Nishii Takashi, Tanaka Hisashi, Nakanishi Katsuyuki, Sugano Nobuhiko, Miki Hidenobu, Yoshikawa Hideki
Department of Orthopaedic Surgery, Osaka University Medical School, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan.
AJR Am J Roentgenol. 2005 Aug;185(2):379-85. doi: 10.2214/ajr.185.2.01850379.
Our objective was to assess the diagnostic ability of MDCT arthrography for acetabular and femoral cartilage lesions in patients with hip dysplasia.
A disorder of the articular cartilage was evaluated in 20 hips of 18 patients with acetabular dysplasia who did not have osteoarthritis or who had early stage osteoarthritis before undergoing pelvic osteotomy surgery. The findings on fat-suppressed 3D fast spoiled gradient-echo MRI and MDCT arthrography of the hip were evaluated by two independent observers, and sensitivity, specificity, and accuracy were determined using arthroscopic findings as the standard of reference. Kappa values were calculated to quantify the level of interobserver agreement.
The sensitivity and specificity for the detection of any cartilage disorder (grade 1 or higher) were (observer 1/observer 2) 49%/67% and 89%/76%, respectively, on MRI, and 67%/67% and 89%/82%, respectively, on CT arthrography. The sensitivity and specificity for the detection of cartilage lesions with substance loss (grade 2 or higher) were (observer 1/observer 2) 47%/53% and 92%/87%, respectively, on MRI, and 70%/79% and 93%/94%, respectively, on CT arthrography. CT arthrography provided significantly higher sensitivity in the detection of grade 2 or higher lesions than MRI for both observers. Interobserver agreement in the detection of grade 2 or higher cartilage lesions was moderate (kappa = 0.53) on MRI and substantial (kappa = 0.78) on CT.
MDCT arthrography is a sensitive and reproducible method for assessing articular cartilage lesions with substance loss in patients with hip dysplasia.
我们的目的是评估多排螺旋CT关节造影对发育性髋关节发育不良患者髋臼和股骨软骨损伤的诊断能力。
对18例髋臼发育不良患者的20个髋关节进行关节软骨疾病评估，这些患者在接受骨盆截骨手术前无骨关节炎或处于早期骨关节炎阶段。由两名独立观察者评估髋关节脂肪抑制三维快速扰相梯度回波磁共振成像（MRI）和多排螺旋CT关节造影的结果，并以关节镜检查结果作为参考标准确定敏感性、特异性和准确性。计算kappa值以量化观察者间的一致性水平。
在MRI上，检测任何软骨疾病（1级或更高）的敏感性和特异性分别为（观察者1/观察者2）49%/67%和89%/76%，在CT关节造影上分别为67%/67%和89%/82%。在MRI上，检测有实质缺损的软骨损伤（2级或更高）的敏感性和特异性分别为（观察者1/观察者2）47%/53%和92%/87%，在CT关节造影上分别为70%/79%和93%/94%。对于两名观察者而言，CT关节造影在检测2级或更高损伤方面的敏感性均显著高于MRI。在MRI上，检测2级或更高软骨损伤时观察者间一致性为中等（kappa = 0.53），在CT上为高度一致（kappa = 0.78）。
多排螺旋CT关节造影是评估发育性髋关节发育不良患者有实质缺损的关节软骨损伤的一种敏感且可重复的方法。
