From the Department of Radiology, Vancouver General Hospital, University of British Columbia, 3350-950 W 10th Ave, Vancouver, BC, Canada V5Z 4E3.
Radiology. 2017 Sep;284(3):798-805. doi: 10.1148/radiol.2017161063. Epub 2017 Mar 16.
Purpose To quantify the sensitivity and specificity of dual-energy computed tomographic (CT) virtual noncalcium images in the detection of nondisplaced hip fractures and to assess whether obtaining these images as a complement to bone reconstructions alters sensitivity, specificity, or diagnostic confidence. Materials and Methods The clinical research ethics board approved chart review, and the requirement to obtain informed consent was waived. The authors retrospectively identified 118 patients who presented to a level 1 trauma center emergency department and who underwent dual-energy CT for suspicion of a nondisplaced traumatic hip fracture. Clinical follow-up was the standard of reference. Three radiologists interpreted virtual noncalcium images for traumatic bone marrow edema. Bone reconstructions for the same cases were interpreted alone and then with virtual noncalcium images. Diagnostic confidence was rated on a scale of 1 to 10. McNemar, Fleiss κ, and Wilcoxon signed-rank tests were used for statistical analysis. Results Twenty-two patients had nondisplaced hip fractures and 96 did not have hip fractures. Sensitivity with virtual noncalcium images was 77% and 91% (17 and 20 of 22 patients), and specificity was 92%-99% (89-95 of 96 patients). Sensitivity increased by 4%-5% over that with bone reconstruction images alone for two of the three readers when both bone reconstruction and virtual noncalcium images were used. Specificity remained unchanged (99% and 100%). Diagnostic confidence in the exclusion of fracture was improved with combined bone reconstruction and virtual noncalcium images (median score: 10, 9, and 10 for readers 1, 2, and 3, respectively) compared with bone reconstruction images alone (median score: 9, 8, and 9). Conclusion When used as a supplement to standard bone reconstructions, dual-energy CT virtual noncalcium images increased sensitivity for the detection of nondisplaced traumatic hip fractures and improved diagnostic confidence in the exclusion of these fractures. RSNA, 2017 Online supplemental material is available for this article. An earlier incorrect version of this article appeared online. This article was corrected on March 17, 2017.
目的 定量分析双能 CT 虚拟非钙图像在检测无移位髋部骨折中的敏感性和特异性，并评估是否获得这些图像作为骨重建的补充会改变敏感性、特异性或诊断信心。
材料与方法 临床研究伦理委员会批准了病历回顾，且无需获得知情同意。作者回顾性地确定了 118 名因疑似无移位创伤性髋部骨折而到 1 级创伤中心急诊就诊并接受双能 CT 检查的患者。临床随访是参考标准。3 名放射科医生对创伤性骨髓水肿的虚拟非钙图像进行了解读。对同一病例的骨重建进行单独解读，然后与虚拟非钙图像一起解读。诊断信心的评分范围为 1 至 10。采用 McNemar、Fleiss κ 和 Wilcoxon 符号秩检验进行统计学分析。
结果 22 例患者有非移位髋部骨折，96 例患者无髋部骨折。使用虚拟非钙图像的敏感性为 77%和 91%（22 例患者中的 17 例和 20 例），特异性为 92%-99%（96 例患者中的 89 例和 95 例）。当使用骨重建和虚拟非钙图像时，三位读者中的两位读者的敏感性比仅使用骨重建图像时提高了 4%-5%。特异性保持不变（99%和 100%）。与仅使用骨重建图像相比，使用联合骨重建和虚拟非钙图像（读者 1、2 和 3 的中位数评分为 10、9 和 10）可提高排除骨折的诊断信心（中位数评分为 9、8 和 9）。
结论 当作为标准骨重建的补充时，双能 CT 虚拟非钙图像提高了检测无移位创伤性髋部骨折的敏感性，并提高了排除这些骨折的诊断信心。
