Radiology Department, APHM, Marseille, France.
CNRS, ISM UMR 7287, Aix-Marseille Université, Marseille, France.
Skeletal Radiol. 2020 Aug;49(8):1259-1265. doi: 10.1007/s00256-020-03398-9. Epub 2020 Mar 7.
The purpose of this study was to compare the diagnostic performance of flat-panel computed tomography (FPCT) arthrography for cartilage defect detection in the ankle joint to direct magnetic resonance (MR) arthrography using multidetector computed tomography (MDCT) arthrography as the reference standard.
Twenty-seven patients with specific suspicion of articular cartilage lesion underwent ankle arthrography with injection of a mixture of diluted gadolinium and iobitridol and were examined consecutively with the use of FPCT, MDCT, and 1.5 T MR imaging. FPCT, MDCT, and MR arthrography examinations were blinded and randomly evaluated by two musculoskeletal radiologists in consensus. In each ankle, eight articular cartilage areas were assessed separately: medial talar surface, medial talar trochlea, lateral talar trochlea, lateral talar surface, tibial malleolus, medial tibial plafond, lateral tibial plafond, and fibular malleolus. Findings at FPCT and MR were compared with MDCT assessments in 216 cartilage areas.
For the detection of cartilage defects, FPCT demonstrated a sensitivity of 97%, specificity of 95%, and accuracy of 96%; and MR arthrography showed a sensitivity of 69%, specificity of 94%, and accuracy of 87%. FPCT and MR arthrography presented almost perfect agreement (κ = 0.87) and moderate agreement (κ = 0.60), respectively, with MDCT arthrography. Mean diagnostic confidence was higher for FPCT (2.9/3) than for MR (2.3/3) and MDCT (2.7/3) arthrography.
FPCT demonstrated better accuracy than did 1.5 T MR arthrography for cartilage defect detection in the ankle joint. Therefore, FPCT should be considered in patients scheduled for dedicated imaging of ankle articular cartilage.
本研究旨在比较平板式计算机断层（FPCT）关节造影术检测踝关节软骨缺损的诊断性能与多排计算机断层（MDCT）关节造影术直接磁共振（MR）关节造影术的诊断性能，以 MDCT 关节造影术为参考标准。
27 例患者因特定的关节软骨病变怀疑而接受踝关节关节造影术，注射稀释的钆和碘比醇混合物，然后连续使用 FPCT、MDCT 和 1.5T MR 成像进行检查。FPCT、MDCT 和 MR 关节造影检查均为盲法，并由两位肌肉骨骼放射科医生进行共识评估。在每个踝关节中，分别评估 8 个关节软骨区域：内侧距骨表面、内侧距骨滑车、外侧距骨滑车、外侧距骨表面、胫骨内踝、内侧胫骨平台、外侧胫骨平台和腓骨内踝。在 216 个软骨区域中，将 FPCT 和 MR 的发现与 MDCT 评估进行比较。
对于检测软骨缺损，FPCT 的敏感性为 97%，特异性为 95%，准确性为 96%；MR 关节造影术的敏感性为 69%，特异性为 94%，准确性为 87%。FPCT 和 MR 关节造影术与 MDCT 关节造影术分别具有近乎完美的一致性（κ=0.87）和中度一致性（κ=0.60）。FPCT 的平均诊断信心（2.9/3）高于 MR（2.3/3）和 MDCT（2.7/3）关节造影术。
FPCT 关节造影术在检测踝关节软骨缺损方面的准确性优于 1.5T MR 关节造影术。因此，在计划对踝关节关节软骨进行专门成像的患者中，应考虑使用 FPCT。
