双能计算机断层扫描在检测前交叉韧带损伤中的诊断性能：一项系统评价和荟萃分析。

Diagnostic performance of dual-energy computed tomography in detecting anterior cruciate ligament injuries: a systematic review and meta-analysis.

作者信息

Valizadeh Parya, Jannatdoust Payam, Pahlevan-Fallahy Mohammad-Taha, Bagherieh Sara, Adli Paniz, Amoukhteh Melika, Hassankhani Amir, Matcuk George R, Gholamrezanezhad Ali

机构信息

School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.

School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.

出版信息

Skeletal Radiol. 2025 Jun;54(6):1247-1262. doi: 10.1007/s00256-024-04833-x. Epub 2024 Nov 21.

OBJECTIVE

Anterior cruciate ligament (ACL) injuries are common and lead to significant physical limitations. While MRI is the diagnostic gold standard, its use is restricted in acute trauma cases due to contraindications and longer imaging times. Dual-energy computed tomography (DECT) has emerged as a potential alternative. This meta-analysis evaluates the diagnostic accuracy of DECT for ACL injuries.

MATERIALS AND METHODS

Following PRISMA guidelines, a comprehensive literature search was conducted using PubMed, Web of Science, Scopus, and Embase for studies published up to June 2024. Studies that provided diagnostic accuracy data for DECT in ACL ruptures were included. Metrics of diagnostic accuracy were aggregated using a bivariate random effects model.

RESULTS

The meta-analysis, which included five studies with a total of 191 patients, found that DECT had a pooled sensitivity of 88.1% (95% CI, 78.0-93.9%) and a specificity of 82.0% (95% CI, 62.0-92.7%) for diagnosing ACL ruptures, with an AUC of 0.92 (95% CI, 0.72-0.96). For complete ruptures, sensitivity was 83.2% (95% CI, 68.2-92.0%), and specificity was 94.9% (95% CI, 92.2-96.7%), with an AUC of 0.96 (95% CI, 0.81-0.98). In acute/subacute settings, sensitivity was 89.4% (95% CI, 76.8-95.6%), and specificity was 82.1% (95% CI, 56.2-94.2%), with an AUC of 0.93 (95% CI, 0.71-0.97).

CONCLUSION

Our findings suggest that DECT is a valuable diagnostic tool for ACL injuries, particularly as an adjunct or alternative when MRI is unavailable or contraindicated, enabling timely and accurate diagnosis.

目的

前交叉韧带（ACL）损伤较为常见，会导致严重的身体功能受限。虽然磁共振成像（MRI）是诊断的金标准，但由于存在禁忌证和成像时间较长，其在急性创伤病例中的应用受到限制。双能计算机断层扫描（DECT）已成为一种潜在的替代方法。本荟萃分析评估了DECT对ACL损伤的诊断准确性。

材料与方法

按照系统评价和Meta分析的首选报告项目（PRISMA）指南，使用PubMed、科学网、Scopus和Embase对截至2024年6月发表的研究进行了全面的文献检索。纳入了提供DECT对ACL断裂诊断准确性数据的研究。使用双变量随机效应模型汇总诊断准确性指标。

结果

该荟萃分析纳入了5项研究，共191例患者，发现DECT诊断ACL断裂的合并敏感度为88.1%（95%置信区间，78.0 - 93.9%），特异度为82.0%（95%置信区间，62.0 - 92.7%），曲线下面积（AUC）为0.92（95%置信区间，0.72 - 0.96）。对于完全断裂，敏感度为83.2%（95%置信区间，68.2 - 92.0%），特异度为94.9%（95%置信区间，92.2 - 96.7%），AUC为0.96（95%置信区间，0.81 - 0.98）。在急性/亚急性情况下，敏感度为89.4%（95%置信区间，76.8 - 95.6%），特异度为82.1%（95%置信区间，56.2 - 94.2%），AUC为0.93（95%置信区间，0.71 - 0.97）。