目的：评估双能量CT（DECT）去钙成像技术对急性腕关节骨挫伤的诊断性能。方法：35例急性腕关节损伤患者行DECT检查并在3 d内进行MRI检查。分别对VNCa图像和MRI进行评分，并测量VNCa图像中骨髓CT值。结果：所有骨髓病变以MR图像作为参考标准、2~3级骨髓作为阳性结果，分析DECT图像尺桡骨远端骨髓病变敏感性83.33%，特异性91.30%，阳性预测值为83.33%，阴性预测值为91.30%。DECT去钙图像中骨挫伤病灶随着CT值增高，骨髓等级也逐渐增加。骨髓阳性区域与阴性区域的CT值有显著差异（P＜0.001）。以骨髓VNCa图像的CT值做ROC曲线分析，尺桡骨远端的曲线下面积＞0.5。结论：以MR成像作为参考标准，DECT的VNCa图像在检测腕关节骨挫伤病灶中具有良好的诊断价值，可能是磁共振成像禁忌症患者的一个潜在替代扫描方法。
Abstract
Objective: To evaluate the performance of virtual non-calcium images reconstructed from DECT for the diagnosis of bone marrow lesions in patients with acute wrist joint trauma in comparison with MRI. Methods: Thirty-five patients underwent DECT(80 kVp and 140 kVp with tin filter) and MR imaging within 3 day following acute wrist trauma. Presence of traumatic bone bruise on MR and virtual non-calcium images were graded respectively by the readers using a four-point system(3=distinct bone marrow lesion, 0=no lesion), and CT values in virtual non-calcium images were calculated. Results: All bone marrow lesions used MR images as a reference standard. Bone marrow graded 2~3 was considered positive. The sensitivity, specifity, negative predictive value and positive predictive value were 83.33%, 91.30%, 83.33% and 91.30% by analyzing DECT images of the distal ulnar radius bone marrow. In non-calcium images, the grades of bone marrow lesion gradually increased from 0 to 3(P<0.001) with increasing corresponding CT values. There were significant differences in CT values between the positive and negative regions(P<0.001). CT numbers for distal ulna and radius bone marrow lesions were analyzed by ROC, revealing areas under the receiver operating characteristic curve greater than 0.5. Conclusion: Compared with MR images, bone bruises of the wrist joint can be diagnosed on virtual non-calcium images reconstructed from DECT with high specificity and excellent negative predictive value. DECT may be a potential alternative method to MRI contraindications.
关键词
腕损伤 /
体层摄影术 /
X线计算机 /
磁共振成像
Key words
Wrist injuries /
Tomography, X-ray computed /
Magnetic resonance imaging
中图分类号：
Ｒ684
Ｒ681.7
Ｒ814.42
Ｒ445.2
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基金
湖南省自然科学基金资助项目（2017JJ2225）；湖南省高等学校科学研究重点项目（14A216）；
湖南省自然科学基金资助项目（14JJ2086）；衡阳市科学技术发展计划项目（2013KJ52）。
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