常规外伤头颅CT液面征与气泡征对无移位颞骨骨折的预测价值
该回顾性研究纳入167例同时行常规平扫头颅CT和高分辨率颞骨CT的外伤患者，评估外耳道及中耳腔「液面征」和「气泡征」对无移位颞骨骨折的预测价值。结果显示液面征比值比最高（30.7），联合气泡征后敏感度80.6%、特异度87.5%，可提示加做颞骨专用CT。
要点
- 外伤头颅CT见外耳道或中耳腔液面征时，无移位颞骨骨折可能性显著增高。
- 联合液面征与气泡征可提高敏感度至80.6%，适合作为加做颞骨CT的提示。
- 乳突气房浑浊敏感度高（85.4%）但特异度低，单独使用价值有限。
核心结论
- 气泡征和液面征是常规外伤头颅CT上无移位颞骨骨折的强提示征象，可支持推荐加做颞骨专用CT以早期识别细微骨折。
研究设计与样本
- 回顾性研究，纳入167例18-93岁头部外伤患者，均行常规平扫头颅CT和高分辨率颞骨CT。
- 由一名神经放射科医生盲法评估头颅CT上外耳道和中耳腔的液面征、气泡征及乳突和中耳腔浑浊，另50例由第二名医生独立评估观察者间一致性。
- 以同期颞骨CT作为确认无移位颞骨骨折及记录骨折位置的参考标准。
关键影像表现/征象
- 无移位颞骨骨折103/167例（61.7%），最常累及乳突段（89.3%）和骨性外耳道（77.7%）。
- 液面征、气泡征、乳突浑浊、中耳腔浑浊在骨折阳性组的发生率分别为60.2%、68%、85.4%、71.8%，均显著高于阴性组的4.7%、9.4%、34.4%、21.9%（p<0.0001）。
诊断标准与关键数值
- 液面征比值比30.7（95% CI: 9.03-104.6），敏感度60.2%（95% CI: 50.5%-69.1%），特异度95.3%（95% CI: 87.1%-98.4%）。
- 乳突浑浊敏感度最高（85.4%，95% CI: 77.4%-91%），但特异度低（65.6%，95% CI: 53.4%-76.1%）。
- 联合液面征和气泡征敏感度80.6%（95% CI: 71.9%-87.1%），特异度87.5%（95% CI: 77.2%-93.5%）。
- 观察者间一致性kappa 0.72-0.92。
临床应用与阅片要点
- 阅片时注意观察外耳道和中耳腔有无液面征或气泡征，阳性时提示无移位颞骨骨折可能。
- 乳突浑浊敏感度高但特异度低，需结合液面征、气泡征综合判断。
- 发现上述征象时可建议加做颞骨高分辨率CT以确认骨折。
局限性
- 回顾性单中心研究，样本量有限。
- 仅部分病例（50例）评估观察者间一致性。
以上解读依据论文摘要（全文未开放获取或许可不允许翻译转载）。
英文原文（摘要）· 点击展开
BACKGROUND AND PURPOSE: Temporal bone fractures are common in patients with head trauma and can be easily overlooked on routine head CT when nondisplaced. This study evaluated the diagnostic utility of the "meniscus" and "air bubble" signs on standard trauma head CTs in predicting nondisplaced temporal bone fractures.
MATERIALS AND METHODS: We retrospectively reviewed 167 patients with head trauma (age 18-93 years) who underwent both a standard noncontrast head CT and a dedicated high-resolution temporal bone CT. A neuroradiologist blindly evaluated head CTs for the presence of a "meniscus" or "air bubble" sign in the external auditory canal and middle ear cavity, as well as presence of mastoid and middle ear cavity opacification. A second neuroradiologist independently reviewed a subset of 50 cases to assess interobserver agreement. A concurrent temporal bone CT served as the reference standard for confirming nondisplaced temporal bone fractures and recording fracture locations.
RESULTS: Nondisplaced temporal bone fractures were identified in 103 of 167 patients (61.7%), most commonly involving the mastoid segment (89.3%) and bony external auditory canal (77.7%). The meniscus sign, air bubble sign, mastoid opacification, and middle ear cavity opacification were significantly more frequent in scans positive for nondisplaced temporal bone fractures (60.2%, 68%, 85.4%, 71.8%) compared to negative scans (4.7%, 9.4%, 34.4%, 21.9%) (p<0.0001 for all). The meniscus sign showed the highest odds ratio (30.7, 95% CI: 9.03-104.6), with 60.2% (95% CI: 50.5%-69.1%) sensitivity and 95.3% (95% CI: 87.1%-98.4%) specificity. Mastoid opacification had the highest sensitivity (85.4%, 95% CI: 77.4%-91%) but low specificity (65.6%, 95% CI: 53.4%-76.1%). Combining the meniscus and air bubble signs increased sensitivity to 80.6% (95% CI: 71.9%-87.1%) and decreased specificity to 87.5% (95% CI: 77.2%-93.5%), improving the overall diagnostic performance for detecting nondisplaced temporal bone fractures. Interobserver agreement was substantial to almost perfect (kappa 0.72-0.92).
CONCLUSIONS: The air bubble and meniscus signs are strong indicators of nondisplaced temporal bone fractures on routine trauma head CT and may support recommending dedicated temporal bone CT to facilitate earlier recognition of subtle fractures.
引用
- Azrak O, Nasir A, Battal B, et al. Predictive Value of Air Bubble and Meniscus Signs on Routine Trauma Head CT for Nondisplaced Temporal Bone Fractures. AJNR Am J Neuroradiol. 2026. PMID: 42209150. doi:10.3174/ajnr.A9434
供执业医师工作参考，不替代临床判断；数值与分级以指南原文为准。