双能量CT对腕关节骨挫伤的诊断价值  

Diagnostic performance of dual-energy CT for the detection of bone bruise in the wrist

作　　者：任秋萍[1] 唐德秋[1] 赵衡[1] 刘进才[1] 肖文莲[1] 李劲松[1] 罗远红[1] 吴晓东[1] 卿伟鹏[1] 李显美 许娟 REN Qiu-ping;TANG De-qiu;ZHAO Heng;LIU Jin-cai;XIAO Wen-Iian;L;LUO Yuan-hong;WU Xiao-dong;QING Wei-peng;LI Xian-mei;XU Juan(Department of Radiology,the First Affiliated Hospital,University of South China,Hengyang Hunan 421001,China)

机构地区：[1]南华大学附属第一医院放射科,湖南衡阳421001

出　　处：《中国临床医学影像杂志》2018年第7期505-509,共5页Journal of China Clinic Medical Imaging

基　　金：湖南省自然科学基金资助项目(2017JJ2225);湖南省自然科学基金资助项目(14JJ2086);湖南省高等学校科学研究重点项目(14A216);衡阳市科学技术发展计划项目(2013KJ52)

摘　　要：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。Objective： To evaluate the performance of virtual non-calcium images reconstructed from DECT for the diag-nosis of bone marrow lesions in patients with acute wrist joint trauma in comparison with MRI. Methods： Thirty-five patients underwent DECT（80 k Vp and 140 k Vp 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 sys-tem（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 sensitiv-ity, 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 in-creased from 0 to 3（P〈0.001） with increasing corresponding CT values. There were significant differences in CT values be-tween 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 

分 类 号：R684[医药卫生—骨科学] R681.7[医药卫生—外科学]