及外院X线、CT常规轴 位平扫检查阴性，临床高度怀疑骨折的 隐匿性骨折患者50例为研究对象，后行 MSCT扫描，将扫描图像进行多平面重建 (MPR)、三维最大密度投影(MIP)、容积 再现法(VRT)、表面遮盖显示(SSD)等后 处理，分析MSCT诊断隐匿性骨折的阳性 率、漏诊率、误诊率，对比各重建技术 的确诊率及影像特点。结果 50例患者经 MSCT扫描及后处理47例显示骨折，其中 脊柱骨折12例，胫骨平台骨折10例，髋 关节骨折7例，眼眶骨折7例，肋骨骨折6 例，跟骨骨折5例，排除骨折3例，阳性 率达94.00%；以病理结果为准，MSCT对 隐匿性骨折的漏诊率为6.00%，误诊率为 2.00%；MPR、MIP、VRT、SSD、CPR对隐匿 性骨折的确诊率依次为94.00%、52.08%、 84.78%、81.63%、100.00%，以CPR确诊 率最高；MSCT可清晰显示X线未显示的骨 折,局部塌陷、骨折线、隐匿性病变及软 组织损伤，其中MIP层次感强，VRT立体感 好，CPR图像整体感强。结论 MSCT扫描及 三维重建技术可有效降低隐匿性骨折漏诊 率，尤其是三维重建中CPR、VRT、SSD层 次及立体感强，对可疑隐匿性骨折作出 准确诊断，为临床制定治疗方案提供依 据。

Objective To explore the application value of multi-slice spiral CT (MSCT) scan and three-dimensional (3D) reconstruction in reducing the missed diagnosis rate of occult fractures. Methods From July 2014 and August 2016, 50 patients with highly suspected occult fractures which were examined with X-ray and routine CT axial scan, and the results were negative were enrolled in the study. After MSCT scanning, their mages were processed by multi-planar reconstruction (MPR), 3D maximum intensity projection (MIP), volume rendering (VRT) and surface shaded display (SSD). The positive rate, missed diagnosis rate and misdiagnosis rate of MSCT in the diagnosis of occult fractures were analyzed. Results MSCT scan and postprocessing showed that there were 47 cases with fractures, including 12 cases with vertebral fractures, 10 cases with tibial plateau fractures, 7 cases with hip fractures, 7 cases with orbital fracture, 6 cases with rib fracture, 5 cases with calcaneal fractures and 3 cases without fractures, and the positive rate was 94.00%. According to the pathological results, the missed diagnosis rate and the misdiagnosis rate of MSCT were 6.00% and 2.00%. The accuracy rates of MPR, MIP, VRT, SSD and CPR in the diagnosis of occult fractures were 94.00%, 52.08%, 84.78%, 81.63% and 100.00%, and the diagnosis rate of CPR was the highest. MSCT can clearly show the fracture local collapse, fracture line, occult lesions and soft tissue injury which were not displayed by X-ray. The hierarchy of MIP was strong, three-dimensional sense of VRT was good, and the image associative perception of CPR was strong. Conclusion MSCT scan and 3D reconstruction can effectively reduce the of missed diagnosis rate of occult fractures, especially in 3D reconstruction, the three-dimensional sense of CPR,VRT and SSD is strong, which can be used to make accurate diagnosis of suspected occult fractures, providing the basis for clinical treatment.