Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China.
Department of Radiology, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China.
Eur Radiol. 2023 Nov;33(11):7769-7778. doi: 10.1007/s00330-023-09720-y. Epub 2023 May 12.
OBJECTIVES: To determine whether dual-energy CT (DECT) can be used to accurately and reliably detect anterior cruciate ligament (ACL) rupture. MATERIALS AND METHODS: Participants with unilateral ACL rupture were prospectively enrolled, and the bilateral knees were scanned by DECT. A tissue-specific mapping algorithm was applied to improve the visualization of the ACLs. The 80-keV CT value, mixed-keV CT value, electron density (Rho), and effective atomic number (Z) were measured to quantitatively differentiate torn ACLs from normal ACLs. MRI and arthroscopy served as the reference standards. RESULTS: Fifty-one participants (mean age, 27.0 ± 8.7 years; 31 men) were enrolled. Intact and torn ACLs were explicitly differentiated on color-coded DECT images. The 80-keV CT value, mixed-keV CT value, and Rho were significantly lower for the torn ACLs than for the intact ACLs (p < 0.001). The optimal cutoff values were an 80-keV CT value of 61.8 HU, a mixed-keV CT value of 60.9 HU, and a Rho of 51.8 HU, with AUCs of 98.0% (95% CI: 97.0-98.9%), 99.2% (95% CI: 98.6-99.7%), and 99.8% (95% CI: 99.6-100.0%), respectively. Overall, DECT had almost perfect reliability and validity in detecting ACL integrity (sensitivity = 97.1% [95% CI: 88.1-99.8%]; specificity = 98.0% [95% CI: 89.5-99.9%]; PPV = 98.0% [95% CI: 93.0-99.8%]; NPV = 97.1% [95% CI: 91.7-99.4%]; accuracy = 97.5% [95% CI: 94.3-99.2%]). There was no evidence of a difference between MRI and DECT in the diagnostic performance (p > 0.99). CONCLUSION: DECT has excellent diagnostic accuracy and reliability in qualitatively and quantitatively diagnosing ACL rupture. CLINICAL RELEVANCE STATEMENT: DECT could validly and reliably diagnose ACL rupture using both qualitative and quantitative methods, which may become a promising substitute for MRI to evaluate the integrity of injured ACLs and the maturity of postoperative ACL autografts. KEY POINTS: • On color-coded DECT images, an uncolored ACL was a reliable sign for qualitatively diagnosing ACL rupture. • The 80-keV CT value, mixed-keV CT value, and Rho were significantly lower for the torn ACLs than for the intact ACLs, which contributed to the quantitative diagnosis of ACL rupture. • DECT had an almost perfect diagnostic performance for ACL rupture, and diagnostic capability was comparable between MRI and DECT.
目的：确定双能 CT（DECT）是否可用于准确、可靠地检测前交叉韧带（ACL）撕裂。
材料和方法：前瞻性纳入单侧 ACL 撕裂的参与者，并对双侧膝关节进行 DECT 扫描。应用组织特异性映射算法提高 ACL 的可视化效果。测量 80keV CT 值、混合 keV CT 值、电子密度（Rho）和有效原子序数（Z），以定量区分撕裂的 ACL 和正常 ACL。MRI 和关节镜检查作为参考标准。
结果：共纳入 51 名参与者（平均年龄 27.0±8.7 岁；31 名男性）。在彩色编码的 DECT 图像上明确区分了完整和撕裂的 ACL。撕裂的 ACL 的 80keV CT 值、混合 keV CT 值和 Rho 均明显低于完整的 ACL（p<0.001）。最佳截断值为 80keV CT 值 61.8HU、混合 keV CT 值 60.9HU 和 Rho 51.8HU，其 AUC 分别为 98.0%（95%CI：97.0-98.9%）、99.2%（95%CI：98.6-99.7%）和 99.8%（95%CI：99.6-100.0%）。总体而言，DECT 在检测 ACL 完整性方面具有近乎完美的可靠性和有效性（灵敏度=97.1%[95%CI：88.1-99.8%]；特异性=98.0%[95%CI：89.5-99.9%]；PPV=98.0%[95%CI：93.0-99.8%]；NPV=97.1%[95%CI：91.7-99.4%]；准确性=97.5%[95%CI：94.3-99.2%]）。MRI 和 DECT 在诊断性能方面无差异（p>0.99）。
结论：DECT 在定性和定量诊断 ACL 撕裂方面具有出色的诊断准确性和可靠性。
临床相关性：DECT 可通过定性和定量方法有效可靠地诊断 ACL 撕裂，可能成为 MRI 的有前途替代品，用于评估受伤 ACL 的完整性和术后 ACL 自体移植物的成熟度。
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