Center for Musculoskeletal Surgery, Charité - University Medicine Berlin, Charitéplatz 1, 10117, Berlin, Germany.
Department of Radiology, Charité - University Medicine Berlin, Charitéplatz 1, 10117, Berlin, Germany.
Skeletal Radiol. 2021 Jul;50(7):1359-1367. doi: 10.1007/s00256-020-03685-5. Epub 2020 Dec 4.
To investigate the diagnostic accuracy of collagen-sensitive maps derived from dual-energy computed tomography (DECT) for the detection of lumbar disk pathologies in a feasibility setting.
We retrospectively reviewed magnetic resonance imaging (MRI), computed tomography (CT), and DECT datasets acquired in patients who underwent periradicular therapy of the lumbar spine from June to December 2019. Three readers scored DECT collagen maps, conventional CT, and MRI for presence, type, and extent of disk pathology. Contingency table analyses were performed to determine diagnostic accuracy using MRI as standard of reference. Interrater agreement within and between imaging modalities was evaluated by computing intraclass correlation coefficients (ICCs) and Cohen's kappa. Correlation between sum scores of anteroposterior disk displacement was determined by calculation of a paired t test.
In 21 disks in 13 patients, DECT had a sensitivity of 0.87 (0.60-0.98) and specificity of 1.00 (0.54-1.00) for the detection of disk pathology. Intermodality agreement for anteroposterior disk displacement was excellent for DECT (ICC 0.963 [0.909-0.985]) and superior to CT (ICC 0.876 [0.691-0.95]). For anteroposterior disk displacement, DECT also showed greater within-modality interrater agreement (ICC 0.820 [0.666-0.916]) compared with CT (ICC 0.624 [0.39-0.808]).
Our data suggest that collagen-sensitive imaging has an added benefit, allowing more accurate evaluation of the extent of disk displacement with higher interrater reliability. Thus, DECT could provide useful diagnostic information in patients undergoing CT for other indications or with contraindications to MRI.
在可行性研究中，探究双能 CT（DECT）衍生的胶原敏感图对腰椎间盘病变的诊断准确性。
我们回顾性分析了 2019 年 6 月至 12 月间接受腰椎旁治疗的患者的磁共振成像（MRI）、计算机断层扫描（CT）和 DECT 数据集。三位观察者对 DECT 胶原图、常规 CT 和 MRI 进行评分，以评估椎间盘病变的存在、类型和程度。使用 MRI 作为标准参考，通过列联表分析评估诊断准确性。通过计算组内相关系数（ICC）和 Cohen's kappa 评估不同成像方式内和之间的观察者间一致性。通过计算配对 t 检验确定前后向椎间盘位移总和评分之间的相关性。
在 13 名患者的 21 个椎间盘内，DECT 检测椎间盘病变的敏感性为 0.87（0.60-0.98），特异性为 1.00（0.54-1.00）。DECT 在前后向椎间盘位移方面的跨模态一致性极佳（ICC 0.963[0.909-0.985]），优于 CT（ICC 0.876[0.691-0.95]）。对于前后向椎间盘位移，DECT 也显示出更高的同模态观察者间一致性（ICC 0.820[0.666-0.916]），优于 CT（ICC 0.624[0.39-0.808]）。
我们的数据表明，胶原敏感成像具有附加优势，可以更准确地评估椎间盘位移的程度，并具有更高的观察者间可靠性。因此，在因其他原因行 CT 检查或因 MRI 禁忌而行 CT 检查的患者中，DECT 可以提供有用的诊断信息。
