Assessment of the diagnostic value of dual-energy CT and MRI in the detection of iatrogenically induced injuries of anterior cruciate ligament in a porcine model
Assessment of the diagnostic value of dual-energy CT and MRI in the detection of iatrogenically induced injuries of anterior cruciate ligament in a porcine model
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DOI：
10.1007/s00256-012-1500-8
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发表时间：
2013-03-01
影响因子：
2.1
通讯作者：
Jochum, S.
中科院分区：
文献类型：
--
作者：
Fickert, S.;Niks, M.;Jochum, S.
磁共振成像（MRI）是无创评估膝关节韧带损伤的参考标准。双能CT （DE-CT）的发展使得通过同时测量两个不同管电压的CT来区分不同密度的组织成为可能。该方法使DE-CT能够在不注射关节内造影剂的情况下识别韧带结构。本研究的目的一方面是确定前交叉韧带（ACL）的轮廓，另一方面是评估DE-CT和MRI在猪膝关节模型医源性ACL损伤检测中的诊断价值。使用DE-CT扫描20只猪后腿，将其放置在预成型的石膏中以达到标准化的位置。此后，采用标准方案进行1.5 t MRI检查。在关节镜下诱导确定病变（全部或部分切口）后，重复相同参数的成像程序。经过后处理，两名放射科医生和两名骨科医生首先分析了前交叉韧带的划定，然后，使用共识的方法，医源性病变。关节切开术的结果作为参考标准。100%的病例在DE-CT和MRI上都能看到ACL。在MRI上，与明确的关节切开术相比，完整交叉韧带的敏感性和特异性分别为66.7%和78.6%，完整交叉韧带的敏感性和特异性分别为100%和75%，前内侧束病变的敏感性和特异性分别为33.3%和78.6%，后外侧束病变的敏感性和特异性分别为0%和100%。相比之下，DE-CT对完整交叉韧带的敏感性和特异性分别为66.7%和71.4%，对acl完全中断的敏感性和特异性分别为75%和68.8%，对前内侧束病变的敏感性和特异性分别为0%和92.9%，对后外侧束病变的敏感性和特异性分别为25%和87.5%。本离体实验表明，两种研究方式（DE-CT和MRI）对ACL的描绘是相同的，而MRI对医源性完全性ACL病变具有更高的敏感性和特异性。在诊断膝关节韧带损伤的某些适应症时，DE-CT可能是MRI的替代方法。
Magnetic resonance imaging (MRI) is the standard of reference for the non-invasive evaluation of ligament injuries of the knee. The development of dual-energy CT (DE-CT) made it possible to differentiate between tissues of different density by two simultaneous CT measurements with different tube voltages. This approach enables DE-CT to discriminate ligament structures without intra-articular contrast media injection.The aims of this study were on the one hand to determine the delineation of the anterior cruciate ligament (ACL) and on the other hand to assess the diagnostic value of DE-CT and MRI in the detection of iatrogenically induced injury of the ACL in a porcine knee joint model.Twenty porcine hind legs, which were placed in a preformed cast in order to achieve a standardized position, were scanned using DE-CT. Thereafter, a 1.5-T MRI using a standard protocol was performed. The imaging procedures were repeated with the same parameters after inducing defined lesions (total or partial incision) on the ACL arthroscopically. After post-processing, two radiologists and two orthopedic surgeons first analyzed the delineation of the ACL and then, using a consensus approach, the iatrogenically induced lesions. The result of the arthrotomy was defined as the standard of reference.The ACL could be visualized both on DE-CT and MRI in 100% of the cases. As for the MRI, the sensitivity and specificity of detecting the cruciate ligament lesion respectively compared with the defined arthrotomy was 66.7% and 78.6% for intact cruciate ligaments, 100% and 75% in the case of a complete lesion, 33.3% and 78.6% for lesions of the anteromedial bundle, and 0% and 100% for lesions of the posterolateral bundle.In comparison, DE-CT demonstrated a sensitivity and specificity of 66.7% and 71.4% in the case of intact cruciate ligaments, 75% and 68.8% in the case of completely discontinued ACLs, 0% and 92.9% in the case of lesions of the anteromedial bundle, and 25% and 87.5% in the case of lesions of the posterolateral bundle.The present ex vivo experiment shows that both study modalities (DE-CT and MRI) are equal with regard to the delineation of the ACL, while MRI achieved higher sensitivity and specificity regarding iatrogenically induced complete ACL lesions. DE-CT could be a possible alternative to MRI for certain indications in the diagnosis of a knee ligament injury.