From the Division of Experimental and Translational Imaging (C.B., J.N., S.S.M., M.H.A., I.Y., L.L., T.D., J.L.W.) and Department of Diagnostic and Interventional Radiology (T.G.R., K.E., T.J.V.), University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany; and Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, Messina, Italy (T.D.).
Radiology. 2019 Feb;290(2):446-455. doi: 10.1148/radiol.2018181286. Epub 2018 Dec 4.
Purpose To assess the diagnostic performance of dual-energy CT with reconstruction of virtual noncalcium (VNCa) images for the detection of lumbar disk herniation compared with standard CT image reconstruction. Materials and Methods For this retrospective study, 41 patients (243 intervertebral disks; overall mean age, 68 years; 24 women [mean age, 68 years] and 17 men [mean age, 68 years]) underwent clinically indicated third-generation, dual-source, dual-energy CT and 3.0-T MRI within 2 weeks between March 2017 and January 2018. Six radiologists, blinded to clinical and MRI information, independently evaluated conventional gray-scale dual-energy CT series for the presence and degree of lumbar disk herniation and spinal nerve root impingement. After 8 weeks, readers reevaluated examinations by using color-coded VNCa reconstructions. MRI evaluated by two separate experienced readers, blinded to clinical and dual-energy CT information, served as the standard of reference. Sensitivity and specificity were the primary metrics of diagnostic performance. Results A total of 112 herniated lumbar disks were depicted at MRI. VNCa showed higher overall sensitivity (612 of 672 [91%] vs 534 of 672 [80%]) and specificity (723 of 786 [92%] vs 665 of 786 [85%]) for detecting lumbar disk herniation compared with standard CT (all comparisons, P < .001). Interreader agreement was excellent for VNCa and substantial for standard CT (κ = 0.82 vs 0.67; P < .001). VNCa achieved superior diagnostic confidence, image quality, and noise scores compared with standard CT (all comparisons, P < .001). Conclusion Color-coded dual-energy CT virtual noncalcium reconstructions show substantially higher diagnostic performance and confidence for depicting lumbar disk herniation compared with standard CT. © RSNA, 2018.
目的 评估双能 CT 虚拟非钙（VNCa）图像重建在腰椎间盘突出症检测中的诊断性能，并与标准 CT 图像重建进行比较。
材料与方法 本回顾性研究共纳入 41 例患者（243 个椎间盘；总体平均年龄为 68 岁；24 名女性[平均年龄 68 岁]和 17 名男性[平均年龄 68 岁]），于 2017 年 3 月至 2018 年 1 月在 2 周内行临床可疑的第三代双源双能 CT 和 3.0-T MRI 检查。6 名放射科医师在不知临床和 MRI 信息的情况下，分别独立评估常规灰度双能 CT 序列以判断腰椎间盘突出症和脊神经根受压的存在和程度。8 周后，读者使用彩色编码 VNCa 重建再次评估检查结果。由两名独立的有经验的读者评估 MRI，他们对临床和双能 CT 信息均不知情，作为标准参考。敏感性和特异性是诊断性能的主要指标。
结果 MRI 共显示 112 个椎间盘突出。VNCa 对腰椎间盘突出症的总体敏感性（672 个中有 612 个[91%]，672 个中有 534 个[80%]）和特异性（786 个中有 723 个[92%]，786 个中有 665 个[85%]）均高于标准 CT（所有比较，P <.001）。VNCa 的读者间一致性极好，标准 CT 的读者间一致性较好（κ=0.82 比 0.67；P <.001）。VNCa 在诊断信心、图像质量和噪声评分方面均优于标准 CT（所有比较，P <.001）。
结论 与标准 CT 相比，彩色编码双能 CT 虚拟非钙重建对腰椎间盘突出症的显示具有更高的诊断性能和诊断信心。
© 2018 RSNA.
