Foti Giovanni, Longo Chiara, D'Onofrio Mirko, Natali Simone, Piovan Gianluca, Oliboni Eugenio, Iacono Venanzio, Guerriero Massimo, Zorzi Claudio
From the Departments of Radiology (G.F., C.L., E.O.) and Orthopaedic Surgery (S.N., G.P., V.I., C.Z.), IRCCS Sacro Cuore Don Calabria Hospital, Via Don A. Sempreboni 10, 37024 Negrar, Italy; Department of Radiology, Verona University Hospital, Verona, Italy (M.D.); and Department of Computer Science, University of Verona, Verona, Italy (M.G.).
Radiology. 2023 Mar;306(3):e211818. doi: 10.1148/radiol.211818. Epub 2022 Oct 18.
Background Dual-energy CT (DECT) is an alternative to radiography and single-energy CT (SECT) for detecting prosthesis-related complications. Purpose To compare the diagnostic performance of DECT, SECT, and radiography for knee prosthesis loosening, with use of surgery or imaging follow-up reference standards. Materials and Methods In this prospective single-center study from December 2018 to June 2021, participants with unilateral painful knee prostheses underwent radiographic, SECT, and DECT imaging. Five blinded readers, four radiologists, and one orthopedic surgeon evaluated the images. Prosthesis loosening was diagnosed by a periprosthetic lucent zone greater than 2 mm. The sensitivity, specificity, and area under the receiver operating characteristic curve (AUC) of each method were determined and compared with use of a multireader multicase analysis. Results There were 92 study participants (mean age ± SD, 70 years ± 9.4; 67 women) evaluated. Tibial and femoral loosening were diagnosed in 47 and 24 participants, respectively. For the tibia, mean sensitivity and specificity for arthroplasty loosening were 88% and 91%, respectively, for DECT, 73% and 78% for SECT, and 68% and 81% for radiography. For the tibia, DECT demonstrated similar diagnostic performance (AUC, 0.90) to SECT (AUC: 0.90 vs AUC: 0.87, respectively; = .13) but was superior to radiography (AUC: 0.90 vs AUC: 0.82; = .002). Overall diagnostic performance of DECT (AUC, 0.87) for the femur was superior to both SECT and radiography ( < .001). Conclusion Dual-energy CT had generally better diagnostic performance in detecting loosening of tibial and femoral components after total knee arthroplasty compared with single-energy CT or radiography. Clinical trial registration no. 2942 © RSNA, 2022.
背景 双能CT（DECT）是用于检测假体相关并发症的一种替代传统X线摄影和单能CT（SECT）的方法。目的 采用手术或影像随访参考标准，比较DECT、SECT和X线摄影对膝关节假体松动的诊断性能。材料与方法 在这项于2018年12月至2021年6月进行的前瞻性单中心研究中，对单侧膝关节假体疼痛的参与者进行了X线摄影、SECT和DECT成像。五名不知情的阅片者，四名放射科医生和一名骨科医生对图像进行了评估。假体松动通过假体周围透亮区大于2mm来诊断。采用多阅片者多病例分析方法确定并比较了每种方法的敏感性、特异性和受试者操作特征曲线下面积（AUC）。结果 共评估了92名研究参与者（平均年龄±标准差，70岁±9.4；67名女性）。分别在47名和24名参与者中诊断出胫骨和股骨松动。对于胫骨，DECT对关节成形术松动的平均敏感性和特异性分别为88%和91%，SECT为73%和78%，X线摄影为68%和81%。对于胫骨，DECT显示出与SECT相似的诊断性能（AUC，0.90）（分别为AUC：0.90与AUC：0.87；P = 0.13），但优于X线摄影（AUC：0.90与AUC：0.82；P = 0.002）。DECT对股骨的总体诊断性能（AUC，0.87）优于SECT和X线摄影（P < 0.001）。结论 与单能CT或X线摄影相比，双能CT在检测全膝关节置换术后胫骨和股骨组件松动方面通常具有更好的诊断性能。临床试验注册号2942 © RSNA，2022。
