踝关节骨髓水肿的识别：双能 CT 与 MRI 的诊断准确性比较。
Identification of bone marrow edema of the ankle: diagnostic accuracy of dual-energy CT in comparison with MRI.
机构信息
Department of Radiology, IRCCS Sacro Cuore Hospital, Via Don A. Sempreboni 10, 37024, Negrar, VR, Italy.
Department of Orthopedic Surgery, IRCCS Sacro Cuore Hospital, Negrar, Italy.
出版信息
Radiol Med. 2019 Oct;124(10):1028-1036. doi: 10.1007/s11547-019-01062-4. Epub 2019 Jul 4.
OBJECTIVE
To evaluate the diagnostic accuracy of dual-energy computed tomography (DECT) to identify bone marrow edema (BME) of the ankle.
METHODS
This prospective institutional review board approved study included 40 consecutive patients (29 males and 11 females; mean age of 32.3 years) studied with DECT (80 kV and tin filter 150 kV) and MRI within 10 days. DECT data were post-processed for generating non-calcium images of the ankle. Two radiologists evaluated the presence of BME on color-coded maps. Diagnostic accuracy values for diagnosing BME were calculated for DECT maps (qualitative assessment) and for CT numbers (quantitative assessment) by using receiver operator curves and area under the curve (AUC), using MRI as the gold standard. Interobserver and intraobserver agreements were calculated with k-statistics. A p < 0.05 was considered statistically significant.
RESULTS
DECT depicted BME in 23/25 patients (92.0%). The sensitivity, specificity, PPV and NPV, and accuracy achieved by evaluating the DECT images were 92.0, 86.6, 92.0, 84.6, and 90.0%, for reader 1 and 88.0, 86.6, 91.6, 78.6, and 87.5, for reader 2, respectively. The interobserver and intraobsever agreements were near perfect (k = 0.87 and k = 0.83, respectively). DECT numbers were significantly different between positive (mean - 12.6 ± 29.6 HU) and negative cases (mean - 64.2 ± 34.5 HU) with a p value < 0.001. By using - 20HU cutoff to identify BME (AUC of 0.896.), the sensitivity, specificity, PPV and NPV, and accuracy of the quantitative analysis were 88.0, 92.6, 95.7, 92.6, and 87.5%, respectively.
CONCLUSION
DECT represents an accurate imaging tool for demonstration of BME of the ankle when compared to MRI.
目的
评估双能 CT（DECT）诊断踝关节骨髓水肿（BME）的准确性。
方法
本前瞻性机构审查委员会批准的研究纳入 40 例连续患者（29 名男性和 11 名女性；平均年龄 32.3 岁），在 10 天内分别进行 DECT（80kV 和锡滤 150kV）和 MRI 检查。对 DECT 数据进行后处理，以生成踝关节的非钙图像。两位放射科医生在彩色编码图上评估 BME 的存在。使用接收器操作曲线和曲线下面积（AUC）计算 DECT 图（定性评估）和 CT 值（定量评估）的诊断 BME 的准确性值，以 MRI 为金标准。采用 K 统计量计算观察者间和观察者内的一致性。P<0.05 被认为具有统计学意义。
结果
DECT 显示 25 例患者中的 23 例（92.0%）存在 BME。评估 DECT 图像的读者 1 的灵敏度、特异性、PPV 和 NPV 以及准确性分别为 92.0%、86.6%、92.0%、84.6%和 90.0%，读者 2 分别为 88.0%、86.6%、91.6%、78.6%和 87.5%。观察者间和观察者内的一致性接近完美（k=0.87 和 k=0.83）。DECT 数值在阳性（平均-12.6±29.6HU）和阴性病例（平均-64.2±34.5HU）之间有显著差异，p 值<0.001。通过使用-20HU 作为界值来识别 BME（AUC 为 0.896），定量分析的灵敏度、特异性、PPV 和 NPV 以及准确性分别为 88.0%、92.6%、95.7%、92.6%和 87.5%。
结论
与 MRI 相比，DECT 是一种准确的踝关节骨髓水肿成像工具。
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