X线片、CT、MRI在隐匿性Lisfranc损伤诊断中的临床应用价值  

Comparative study on the diagnostic efficacy of X-ray film,CT and MRI for subtle Lisfranc injury

作　　者：唐陆波 刘三彪 吴晨曦 熊常悦 尤田[1] 白露[1] Tang Lubo;Liu Sanbiao;Wu Chenxi;Xiong Changyue;You Tian;Bai Lu(Sports medicine department,Peking University Shenzhen Hospital,Shenzhen 518000,China)

机构地区：[1]北京大学深圳医院运动医学科,广东深圳518000

出　　处：《足踝外科电子杂志》2022年第1期17-22,共6页Electronic Journal of Foot and Ankle Surgery

基　　金：深圳市卫计委三名工程学科能力提升项目(SZXJ2018085);深圳市卫计委基金会项目(SZXJ2018083)。

摘　　要：目的比较X线片、CT、MRI三种影像学检查对隐匿性Lisfranc损伤的诊断效能。方法回顾性分析2013年9月至2019年12月27例手术证实为隐匿性Lisfranc损伤患者的足部X线片、CT、MRI影像资料,以术中确诊为“金标准”,比较这三种影像检查的诊断阳性率、漏诊率。以X线片+MRI+CT联合诊断结果作为“参考标准”,比较各检查方法的灵敏度、组间一致性。结果X线片检出率为11.1%(3/27),CT检出率为29.6%(8/27),MRI检出率为74.1%(20/27);MRI的检出率最高,CT次之,X线片的检出率最低;X线片和CT检查结果比较差异无统计学意义(P>0.05),X线片和MRI、CT检查结果比较差异有统计学意义(P<0.05)。X线片+CT+MRI联合诊断在27例确诊患者中的检出率为85.2%(23/27)。以三种检查联合诊断的结果作为“参考标准”,MRI检查结果与“参考标准”比较差异无统计学意义(P<0.05),X线片、CT与“参考标准”比较差异有统计学意义(P<0.05)。X线片灵敏度为13.0%(曲线下面积[AUC]:0.565,CI:0.281~0.849),k值0.043;CT灵敏度为34.8%([AUC]:0.674,CI:0.438~0.910),k值0.136;MRI灵敏度为87.0%([AUC]:0.935,CI:0.841~1.000),k值0.664。结论三种影像学检查对隐匿性Lisfranc损伤诊断均存在一定的漏诊率,MRI对隐匿性Lisfranc损伤的诊断检出率最高,X线片对隐匿性Lisfranc的诊断检出率最低。而MRI+CT+X线片的联合诊断结果与单一MRI检查的结果比较,在统计学上并无差异。Objective To compare the diagnostic efficacy of X-ray,CT and MRI for subtle Lisfranc injury.Methods The X-ray,CT and MRI images of total 27 patients with subtle Lisfranc injury confirmed by surgery,from September 2013 to December 2019,were retrospectively analyzed.Taking the intraoperative diagnosis as the“gold standard”,the diagnostic positive rate and missed diagnosis rate of the three imaging examinations were compared.Using the combined diagnosis results of X-ray+MRI+CT as the“reference standard”to compare the sensitivity and consistency between groups.Results The imaging data of all patients included in the study were analyzed.The detection rate of X-ray was 11.1%(3/27),CT was 29.6%(8/27)and MRI was 74.1%(20/27).The detection rate of MRI was the highest,followed by CT,and the X-ray was the lowest.There was no statistical difference between the results of X-ray and CT examinations(P>0.05),but there was statistical differences between X-ray and MRI,CT and MR examinations(P<0.05).The detection rate of X-ray+CT+MRI combined diagnosis in 27 confirmed patients was 85.2%(23/27).Taking the combined diagnostic results of the three examinations as the“reference standard”,there was no statistical difference between the MRI and the“reference standard”(P<0.05),while the X-ray and CT were all statistical different from the“reference standard”(P<0.05);X-ray sensitivity was 13.0%(area under the curve[AUC]:0.565,CI:0.281~0.849),k=0.043;CT sensitivity was 34.8%([AUC]:0.674,CI:0.438~0.910),k=0.136;MRI sensitivity was 87.0%([AUC]:0.935,CI:0.841~1.000),k=0.664.Conclusion Each imaging examination has a certain missed diagnosis rate for the diagnosis of snutle Lisfranc injury.MRI has the highest diagnostic detection rate for subtle Lisfranc injury,and X-ray has the lowest diagnostic detection rate,with a very high missed diagnosis rate.There is no statistical difference between the results of the combined diagnosis of MRI+CT+X-ray and the results of single MRI examination.

关 键 词：隐匿性Lisfranc损伤 X线片、CT、MRI 

分 类 号：R681.8[医药卫生—骨科学]