双能计算机断层扫描在脊柱骨折中的应用：一项系统评价与荟萃分析
Dual-Energy Computed Tomography in Spine Fractures: A Systematic Review and Meta-Analysis.
作者信息
Bäcker Henrik C, Wu Chia H, Perka Carsten, Panics Gergely
机构信息
Department of Orthopaedic Surgery and Traumatology, Charité Berlin, University Hospital, Berlin, Germany.
Department of Orthopedics & Sports Medicine, Baylor College of Medicine Medical Center, Houston, Texas, USA.
出版信息
Int J Spine Surg. 2021 Jun;15(3):525-535. doi: 10.14444/8074. Epub 2021 May 7.
BACKGROUND
The purpose of this study was to perform a systematic literature review and meta-analysis to evaluate the sensitivity, specificity, and accuracy of dual-energy computed tomography (DE-CT) of bone marrow edema and disc edema in spine injuries.In vertebral injuries, prompt diagnosis is essential to avoid any delays in treatment. Conventional radiography may only reveal indirect signs of fractures, such as when it is displaced. Therefore, to detect the presence of bone marrow or disc edemas, adjunctive tools are required, such as magnetic resonance imaging (MRI) or DE-CT.
METHODS
Search terms included ((DECT) OR (DE-CT) OR (dual-energy CT) OR "Dual energy CT" OR (dual-energy computed tomography) OR (dual energy computed tomography)) AND ((spine) OR (vertebral)), and the PubMed, EMBASE, and MEDLINE databases and the Cochrane Library and Google were used. We found 1233 articles on our preliminary search, but only 13 articles met all criteria. Data were extracted to calculate the pooled sensitivity, specificity, and diagnostic odds ratio for analysis using R software.
RESULTS
Within the 13 studies, 515 patients, 3335 vertebrae, and 926 acute fractures (27.8%) defined by MRI were included. The largest cohort included 76 patients with 774 vertebrae. In 12 publications, MRI was reported for comparison. For DE-CT, the overall sensitivity was 86.2% with a specificity of 91.2% and accuracy of 89.3%. Furthermore, 5 studies reported the accuracy of CT with an overall sensitivity of 81.3%, specificity of 80.7%, and accuracy with 80.9%. Significant differences were found for specificity ( < .001) and accuracy ( = .023). However, significant interobserver differences were reported.
CONCLUSIONS
DE-CT seems to be a promising diagnostic tool to detect bone marrow and disc edemas, which can potentially replace the current gold standard, the MRI.
LEVEL OF EVIDENCE
CLINICAL RELEVANCE
This study shows that DE-CT seems to be a promising diagnostic tool with an accuracy of 89.3%.
背景
本研究旨在进行系统的文献综述和荟萃分析，以评估双能计算机断层扫描（DE-CT）对脊柱损伤中骨髓水肿和椎间盘水肿的敏感性、特异性及准确性。在椎体损伤中，及时诊断对于避免治疗延误至关重要。传统X线摄影可能仅显示骨折的间接征象，如骨折移位时。因此，要检测骨髓或椎间盘水肿的存在，需要辅助工具，如磁共振成像（MRI）或DE-CT。
方法
检索词包括（（DECT）或（DE-CT）或（双能CT）或“双能CT”或（双能计算机断层扫描）或（双能计算机断层扫描））以及（（脊柱）或（椎体）），使用了PubMed、EMBASE和MEDLINE数据库以及Cochrane图书馆和谷歌。初步检索找到1233篇文章，但只有13篇符合所有标准。提取数据以计算合并敏感性、特异性和诊断比值比，使用R软件进行分析。
结果
13项研究纳入了515例患者、3335个椎体以及926例经MRI定义的急性骨折（27.8%）。最大队列包括76例患者和774个椎体。12篇出版物报告了用于比较的MRI。对于DE-CT，总体敏感性为86.2%，特异性为91.2%，准确性为89.3%。此外，5项研究报告了CT的准确性，总体敏感性为81.3%，特异性为80.7%，准确性为80.9%。特异性（P<0.001）和准确性（P=0.023）存在显著差异。然而，报告了显著的观察者间差异。
结论
DE-CT似乎是检测骨髓和椎间盘水肿的一种有前景的诊断工具，有可能取代当前的金标准MRI。
证据级别
2级。
临床相关性
本研究表明，DE-CT似乎是一种有前景的诊断工具，准确性为89.3%。
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