Department of Radiology, IRCCS Sacro Cuore Don Calabria Hospital, Via Don A. Sempreboni 10, 37024, Negrar, Italy.
Department of Radiology, Verona University Hospital, Verona, Italy.
Eur Radiol. 2020 Jul;30(7):4098-4106. doi: 10.1007/s00330-020-06775-z. Epub 2020 Mar 12.
To evaluate the diagnostic accuracy of dual-energy computed tomography (DECT) in identifying bone marrow edema (BME) around the hip joint in non-traumatic patients.
This prospective IRB-approved study was conducted between January 2019 and October 2019 and included 59 consecutive patients (18 males, 41 females; mean age 61.5 years, range 32-82) who were assessed by DECT and magnetic resonance imaging (MRI) within a 5-day period. Diagnostic accuracy values for diagnosing BME on a per-patient and on a per-partition-basis analysis were calculated for DECT images by two readers (R1 and R2, with 15 and 10 years of experience, respectively), using MRI as reference for diagnosis. Inter-observer agreements were calculated with k-statistics. A p value of < 0.05 was considered as statistically significant.
MRI depicted BME in 44/59 patients (74.58%), with the involvement of 83/708 (11.72%) partitions. The sensitivity, specificity, and accuracy of R1 and R2 were 95.45% (42/44), 86.67% (13/15), and 93.22% (55/59) for R1, and 86.36% (38/44), 80.00% (12/15), and 84.75% (50/59) for R2. For both readers, the BME detection rate was higher in patients with severe edema (100%) in comparison to patients with mild edema (91.30% and 73.91%). In the partition-basis analysis, sensitivity, specificity, and accuracy ranges were 33.3 to 100%, 91.84 to 100%, and 88.14 to 100%, respectively. The inter-observer agreement for patients' analysis was substantial (k = 0.7065), whereas for partition analysis ranged from fair (k = 0.2976) to near-perfect (k = 1.000).
DECT can accurately identify BME around the hip joint, in comparison to MRI.
• DECT can accurately identify bone marrow edema around the hip joint in a cohort of non-traumatic patients. • The detection of bone marrow edema by means of DECT may help the radiologist to identify associated findings, including avascular necrosis of the femoral head and insufficiency or stress fractures. • In cases of patients suffering from groin pain with bone marrow edema identified by DECT, the concurrent reading of high-resolution conventional CT images may increase the confidence of diagnosis and/or reduce the reading time.
评估双能 CT（DECT）在识别非创伤性患者髋关节周围骨髓水肿（BME）中的诊断准确性。
这是一项前瞻性 IRB 批准的研究，于 2019 年 1 月至 2019 年 10 月进行，共纳入 59 例连续患者（男 18 例，女 41 例；平均年龄 61.5 岁，范围 32-82 岁），在 5 天内同时接受 DECT 和磁共振成像（MRI）检查。两位读者（分别具有 15 年和 10 年经验的 R1 和 R2）通过 DECT 图像计算每位患者和每个分区基础上的 BME 诊断的诊断准确性值，并使用 MRI 作为诊断参考。采用 k 统计量计算观察者间一致性。p 值<0.05 被认为具有统计学意义。
MRI 显示 44/59 例（74.58%）患者存在 BME，83/708 个（11.72%）分区受累。R1 和 R2 的灵敏度、特异性和准确性分别为 95.45%（42/44）、86.67%（13/15）和 93.22%（55/59），86.36%（38/44）、80.00%（12/15）和 84.75%（50/59）。对于两位读者，严重水肿患者（100%）的 BME 检出率高于轻度水肿患者（91.30%和 73.91%）。在分区基础分析中，灵敏度、特异性和准确性范围分别为 33.3-100%、91.84-100%和 88.14-100%。对于患者分析，观察者间一致性较高（k=0.7065），而对于分区分析，范围从适度（k=0.2976）到近乎完美（k=1.000）。
与 MRI 相比，DECT 可以准确识别髋关节周围的 BME。
• DECT 可准确识别非创伤性患者髋关节周围骨髓水肿。
• 通过 DECT 检测骨髓水肿有助于放射科医生识别相关发现，包括股骨头缺血性坏死和不足或应力性骨折。
• 在 DECT 发现骨髓水肿的腹股沟疼痛患者中，同时阅读高分辨率常规 CT 图像可能会增加诊断信心和/或减少阅读时间。
