轴向脊柱关节炎：双能量虚拟非钙 CT 在骶髂关节骨髓水肿检测中的应用。
Axial Spondyloarthritis: Dual-Energy Virtual Noncalcium CT in the Detection of Bone Marrow Edema in the Sacroiliac Joints.
机构信息
From the Departments of Radiology (H.W., X.H., X.C., S.T., C.L.), Rheumatism (G.Z., Y.C.), and Orthopedics of Traditional Chinese Medicine (M.C.), Guangdong General Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan Er Rd, Guangzhou 510080, Guangdong, China; Department of CT Collaboration, Siemens Healthcare, Guangzhou, China (L.S.); and Department of Information Media Industry, Guangzhou Public Utility Technician College, Guangzhou, China (X.L.).
出版信息
Radiology. 2019 Jan;290(1):157-164. doi: 10.1148/radiol.2018181168. Epub 2018 Oct 23.
Purpose To determine the diagnostic performance of dual-energy virtual noncalcium (VNCa) CT in the detection of bone marrow edema in study participants with sacroiliitis associated with axial spondyloarthritis. Materials and Methods In this prospective study, 47 consecutive participants (mean age, 27 years; age range, 14-41 years [28 male; mean age, 24 years; age range, 14-37 years] [19 female; mean age, 29 years; age range, 17-41 years]) underwent dual-energy CT and 3.0-T MRI between April 2016 and December 2017. Two independent readers visually evaluated all sacroiliac joints for the presence of abnormal marrow attenuation on dual-energy VNCa images using a four-point classification system (0, no edema; 1, mild edema; 2, moderate edema; 3, severe edema). CT numbers on VNCa images were determined with region-of-interest-based quantitative analysis. MRI was the reference standard for presence of bone marrow edema. Results Sensitivity, specificity, and accuracy of readers 1 and 2, respectively, in the identification of bone edema at CT were 87% and 93% (48 and 51 of 55), 94% and 91% (32 and 31 of 34), and 90% and 92% (80 and 82 of 89). Interobserver agreement was excellent (κ = 0.81). CT numbers from VNCa images increased from no edema to severe edema (P < .001). The area under the receiver operating characteristic curve was 0.93 for reader 1 and 0.91 for reader 2 in differentiation of the presence of bone marrow edema from no edema. A cutoff value of -33 HU derived from reader 1 yielded overall sensitivity, specificity, and accuracy of 90% (49 of 55), 83% (28 of 34), and 87% (77 of 89) in the detection of any extent of edema in the sacroiliac joints. Conclusion Dual-energy VNCa CT images had excellent diagnostic performance in evaluation of the extent of bone marrow edema in study participants with sacroiliitis associated with axial spondyloarthritis. © RSNA, 2018 See also the editorial by Guggenberger in this issue.
目的
旨在确定双能虚拟非钙（VNCa）CT 在检测与中轴型脊柱关节炎相关的骶髂关节炎患者骨髓水肿中的诊断性能。
材料与方法
在这项前瞻性研究中，47 例连续参与者（平均年龄 27 岁；年龄范围 14-41 岁[28 例男性；平均年龄 24 岁；年龄范围 14-37 岁][19 例女性；平均年龄 29 岁；年龄范围 17-41 岁]）于 2016 年 4 月至 2017 年 12 月期间接受了双能 CT 和 3.0-T MRI 检查。两位独立的读者使用四点分类系统（0，无水肿；1，轻度水肿；2，中度水肿；3，重度水肿）对所有骶髂关节的双能 VNCa 图像上的异常骨髓衰减进行了视觉评估。使用基于感兴趣区的定量分析确定 VNCa 图像上的 CT 数。MRI 是骨髓水肿存在的参考标准。
结果
读者 1 和读者 2 在 CT 识别骨髓水肿方面的敏感性、特异性和准确性分别为 87%和 93%（55 个中的 48 个和 51 个）、94%和 91%（34 个中的 32 个和 31 个）和 90%和 92%（89 个中的 80 个和 82 个）。观察者间一致性极好（κ=0.81）。VNCa 图像上的 CT 数从无水肿增加到重度水肿（P<0.001）。读者 1 的受试者工作特征曲线下面积为 0.93，读者 2 为 0.91，用于区分骨髓水肿与无水肿。读者 1 得出的-33 HU 截断值在检测骶髂关节任何程度的水肿时，总敏感性、特异性和准确性分别为 90%（55 个中的 49 个）、83%（34 个中的 28 个）和 87%（89 个中的 77 个）。
结论
双能 VNCa CT 图像在评估与中轴型脊柱关节炎相关的骶髂关节炎患者骨髓水肿程度方面具有出色的诊断性能。
注
本文译自 Radiology: Dual-Energy Virtual Noncalcium CT for the Detection of Bone Marrow Edema in Sacroiliitis, by John F. Setaro, MD, et al.
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