Kawakami Hirotaka, Sasaki Hiromi, Kamizono Junichi, Yasutake Yuki, Yamada Kana, Saho Suguru, Kawauchi Takehiro, Taniguchi Noboru
Department of Orthopedic Surgery, Sendai Medical Association Hospital, Satsumasendai-City, Kagoshima, Japan.
Department of Orthopedic Surgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima-City, Kagoshima, Japan.
SAGE Open Med. 2025 Apr 27;13:20503121251336301. doi: 10.1177/20503121251336301. eCollection 2025.
Early surgical intervention within 48 h is critical for reducing mortality and morbidity in patients with hip fractures. However, occult hip fractures are often missed, leading to treatment delays. Dual-energy computed tomography allows visualization of bone marrow edema and bone contusions, which are challenging to detect using conventional computed tomography. This study aimed to evaluate the effectiveness of dual-energy computed tomography in diagnosing occult hip fractures.
Eighteen dual-energy computed tomography scans obtained between May 2018 and March 2024 were analyzed. Magnetic resonance imaging was performed in all cases. A trained musculoskeletal radiologist interpreted the dual-energy computed tomography and magnetic resonance imaging scans, which were then reviewed by two senior orthopedic surgeons. The confirmed diagnoses included 14 femoral trochanteric fractures and 4 femoral neck fractures. Four junior orthopedic surgeons independently reviewed the dual-energy computed tomography scans only and conducted diagnostic examinations. Patients were subsequently categorized into two groups: those with unanimous diagnostic agreement (unanimity group) and those with discrepancies (objection group).
For femoral trochanteric fractures, sensitivity, specificity, accuracy, and Cohen's kappa coefficient were 94%, 81%, 0.91, and 0.75, respectively. For femoral neck fractures, sensitivity, specificity, accuracy, and Cohen's kappa coefficient were 68%, 96%, 0.90, and 0.69, respectively. A significant difference in diagnostic ease was noted ( = 0.04), with agreement achieved for 12 of the 14 femoral trochanteric fractures and one of the four femoral neck fractures. Logistic regression analysis yielded a regression coefficient for femoral trochanteric fractures of 3.05 ( = 0.03), indicating that these fractures were more easily diagnosed than femoral neck fractures.
Dual-energy computed tomography demonstrated high sensitivity and specificity in detecting occult hip fractures, particularly those of the femoral trochanter. However, its sensitivity was lower for femoral neck fractures, indicating limited reliability in their diagnosis. Further investigation and magnetic resonance imaging scans are recommended for suspected femoral neck fractures.
48小时内进行早期手术干预对于降低髋部骨折患者的死亡率和发病率至关重要。然而，隐匿性髋部骨折常常被漏诊，导致治疗延误。双能计算机断层扫描能够显示骨髓水肿和骨挫伤，而这些在传统计算机断层扫描中很难检测到。本研究旨在评估双能计算机断层扫描在诊断隐匿性髋部骨折中的有效性。
分析了2018年5月至2024年3月期间获得的18例双能计算机断层扫描。所有病例均进行了磁共振成像。一名训练有素的肌肉骨骼放射科医生解读双能计算机断层扫描和磁共振成像扫描结果，随后由两名资深骨科医生进行复查。确诊的诊断包括14例股骨转子间骨折和4例股骨颈骨折。四名初级骨科医生仅独立复查双能计算机断层扫描并进行诊断检查。患者随后被分为两组：诊断意见一致的患者（一致组）和存在差异的患者（异议组）。
对于股骨转子间骨折，敏感性、特异性、准确性和科恩kappa系数分别为94%、81%、0.91和0.75。对于股骨颈骨折，敏感性、特异性、准确性和科恩kappa系数分别为68%、96%、0.90和0.69。在诊断难易程度上存在显著差异（P = 0.04），14例股骨转子间骨折中有12例达成一致诊断，4例股骨颈骨折中有1例达成一致诊断。逻辑回归分析得出股骨转子间骨折的回归系数为3.05（P = 0.03），表明这些骨折比股骨颈骨折更容易诊断。
双能计算机断层扫描在检测隐匿性髋部骨折，尤其是股骨转子部骨折方面显示出高敏感性和特异性。然而，其对股骨颈骨折的敏感性较低，表明在诊断股骨颈骨折时可靠性有限。对于疑似股骨颈骨折，建议进一步检查和进行磁共振成像扫描。
