Radiology:双能CT在人工髋关节疼痛性松动方面的诊断价值

2021-08-23 shaosai MedSci原创

现阶段,髋关节置换术是治疗有症状的髋关节骨关节炎退变的首选治疗手段。全世界每年进行的髋关节置换手术超过100万例。

现阶段,髋关节置换术是治疗有症状的髋关节骨关节炎退变的首选治疗手段。全世界每年进行的髋关节置换手术超过100万例。由于全球人口老龄化,需要治疗的病人越来越多,翻修手术可能成为髋关节假体病人诊治过程中的一个极为常见的情况。翻修手术的原因各不相同,但无菌性松动是最常见的原因之一。

传统的CR检查仍然是评估髋关节植入物的标准成像手段。然而,CR为二维重叠图像,对细微结构的显示十分有限。双能量CT(DECT)可在高千伏峰值下进行虚拟单能量成像(MEI)重建。已有研究表明,无论是单独使用还是与迭代金属伪影重建(或IMAR)相结合,都可以通过减少假体周围骨和软组织的金属伪影来改善图像质量。然而,很少有研究探讨DECT在评估髋关节假体松动方面的作用。

近日,发表在Radiology杂志的一项研究比较了DECT和CR在识别及诊断髋关节假体松动方面的诊断性能,为临床更好的显示髋关节假体提供了参考依据。

本项研究于2018年1月至2020年10月期间回顾性评估了单侧髋关节假体疼痛的连续患者。由两名独立的阅读者(分别有15年和4年的经验)对CR和DECT图像进行了评估。在成像时,假体松动的诊断是针对假体周围的放射状粘连大于或等于2毫米宽或存在两个及以上的次要发现,包括假体周围的骨质溶解、植入物的成角、骨折或异常的骨膜反应。对于每个阅读者和每个成像参数都计算了敏感度和特异度。使用McNemar测试比较每个成像工具的诊断性能。用Cohen κ统计学计算观察者之间的一致性。

本研究共纳入了178名患者(平均年龄±标准差,74岁±20岁;96名男性),其中121名患者接受手术,57名随访。总体而言,178名患者中有87名(49%)被诊断为假体松动。与CR相比,DECT的敏感性和特异性更强,在阅读者1(94%[87次检查中的82次;95%CI:87,98]和93%[91次检查中的85次;95%CI:86,97]与84%[87次检查中的73次;95%CI:74,91]和91%[91次检查中的83次;95%CI:83,96],P < . 001)和阅读者2(分别为92%[87次检查中的80次;95%CI:84,97]和95%[91次检查中的86次;95%CI:88,98]与80%[87次检查中的70次;95%CI:71,88]和91%[91次检查中的83次;95%CI:83,96];P=0.001)之间均为如此,且观察者之间的一致性更好(κ,0.88[95%CI:0.81,0.95] vs 0.78[95%CI:0.69,0.88])。

图 65岁男性,左股骨干髋关节植入物松动的手术修复图像。冠状位(A)和轴位(B)重建的1毫米平扫双能CT单能成像加应用扫描显示,在股骨干外侧和大转子之间存在一个较大的放射状粘连(箭头)。(C, D)在相应的前后位CR图片上,两位阅读者都没有观察到假体周围的放射状粘连(箭头)。

本研究表明,在诊断髋关节假体松动方面,高千伏峰值单能量重建的双能量CT(DECT)比传统的CR更为准确,为DECT在假体松动方面的应用开阔了道路。

原文出处:

Giovanni Foti,Alessandro Fighera,Antonio Campacci,et al.Diagnostic Performance of Dual-Energy CT for Detecting Painful Hip Prosthesis Loosening.DOI:10.1148/radiol.2021203510

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  5. [GetPortalCommentsPageByObjectIdResponse(id=1707156, encodeId=29bc1e07156cf, content=<a href='/topic/show?id=20ff3e5822d' target=_blank style='color:#2F92EE;'>#双能CT#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=37582, encryptionId=20ff3e5822d, topicName=双能CT)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=37c031357597, createdName=ms6832696159214430, createdTime=Mon Nov 08 09:19:38 CST 2021, time=2021-11-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1986830, encodeId=b04c19868302b, content=<a href='/topic/show?id=6b393012106' target=_blank style='color:#2F92EE;'>#关节疼痛#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=49, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=30121, encryptionId=6b393012106, topicName=关节疼痛)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=148754, createdName=gaoxiaoe, createdTime=Thu Oct 21 00:19:38 CST 2021, time=2021-10-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1737151, encodeId=d4cc1e371513f, content=<a href='/topic/show?id=d8b510206147' target=_blank style='color:#2F92EE;'>#髋关节疼痛#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=43, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=102061, encryptionId=d8b510206147, topicName=髋关节疼痛)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=bd7b34248465, createdName=ms6829001416292975, createdTime=Mon Mar 21 02:19:38 CST 2022, time=2022-03-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1721694, encodeId=1d121e21694d0, content=<a href='/topic/show?id=39d6915e9bf' target=_blank style='color:#2F92EE;'>#诊断价值#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=91579, encryptionId=39d6915e9bf, topicName=诊断价值)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=7c7d33065043, createdName=medscijoin, createdTime=Tue May 17 21:19:38 CST 2022, time=2022-05-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1010583, encodeId=382210105837d, content=很有用, beContent=null, objectType=article, channel=null, level=null, likeNumber=43, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=b9b75532127, createdName=ms3000000841841439, createdTime=Mon Aug 23 12:09:22 CST 2021, time=2021-08-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1010562, encodeId=87191010562b8, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=51, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=6bd55581786, createdName=ms2000001224678036, createdTime=Mon Aug 23 11:08:34 CST 2021, time=2021-08-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1010530, encodeId=3b0e101053047, content=真的很受用, beContent=null, objectType=article, channel=null, level=null, likeNumber=46, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210823/180b5455da1342f992d610402bbf042e/53d4a5c119f94c30ad05c9475979f91c.jpg, createdBy=55375581649, createdName=Jasoncheng27, createdTime=Mon Aug 23 09:37:23 CST 2021, time=2021-08-23, status=1, ipAttribution=)]
    2021-08-23 ms3000000841841439

    很有用

    0

  6. [GetPortalCommentsPageByObjectIdResponse(id=1707156, encodeId=29bc1e07156cf, content=<a href='/topic/show?id=20ff3e5822d' target=_blank style='color:#2F92EE;'>#双能CT#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=37582, encryptionId=20ff3e5822d, topicName=双能CT)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=37c031357597, createdName=ms6832696159214430, createdTime=Mon Nov 08 09:19:38 CST 2021, time=2021-11-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1986830, encodeId=b04c19868302b, content=<a href='/topic/show?id=6b393012106' target=_blank style='color:#2F92EE;'>#关节疼痛#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=49, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=30121, encryptionId=6b393012106, topicName=关节疼痛)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=148754, createdName=gaoxiaoe, createdTime=Thu Oct 21 00:19:38 CST 2021, time=2021-10-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1737151, encodeId=d4cc1e371513f, content=<a href='/topic/show?id=d8b510206147' target=_blank style='color:#2F92EE;'>#髋关节疼痛#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=43, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=102061, encryptionId=d8b510206147, topicName=髋关节疼痛)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=bd7b34248465, createdName=ms6829001416292975, createdTime=Mon Mar 21 02:19:38 CST 2022, time=2022-03-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1721694, encodeId=1d121e21694d0, content=<a href='/topic/show?id=39d6915e9bf' target=_blank style='color:#2F92EE;'>#诊断价值#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=91579, encryptionId=39d6915e9bf, topicName=诊断价值)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=7c7d33065043, createdName=medscijoin, createdTime=Tue May 17 21:19:38 CST 2022, time=2022-05-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1010583, encodeId=382210105837d, content=很有用, beContent=null, objectType=article, channel=null, level=null, likeNumber=43, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=b9b75532127, createdName=ms3000000841841439, createdTime=Mon Aug 23 12:09:22 CST 2021, time=2021-08-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1010562, encodeId=87191010562b8, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=51, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=6bd55581786, createdName=ms2000001224678036, createdTime=Mon Aug 23 11:08:34 CST 2021, time=2021-08-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1010530, encodeId=3b0e101053047, content=真的很受用, beContent=null, objectType=article, channel=null, level=null, likeNumber=46, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210823/180b5455da1342f992d610402bbf042e/53d4a5c119f94c30ad05c9475979f91c.jpg, createdBy=55375581649, createdName=Jasoncheng27, createdTime=Mon Aug 23 09:37:23 CST 2021, time=2021-08-23, status=1, ipAttribution=)]
    2021-08-23 ms2000001224678036

    学习了

    0

  7. [GetPortalCommentsPageByObjectIdResponse(id=1707156, encodeId=29bc1e07156cf, content=<a href='/topic/show?id=20ff3e5822d' target=_blank style='color:#2F92EE;'>#双能CT#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=37582, encryptionId=20ff3e5822d, topicName=双能CT)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=37c031357597, createdName=ms6832696159214430, createdTime=Mon Nov 08 09:19:38 CST 2021, time=2021-11-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1986830, encodeId=b04c19868302b, content=<a href='/topic/show?id=6b393012106' target=_blank style='color:#2F92EE;'>#关节疼痛#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=49, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=30121, encryptionId=6b393012106, topicName=关节疼痛)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=148754, createdName=gaoxiaoe, createdTime=Thu Oct 21 00:19:38 CST 2021, time=2021-10-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1737151, encodeId=d4cc1e371513f, content=<a href='/topic/show?id=d8b510206147' target=_blank style='color:#2F92EE;'>#髋关节疼痛#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=43, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=102061, encryptionId=d8b510206147, topicName=髋关节疼痛)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=bd7b34248465, createdName=ms6829001416292975, createdTime=Mon Mar 21 02:19:38 CST 2022, time=2022-03-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1721694, encodeId=1d121e21694d0, content=<a href='/topic/show?id=39d6915e9bf' target=_blank style='color:#2F92EE;'>#诊断价值#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=91579, encryptionId=39d6915e9bf, topicName=诊断价值)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=7c7d33065043, createdName=medscijoin, createdTime=Tue May 17 21:19:38 CST 2022, time=2022-05-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1010583, encodeId=382210105837d, content=很有用, beContent=null, objectType=article, channel=null, level=null, likeNumber=43, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=b9b75532127, createdName=ms3000000841841439, createdTime=Mon Aug 23 12:09:22 CST 2021, time=2021-08-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1010562, encodeId=87191010562b8, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=51, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=6bd55581786, createdName=ms2000001224678036, createdTime=Mon Aug 23 11:08:34 CST 2021, time=2021-08-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1010530, encodeId=3b0e101053047, content=真的很受用, beContent=null, objectType=article, channel=null, level=null, likeNumber=46, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210823/180b5455da1342f992d610402bbf042e/53d4a5c119f94c30ad05c9475979f91c.jpg, createdBy=55375581649, createdName=Jasoncheng27, createdTime=Mon Aug 23 09:37:23 CST 2021, time=2021-08-23, status=1, ipAttribution=)]
    2021-08-23 Jasoncheng27

    真的很受用

    0