Goethe University Frankfurt, University Hospital, Institute for Diagnostic and Interventional Radiology, Frankfurt am Main, Germany.
Department of Cardiology, Angiology, and Pulmonology, University Hospital Heidelberg, Heidelberg, Germany.
Eur J Radiol. 2024 Jan;170:111235. doi: 10.1016/j.ejrad.2023.111235. Epub 2023 Nov 30.
This study aimed to evaluate the clinical utility of modern single and dual-energy computed tomography (CT) for assessing the integrity of the cruciate ligaments in patients that sustained acute trauma.
Patients who underwent single- or dual-energy CT followed by 3 Tesla magnetic resonance imaging (MRI) or knee joint arthroscopy between 01/2016 and 12/2022 were included in this retrospective, monocentric study. Three radiologists specialized in musculoskeletal imaging independently evaluated all CT images for the presence of injury to the cruciate ligaments. An MRI consensus reading of two experienced readers and arthroscopy provided the reference standard. Diagnostic accuracy parameters and area under the receiver operator characteristic curve (AUC) were the primary metrics for diagnostic performance.
CT images of 204 patients (median age, 49 years; IQR 36 - 64; 113 males) were evaluated. Dual-energy CT yielded significantly higher diagnostic accuracy and AUC for the detection of injury to the anterior (94% [240/255] vs 75% [266/357] and 0.89 vs 0.66) and posterior cruciate ligaments (95% [243/255] vs 87% [311/357] and 0.90 vs 0.61) compared to single-energy CT (all parameters, p <.005). Diagnostic confidence and image quality were significantly higher in dual-energy CT compared to single-energy CT (all parameters, p <.005).
Modern dual-energy CT is readily available and can serve as a screening tool for detecting or excluding cruciate ligament injuries in patients with acute trauma. Accurate diagnosis of cruciate ligament injuries is crucial to prevent adverse outcomes, including delayed treatment, chronic instability, or long-term functional limitations.
本研究旨在评估现代单能和双能 CT 在评估急性创伤患者交叉韧带完整性方面的临床应用价值。
本回顾性单中心研究纳入了 2016 年 1 月至 2022 年 12 月期间行单能或双能 CT 检查后又行 3 特斯拉磁共振成像（MRI）或膝关节关节镜检查的患者。三位专门从事肌肉骨骼成像的放射科医生独立评估所有 CT 图像中交叉韧带损伤的存在情况。两名有经验的读者进行 MRI 共识阅读，关节镜检查提供参考标准。诊断准确性参数和受试者工作特征曲线下面积（AUC）是诊断性能的主要指标。
共评估了 204 例患者（中位年龄 49 岁，IQR 36-64；113 名男性）的 CT 图像。双能 CT 在前交叉韧带（94%[240/255]与 75%[266/357]和 0.89 与 0.66）和后交叉韧带（95%[243/255]与 87%[311/357]和 0.90 与 0.61）损伤检测方面的诊断准确性和 AUC 显著高于单能 CT（所有参数，p<0.005）。与单能 CT 相比，双能 CT 的诊断信心和图像质量显著提高（所有参数，p<0.005）。
现代双能 CT 易于获得，可作为急性创伤患者检测或排除交叉韧带损伤的筛查工具。准确诊断交叉韧带损伤对于预防不良后果至关重要，包括延迟治疗、慢性不稳定或长期功能受限。
