From the Departments of Radiology (G.F., G.C.) and Orthopaedic Surgery (A.C., S.N., C.Z.) and the Clinical Research Unit (M.G.), IRCCS Sacro Cuore Don Calabria Hospital, Via Don A. Sempreboni 10, 37024 Negrar, Italy; and Department of Radiology (A.F.), Verona University Hospital, Verona, Italy.
Radiology. 2021 Sep;300(3):641-649. doi: 10.1148/radiol.2021203510. Epub 2021 Jul 6.
Background Revisions of hip prostheses are increasing, and conventional radiography (CR) is a primary tool for managing -complications. However, dual-energy CT (DECT) with virtual monoenergetic imaging is capable of reducing periprosthetic metal artifacts compared with standard CT. Purpose To compare the diagnostic performance of DECT and CR in detecting hip prosthesis loosening, using surgery as a reference for diagnosis. Materials and Methods This retrospective single-center study conducted between January 2018 and October 2020 included -consecutive patients with unilateral painful hip prostheses. Two independent readers (with 15 years and 4 years of experience) who were blinded to clinical findings evaluated CR and DECT images. At imaging, diagnosis of loosening prosthesis was made for -periprosthetic radiolucency greater than or equal to 2 mm wide or the presence of two or more secondary findings, including -periprosthetic osteolysis, angulation of the implant, fracture, or abnormal periosteal reaction. For each reader and for each imaging parameter, -sensitivity and specificity were calculated. The diagnostic performance of each imaging tool was compared by using the McNemar test. Interobserver agreements were calculated with Cohen κ statistics. Statistical software was used. Results Overall, 178 patients (mean age ± standard deviation, 74 years ± 20; 96 men) were included (121 undergoing surgery, 57 follow-up). Overall, 87 of 178 patients (49%) were diagnosed with a loosened prosthesis. DECT had higher sensitivity and specificity than CR for both reader 1 (94% [82 of 87 examinations; 95% CI: 87, 98] and 93% [85 of 91 examinations; 95% CI: 86, 97] vs 84% [73 of 87 examinations; 95% CI: 74, 91] and 91% [83 of 91 examinations; 95% CI: 83, 96], respectively; < .001) and reader 2 (92% [80 of 87 examinations; 95% CI: 84, 97] and 95% [86 of 91 examinations; 95% CI: 88, 98] vs 80% [70 of 87 -examinations; 95% CI: 71, 88] and 91% [83 of 91 examinations; 95% CI: 83, 96], respectively; = .001), with better interobserver agreement (κ, 0.88 [95% CI: 0.81, 0.95] vs 0.78 [95% CI: 0.69, 0.88]). Conclusion Dual-energy CT showed better diagnostic performance than conventional radiography in diagnosing hip prosthesis loosening. See also the editorial by Lutz in this issue. © RSNA, 2021.
背景 髋关节假体的翻修越来越多，传统放射摄影（CR）是管理并发症的主要工具。然而，与标准 CT 相比，双能 CT（DECT）结合虚拟单能量成像能够减少假体周围金属伪影。目的 比较 DECT 和 CR 在检测髋关节假体松动方面的诊断性能，以手术为诊断参考。材料与方法 这是一项回顾性单中心研究，于 2018 年 1 月至 2020 年 10 月进行，纳入了单侧疼痛髋关节假体的连续患者。两名独立的读者（分别具有 15 年和 4 年的经验）在不了解临床发现的情况下评估了 CR 和 DECT 图像。在影像学上，将假体周围透光大于或等于 2 毫米宽或存在两个或更多次要发现（包括假体周围溶骨、植入物角度不正、骨折或异常骨膜反应）诊断为松动的假体。对于每个读者和每个成像参数，计算了敏感性和特异性。使用 McNemar 检验比较每种成像工具的诊断性能。使用 Cohen κ 统计计算观察者间一致性。使用统计软件。结果 总体而言，纳入了 178 名患者（平均年龄±标准差，74 岁±20 岁；96 名男性）（121 名接受手术，57 名随访）。总体而言，178 名患者中有 87 名（49%）被诊断为假体松动。对于读者 1（94%[82 次检查；95%CI：87,98]和 93%[85 次检查；95%CI：86,97]比 84%[73 次检查；95%CI：74,91]和 91%[83 次检查；95%CI：83,96]，分别；<.001）和读者 2（92%[80 次检查；95%CI：84,97]和 95%[86 次检查；95%CI：88,98]比 80%[70 次检查；95%CI：71,88]和 91%[83 次检查；95%CI：83,96]，分别；<.001），DECT 的敏感性和特异性均高于 CR，且观察者间一致性更好（κ，0.88[95%CI：0.81,0.95]比 0.78[95%CI：0.69,0.88]）。结论 DECT 在诊断髋关节假体松动方面的诊断性能优于传统放射摄影。也可参见本期杂志上 Lutz 的社论。©RSNA，2021。
