Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA.
University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
Skeletal Radiol. 2022 Aug;51(8):1603-1610. doi: 10.1007/s00256-022-04000-0. Epub 2022 Feb 3.
UTE MRI offers a radiation-free alternative to CT for bone depiction, but data on children is lacking. The purpose of this study was to determine whether UTE images improve detection and characterization of pediatric tibial eminence fractures.
Fifteen MRIs with UTE from 12 children (10 boys, 2 girls; mean age: 12.6 ± 3.3 years) with tibial eminence fractures (2018-2020) and 15 age-matched MRIs without fractures were included. After randomization, 5 readers reviewed images without and with UTE, at least 1 month apart, and recorded the presence of fracture and preferred images. If fracture is present, radiologists also recorded fragment size, number, and displacement; surgeons assigned Meyers-McKeever grade and management. Disagreements on management were resolved through consensus review. Kappa and intra-class correlation (ICC), sensitivity, and specificity were used to compare agreement between readers and fracture detection between images without and with UTE.
For fracture detection, inter-reader agreement was almost perfect (κ-range: 0.91-0.93); sensitivity and specificity were equivalent between images without and with UTE (range: 95-100%). For fracture characterization, UTE improved agreement on size (ICC = 0.88 to 0.93), number (ICC = 0.52 to 0.94), displacement (ICC = 0.74 to 0.86), and grade (ICC = 0.92 to 0.93) but reduced agreement on management (κ = 0.68 to 0.61), leading to a change in consensus management in 20% (3/15). Radiologists were more likely to prefer UTE for fracture and conventional images for non-fracture cases (77% and 77%, respectively, p < 0.001).
While UTE did not improve diagnosis, it improved agreement on characterization of pediatric tibial eminence fractures, ultimately changing the preferred treatment in 20%.
UTE MRI 为骨骼成像提供了一种无辐射的 CT 替代方案，但目前针对儿童的数据还很缺乏。本研究旨在确定 UTE 图像是否能提高儿童胫骨隆突骨折的检出和特征描述能力。
纳入了 2018 年至 2020 年间 12 名儿童（10 名男孩，2 名女孩；平均年龄：12.6±3.3 岁）15 例 MRI 检查中有 UTE 的胫骨隆突骨折和 15 例年龄匹配的无骨折的 MRI 检查。随机分组后，5 名读者至少相隔 1 个月分别阅读有无 UTE 的图像，并记录骨折的存在和首选图像。如果存在骨折，放射科医生还记录骨折块的大小、数量和移位；外科医生则对 Meyers-McKeever 分级和处理进行评估。对于处理意见的分歧，通过共识审查进行解决。kappa 和组内相关系数（ICC）、敏感性和特异性用于比较读者之间的一致性和有无 UTE 的图像对骨折的检出率。
在骨折检出方面，读者间的一致性近乎完美（kappa 范围：0.91-0.93）；无 UTE 和有 UTE 的图像的敏感性和特异性相当（范围：95-100%）。在骨折特征描述方面，UTE 提高了对大小（ICC=0.88 至 0.93）、数量（ICC=0.52 至 0.94）、移位（ICC=0.74 至 0.86）和分级（ICC=0.92 至 0.93）的一致性，但对处理的一致性降低（kappa=0.68 至 0.61），导致 20%（3/15）的共识处理发生改变。放射科医生更倾向于选择 UTE 图像评估骨折，而选择常规图像评估非骨折病例（分别为 77%和 77%，p<0.001）。
尽管 UTE 并未提高诊断能力，但它提高了对儿童胫骨隆突骨折的特征描述的一致性，最终改变了 20%的首选治疗方案。
