Dual-energy computed tomography in calcium pyrophosphate deposition: initial clinical experience.
Dual-energy computed tomography in calcium pyrophosphate deposition: initial clinical experience.
复制标题
双能计算机断层扫描焦磷酸钙沉积：初步临床经验。
DOI：
10.1016/j.joca.2019.05.007
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发表时间：
2019
影响因子：
7
通讯作者：
J. Budzik
中科院分区：
文献类型：
--
作者：
T. Pascart;L. Norberciak;Julie Legrand;Fabio Becce;J. Budzik
目的测定体内焦磷酸钙沉积（CPPD）中半月板钙化的双能计算机断层扫描（DECT）衰减特性，并评估DECT是否能够区分半月板CPP沉积与软骨下骨和小梁骨中的羟基磷灰石钙（HA）。方法将临床怀疑晶体相关性关节病（痛风和/或CPPD）和膝关节DECT扫描的患者回顾性分配CPPD (n= 19) 或对照组 (n= 21) 组取决于 DECT 上是否存在软骨钙质沉着症。两名观察者在半月板钙化、非钙化半月板以及软骨下骨和小梁骨中绘制了标准化感兴趣区域 (ROI)。获得了五个 DECT 参数：80 和 140 kV 下的 CT 数 (HU)、双能指数 (DEI)、电子密度 (ρe) 和有效原子序数 (Zeff)。使用线性混合模型在患者和对照之间比较四种不同的膝关节结构，调整混杂因素。结果 CPPD 患者的半月板钙化 (n = 89) 在 80 和 140 kV 时的平均±SD CT 数分别为 257 ± 64 和 201 ± 48 HU； DEI 为 0.023 ± 0.007，ρe 和 Zeff 分别为 140 ± 35 和 8.8 ± 0.3。半月板 CPP 沉积物很容易与软骨下骨和小梁骨中的钙 HA 区分开 (p≤0.001)，但单独在 80kV 时除外 (p=0.74)。 Zeffand ρboth 在软骨下骨和小梁骨中的 CPP 沉积物和钙 HA 之间存在显着差异 (p< 0.0001)。结论这项概念验证研究表明，DECT 有潜力区分半月板 CPP 沉积物和体内软骨下骨和小梁骨中的钙 HA，为关节内和关节旁钙晶体沉积物的非侵入性生化特征评估铺平了道路。
ObjectiveTo determine the dual-energy computed tomography (DECT) attenuation properties of meniscal calcifications in calcium pyrophosphate deposition (CPPD)in vivo, and assess whether DECT was able to discriminate meniscal CPP deposits from calcium hydroxyapatite (HA) in subchondral and trabecular bone.MethodPatients with clinical suspicion of crystal-related arthropathy (gout and/or CPPD) and knee DECT scans were retrospectively assigned to CPPD (n= 19) or control (n= 21) groups depending on the presence/absence of chondrocalcinosis on DECT. Two observers drew standardized regions of interest (ROI) in meniscal calcifications, non-calcified menisci, as well as subchondral and trabecular bone. Five DECT parameters were obtained: CT numbers (HU) at 80 and 140 kV, dual-energy index (DEI), electron density (ρe), and effective atomic number (Zeff). The four different knee structures were compared within/between patients and controls using linear mixed models, adjusting for confounders.ResultsMeniscal calcifications (n= 89) in CPPD patients had mean ± SD CT numbers at 80 and 140 kV of 257 ± 64 and 201 ± 48 HU, respectively; with a DEI of 0.023 ± 0.007, and ρeand Zeffof 140 ± 35 and 8.8 ± 0.3, respectively. Meniscal CPP deposits were readily distinguished from calcium HA in subchondral and trabecular bone (p≤ 0.001), except at 80 kV separately (p= 0.74). Zeffand ρeboth significantly differed between CPP deposits and calcium HA in subchondral and trabecular bone (p< 0.0001).ConclusionThis proof-of-concept study shows that DECT has the potential to discriminate meniscal CPP deposits from calcium HA in subchondral and trabecular bonein vivo, paving the way for the non-invasive biochemical signature assessment of intra- and juxta-articular calcium crystal deposits.