Department of Radiology, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul, South Korea.
Department of Radiology, Konkuk University Medical Center, Seoul, South Korea.
AJR Am J Roentgenol. 2021 Apr;216(4):1003-1013. doi: 10.2214/AJR.19.22697. Epub 2021 Feb 10.
The purpose of this study was to evaluate the diagnostic utility of dual-layer CT (DLCT) for evaluating wrist injuries and to compare it with MRI. The cases of 62 patients with suspected wrist fractures who underwent imaging with both DLCT and MRI from January 2018 through February 2019 were retrospectively reviewed. By means of a calcium suppression algorithm, virtual noncalcium (VNCa) image reconstruction was performed, and the images were reviewed by two readers to identify fractures, bone contusions, and nontraumatic lesions in the radius, ulna, and carpal bones. Sensitivity, specificity, PPV, and NPV were calculated and compared between standard CT and VNCa images with a combination of standard CT and MRI as the reference standard. Use of DLCT with VNCa reconstruction increased the sensitivity of diagnosis of fractures in the radius and carpal bones over that of standard CT alone; occult fractures were detected that were not seen with standard CT. The sensitivity and specificity for detecting radius fracture were 98.1% and 93.8% for DLCT and 96.3% and 93.8% for standard CT. For detecting carpal bone fracture, sensitivity and specificity were 100% and 98.9% for DLCT and 93.8% and 100% for standard CT. VNCa reconstruction also had good diagnostic accuracy with regard to diagnosing nonfracture bone contusions in carpal bones. The accuracy was comparable to that of MRI with sensitivity of 92.9% and specificity of 94.5%. Interreader agreement in interpreting VNCa images was generally good to excellent. DLCT with VNCa reconstruction is a promising tool for identifying occult wrist fractures and nonfracture contusion injuries in patients with wrist trauma.
本研究旨在评估双层 CT（DLCT）在评估腕部损伤方面的诊断效用，并将其与 MRI 进行比较。回顾性分析了 2018 年 1 月至 2019 年 2 月间 62 例疑似腕部骨折患者的影像学资料，这些患者同时接受了 DLCT 和 MRI 检查。采用钙抑制算法进行虚拟非钙（VNCa）图像重建，由两位读者对图像进行分析，以识别桡骨、尺骨和腕骨中的骨折、骨挫伤和非创伤性病变。计算并比较了标准 CT 和 VNCa 图像与标准 CT 和 MRI 相结合作为参考标准的骨折、骨挫伤和非创伤性病变的敏感度、特异度、阳性预测值和阴性预测值。与单独使用标准 CT 相比，使用带 VNCa 重建的 DLCT 提高了桡骨和腕骨骨折的诊断灵敏度；可检测到标准 CT 无法发现的隐匿性骨折。DLCT 检测桡骨骨折的敏感度和特异度分别为 98.1%和 93.8%，标准 CT 分别为 96.3%和 93.8%。检测腕骨骨折时，DLCT 的敏感度和特异度分别为 100%和 98.9%，标准 CT 分别为 93.8%和 100%。VNCa 重建对诊断腕骨非骨折性骨挫伤也具有良好的诊断准确性，其敏感度为 92.9%，特异度为 94.5%。解读 VNCa 图像的读者间一致性通常较好到极好。带 VNCa 重建的 DLCT 是一种很有前途的工具，可用于识别腕部创伤患者的隐匿性腕部骨折和非骨折性挫伤损伤。
