Department of Radiology, Gil Medical Center, Gachon University College of Medicine, 21 Namdong-daero, 774beon-gil, Namdong-gu, Incheon 21565, Republic of Korea.
Department of Radiology, Gil Medical Center, Gachon University College of Medicine, 21 Namdong-daero, 774beon-gil, Namdong-gu, Incheon 21565, Republic of Korea.
Eur J Radiol. 2019 Jul;116:225-230. doi: 10.1016/j.ejrad.2019.03.012. Epub 2019 Mar 22.
The purpose of this article is to assess whether dual-energy CT (DECT) collagen material decomposition technique could reliably depict graft integrity in patients with knee ligament reconstruction.
Seventy patients (mean age, 29.8 years; age range, 15-57 years; 61 men, 9 women) who underwent knee DECT, from June 2016 to January 2018, after knee ligament reconstruction were included in our study. A total of 92 intact tendon grafts (autograft, n = 37; allograft, n = 50), confirmed by MRI and clinical assessment or second-look arthroscopy of the operated knee, were evaluated. The type and number of reconstructed ligaments were as follows: anterior cruciate ligament (ACL) (n = 30), posterior cruciate ligament (PCL) (n = 20), medial collateral ligament (MCL) (n = 12), lateral collateral ligament (LCL) (n = 10), posterolateral ligamentous complex (PLC) (n = 7), anterolateral ligament (ALL) (n = 6), and medial patellofemoral ligament (MPFL) (n = 7). All DECT tendon-specific color mapping images were analyzed by two radiologists independently. Each reconstructed ligament was divided into proximal, middle, and distal portion and rated separately using a three-point scale (0 = absent 'dual-energy color staining'; 1 = partial 'dual-energy color staining'; 2 = full 'dual-energy color staining').
The mean of total visualization scores of reconstructed ligaments were 5 or more out of 6 points (PCL: 5.0 ± 0.8; MCL: 5.4 ± 0.7; LCL: 5.5 ± 0.5; PLC: 5.4 ± 1.0; ALL: 5.3 ± 0.6; MPFL: 5.8 ± 0.5), except for ACL (4.3 ± 1.7). No significant difference was observed in the mean of total visualization scores between the autografts and allografts (p > 0.05). The frequency of the score 0 was greater than 10% for the ACL group (15.7%), while less than 5% or 0% for the other groups. Overall, substantial to almost perfect interobserver agreement (range 0.71-0.93) was found for all types of ligaments.
DECT collagen material decomposition technique could be a valuable tool to qualitatively display tendon grafts in the patients with knee ligament reconstruction, but more caution would be needed to assess ACL graft.
本文旨在评估双能 CT（DECT）胶原物质分解技术是否能可靠地显示膝关节韧带重建患者的移植物完整性。
本研究纳入了 70 名（平均年龄 29.8 岁；年龄范围 15-57 岁；61 名男性，9 名女性）于 2016 年 6 月至 2018 年 1 月接受膝关节 DECT 的患者，这些患者均接受了膝关节韧带重建。共有 92 个完整的肌腱移植物（自体移植物，n=37；同种异体移植物，n=50），通过 MRI 和临床评估或手术膝关节的二次关节镜检查得到证实。重建的韧带类型和数量如下：前交叉韧带（ACL）（n=30）、后交叉韧带（PCL）（n=20）、内侧副韧带（MCL）（n=12）、外侧副韧带（LCL）（n=10）、后外侧韧带复合体（PLC）（n=7）、前外侧韧带（ALL）（n=6）和内侧髌股韧带（MPFL）（n=7）。两位放射科医生独立分析所有 DECT 肌腱特异性彩色映射图像。将每个重建的韧带分为近端、中部和远端三部分，并分别使用三分制（0=无“双能颜色染色”；1=部分“双能颜色染色”；2=完全“双能颜色染色”）进行评分。
重建韧带的总可视化评分平均为 6 分中的 5 分或以上（PCL：5.0±0.8；MCL：5.4±0.7；LCL：5.5±0.5；PLC：5.4±1.0；ALL：5.3±0.6；MPFL：5.8±0.5），除 ACL（4.3±1.7）外。自体移植物和同种异体移植物的总可视化评分平均值之间无显著差异（p＞0.05）。ACL 组评分 0 的频率大于 10%（15.7%），而其他组的频率小于 5%或 0%。总体而言，所有类型的韧带均具有高度到几乎完美的观察者间一致性（范围 0.71-0.93）。
DECT 胶原物质分解技术可以成为一种有价值的工具，用于定性显示膝关节韧带重建患者的肌腱移植物，但在评估 ACL 移植物时需要更加谨慎。
