Xie Cheng, Ather Sarim, Mansour Ramy, Gleeson Fergus, Chowdhury Rajat
Department of Radiology, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Headley Way, Headington, OX3 9DU, Oxford, UK.
Department of Radiology, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Windmill Road, Headington, OX3 7HE, Oxford, UK.
Eur Radiol. 2021 Jun;31(6):3610-3615. doi: 10.1007/s00330-020-07604-z. Epub 2020 Dec 19.
Scaphoid injuries occult on plain radiography often require further imaging for definitive diagnosis. We investigate the utility of dual-energy computed tomography (DECT) for the detection of acute bone marrow oedema and fracture of scaphoid compared to MRI.
Twenty patients who presented acutely (without prior injury) to the emergency department with clinically suspected occult scaphoid fracture and had MRI of the wrist were prospectively recruited to have DECT (GE Revolution CT). Material decomposition images of the water-calcium base pair were generated and assessed in conjunction with the monochromatic images to permit correlation of marrow signal changes with any cortical disruption for fracture confirmation. The assessment was performed by two musculoskeletal radiologists blinded from MRI results. The statistical difference of MRI and reviewers' detection of acute bone oedema (1 = present, 0 = absent) was performed using the Friedman test (SPSS v.16).
MRI showed acute scaphoid fracture and/or bone marrow oedema in 14/20 patients of which 6 also had cortical disruption. On DECT, reviewer A identified oedema in 13 and cortical disruption in 10 patients while reviewer B identified oedema in 10 and cortical disruption in seven of the 14 MRI positive patients. No statistically significant difference in oedema detection on MRI and reviewers of DECT (p value 0.61) but DECT was more sensitive at detecting cortical disruption.
DECT has the capability to detect acute scaphoid oedema in addition to cortical fractures. However, compared to MRI, DECT has lower contrast resolution and less sensitive in the detection of mild oedema.
• Dual-energy CT is able to detect acute traumatic scaphoid marrow oedema. • Dual-energy CT has greater detection rate of scaphoid fractures than MRI. • Dual-energy CT is an alternative to MRI for occult scaphoid injury.
平片隐匿性舟骨损伤通常需要进一步影像学检查以明确诊断。我们研究双能计算机断层扫描（DECT）与磁共振成像（MRI）相比，在检测急性舟骨骨髓水肿和骨折方面的效用。
前瞻性招募20例急性（无既往损伤）到急诊科就诊、临床怀疑隐匿性舟骨骨折且已行腕部MRI检查的患者，进行DECT（GE Revolution CT）检查。生成水 - 钙碱基对的物质分解图像，并结合单色图像进行评估，以便将骨髓信号变化与任何皮质中断相关联以确认骨折。评估由两名对MRI结果不知情的肌肉骨骼放射科医生进行。使用Friedman检验（SPSS v.16）对MRI和检查者检测急性骨水肿（1 =存在，0 =不存在）的统计差异进行分析。
MRI显示20例患者中有14例存在急性舟骨骨折和/或骨髓水肿，其中6例也有皮质中断。在DECT上，检查者A在13例患者中识别出水肿，10例患者中识别出皮质中断；而检查者B在14例MRI阳性患者中的10例中识别出水肿，7例中识别出皮质中断。MRI和DECT检查者在水肿检测方面无统计学显著差异（p值0.61），但DECT在检测皮质中断方面更敏感。
DECT除了能检测皮质骨折外，还能够检测急性舟骨水肿。然而，与MRI相比，DECT的对比分辨率较低，在检测轻度水肿方面不太敏感。
•双能CT能够检测急性创伤性舟骨骨髓水肿。•双能CT对舟骨骨折的检出率高于MRI。•双能CT可作为隐匿性舟骨损伤MRI检查的替代方法。
