摘要
目的评价双能CT(DECT)虚拟去钙(VNCa)在创伤性距骨骨髓水肿中的应用价值。方法选取2018年1月至2019年9月间进行DECT和MRI检查的距骨创伤患者65例,进行回顾性分析。根据Hawkin距骨骨折分类系统,将距骨分为六个解剖区域(距骨外侧、距骨中央、距骨内侧、距骨后突、距骨外侧突和距骨头),6位放射科医师在未知临床和MRI结果的前提下,独立评估距骨是否存在骨折,至少8周后,阅片医师利用DECT VNCa图像重新评估距骨骨髓水肿情况,由第7位放射科医师利用VNCa图像测量CT值进行定量分析。2位对临床和CT结果设盲的高年资医师共同评估MRI图像,作为本研究的参考标准,对图像质量、图像噪声和诊断置信度分别使用5点Likert评分系统进行单独评级。结果MRI共发现49例患者的247个区域存在骨髓水肿。定性分析显示,基于区域的VNCa图像描述距骨骨髓水肿的总体敏感性、特异性、PPV、NPV和准确性分别为97.4%、86.9%、88.2%、97.1%和95.5%,医师间的一致性较好(K=0.83);基于患者的敏感性、特异性、PPV、NPV和准确性分别为96.8%、91.9%、91.9%、96.8%和95.4%,医师间的一致性较好(K=0.88);采用−24.2HU的诊断阈值,定量分析DECT的敏感性、特异性、PPV、NPV和准确性分别为98.00%、90.31%、91.00%、92.31%和96.83%,ROC曲线分析显示曲线下面积(AUC)为0.836;MRI和VNCa图像在诊断置信度(P=0.11)、图像噪声(P=0.62)和图像质量(P=0.28)方面没有显著差异,主观评价一致性较高。结论通过定性和定量分析,与MRI相比,DECT VNCa在诊断距骨创伤性骨髓水肿方面具有较高的诊断准确性。
Objective To evaluate the application value of dual-energy CT virtual noncalcium in traumatic talar bone marrow edema.Methods A total of 60 patients with talus trauma undergoing from January 2018 to September 2019 were selected for retrospective analysis.According to Hawkin talus fracture classification system,the talus is divided into six anatomical regions(talus outside,talus center,talus inside,talus posterior process,talus lateral process and caput tali).Without knowing the clinical and MRI results,6 radiologists independently evaluated the talus for fractures.At least 8 weeks later,the film-reading physician re-evaluated the talar bone marrow edema using the DECT-VNCa image,and the seventh radiologist carried out quantitative analysis using the measured CT value of VNCa image.Two senior physicians who were blinded to clinical and CT results jointly evaluated MRI images.As a reference standard for this study,image quality,image noise,and diagnostic confidence were separately rated using a 5-point Likert scoring system.Results MRI found that marrow edema existed in 247 areas of 49 patients.The qualitative analysis indicates that the overall sensitivity of talar bone marrow edema described by region-based VNCa images is 97.4%,86.9%,88.2%,97.1%,and 95.5%,and the consistency among physicians is good(K=0.83);the patient-based sensitivity is 96.8%,91.9%,91.9%,96.8% and 95.4%,and the consistency among physicians is good(K=0.88);when the testing threshold of−24.2HU is used,the sensitivity of quantitative analysis of DECT is 98.00%,90.31%,91.00%,92.31%,and 96.83%,and ROC curve analysis shows that the area under the curve(AUC)is 0.836;there is no significant difference between MRI and VNCa images in diagnostic confidence(P=0.11),image noise(P=0.62)and image quality(P=0.28),and consistency of subjective evaluation is higher.Conclusion By the qualitative and quantitative analysis,compared with MRI,DECT VNCa demonstrated higher diagnostic accuracy in diagnosis of traumatic talus bone marrow edema.
作者
何绪成
周闪闪
叶菊
韩文娟
郭轶智
王贵生
陈晓霞
HE Xu-cheng;ZHOU Shan-shan;YE Ju;HAN Wen-juan;GUO Yi-zhi;WANG Gui-sheng;CHEN Xiao-xia(Department of Radiology,the Third Medical Center of Chinese PLA General Hospital,Beijing 100039,China)
出处
《中国CT和MRI杂志》
2022年第2期161-165,共5页
Chinese Journal of CT and MRI
基金
国家自然科学基金(82001808)。
关键词
双能CT
磁共振成像
骨髓水肿
距骨
Dual Energy CT
Bone Marrow Edema
Magnetic Resonance Imaging
Talus
