常规CT联合虚拟去钙技术诊断早期股骨头坏死的可行性研究  

Feasibility Study of Conventional CT Combined with Virtual Non-Calcium Dual-Energy Computed Tomography in the Diagnosis of Early Stage Osteonecrosis of Femoral Head

作　　者：王爽[1] 范晓飞 张卜天[1] 柳林[1] WANG Shuang;FAN Xiaofei;ZHANG Butian(Department of Radiology,China Japan Union Hospital of Jilin University,Changchun,Jilin Province 130000,P.R.China)

机构地区：[1]吉林大学中日联谊医院放射线科,长春130000

出　　处：《临床放射学杂志》2022年第1期136-140,共5页Journal of Clinical Radiology

摘　　要：目的探讨常规CT联合虚拟去钙技术(VNCa)对早期股骨头坏死(ONFH)诊断的价值。方法前瞻性搜集2020年9月至2021年4月本院拟诊断为ONFH的患者共58例,排除骨折、骨性关节炎,先天性髋关节发育不良、髋关节置换术后、无MR检查患者30例,经X线检查或CT检查排除ONFH(3、4期)髋关节19个,共纳入28例共37个髋关节,获得髋关节双能CT及MR图像时间间隔不超过5天。由两名未知MR结果及临床诊断的影像科医师独立对常规CT图像(A组)及常规CT联合VNCa图像(B组)进行ONFH的诊断,以MRI作为诊断"金标准",使用Kappa值检验两位放射医师对ONFH诊断的一致性,对于出现分歧的结果由另一名高年资影像科医师决定诊断。将VNCa图像及MR显示骨髓水肿(BME)区域范围进行划分,小于股骨头及股骨颈面积的1/3记为1分,1/3~2/3记为2分,大于2/3记为3分,比较两种方法显示BME范围是否存在差异。结果两名阅片者应用两种方法对ONFH的诊断一致性较高(Kappa值分别为0.87、0.90),对A组的敏感度、特异度、阳性预测值及阴性预测值分别为45.0%、94.1%、59.3%、90.0%、对B组的敏感度、特异度、阳性预测值及阴性预测值分别为80.0%、88.2%、88.9%、78.9%,联合VNCa后敏感度及阳性预测率均较常规CT有所提高。对VNCa图像和MRI所示BME范围的大小进行t检验P=0.759,说明两种成像方法对BME范围的显示无统计学差异。结论常规CT联合VNCa图像能够提高CT对早期ONFH的诊断性能,在MRI使用受限的情况下可以作为替代。Objective To explore the value of conventional CT combined with virtual decalcification(VNCa) technology in the diagnosis of early femoral head necrosis. Methods From September 2020 to April 2021, a prospective study of 58 patients with osteonecrosis of the femoral head(ONFH) in our hospital was conducted. Fractures, osteoarthritis, congenital hip dysplasia, and hip replacement were excluded. After 30 patients without MR examination, 19 hip joints with ONFH(stage 3 and 4) were excluded by X-ray examination or CT examination. A total of 37 hip joints in 28 cases were included, and the dual-energy CT and MR image interval of hip joints were obtained.The duration of acquiring CT and MR images should not be exceeded for 5 days.Two independent radiologists who were blinded to MRI results and clinical information made diagnosis by conventional CT images and conventional CT combined with VNCa images. Interobserver agreement for the visual evaluation of VNCa images was calculated with Kappa statistic. MRI was used as the standard reference. Another senior radiologist decided the final diagnosis if there were disagreements.The area of bone marrow edema showed by VNCa and MR was set to 1 point if it was less than the one third area of femoral head and neck, 2 points if it was between one third and two third, and 3 points if it was more than two thirds.Comparedthe two methods with Student’s t test. Results Interobserver agreement was excellent(Kappa=0.87,0.90).The sensitivity, specificity, positive predictive value and negative predictive value of group A and group B in the diagnosis of early stage osteonecrosis of femoral head were 45.0%,94.1%,59.3%,90.0% and 80.0%,88.2%,88.9%,78.9%,respectivel.The sensitivity and positive predictive value of group B were higher than those of group A.The Student’s t test result of BME area shown on VNCa image and MRI indicated that there was no statistical difference between the two examinations.(P= 0.759,higher than 0.05). Conclusion Conventional CT combined with VNCa images can impro

关 键 词：早期股骨头坏死 骨髓水肿 虚拟去钙技术 双能CT 

分 类 号：R681.8[医药卫生—骨科学]