低剂量双能量CT成像与MRI成像在跟腱撕裂诊断中的对比研究
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摘要
目的探讨低剂量单源双能量CT在跟腱撕裂诊断中的应用价值。方法对42例怀疑跟腱撕裂患者行双能量CT和MRI检查,经查跟腱撕裂36例、正常6例。36例跟腱撕裂患者中,25例跟腱完全撕裂均经手术确诊;11例不完全性撕裂中,7例经MRI随访确诊,4例经手术及MRI确诊。6例跟腱正常患者,经查为跟骨粉碎性骨折,骨折线累及跟腱附着处,手术明确及MRI未见跟腱撕裂。行多平面重组(MPR)、肌腱3D容积再现(VR)等二维及三维图像后处理,用以显示跟腱;双能CT虚拟去钙质成像诊断踝关节骨质水肿;计算撕裂及正常跟腱80KeV图像与135KeV图像上的CT差,CT差=CT均值135-CT均值80。结果 99KeV软组织图像窗上横断面结合MPR均能诊断跟腱完全撕裂患者,诊断跟腱完全撕裂灵敏性100%、特异性100%,诊断跟腱部分撕裂的灵敏性81.8%、特异性100%;VR图像上,诊断跟腱完全撕裂的灵敏性100%、特异性100%,诊断跟腱部分撕裂的灵敏性63.6%、特异性100%;虚拟去钙图上,诊断骨质水肿患者灵敏性77.5%、特异性80%。MRI诊断完全及部分跟腱断裂和骨质肿患者的灵敏性100%、特异性100%,诊断骨折的灵敏性40%、特异性100%。结论双能CT成像能有效诊断跟腱完全撕裂和部分撕裂,发现骨折优于MRI、发现骨质水肿差于MRI。
Objective To investigate the application value of low-dose single-source dual-energy CT and MRI in diagnosis of Achilles tendon rupture. Methods A total of 42 patients with suspected Achilles tendon rupture underwent dual-energy CT and MRI scanning.36 cases of Achilles tendon rupture and 6 cases of normal patients were tested. In 36 cases of Achilles tendon rupture patients, 25 patients with complete Achilles tendon rupture were diagnosed by MRI. 11 patients with partial rupture, 7 patients were diagnosed by follow-up MRI, 4 patients were diagnosed by operation and MRI. 6 patients with normal tendons were diagnosed as calcaneal fracture, the fracture line involved the attachment of the Achilles tendon. The operation was clear and no rupture of Achilles tendon was observed in operation. Two-dimensional and three-dimensional image post processing, such as multiplanar reconstruction(MPR), tendon 3 D volume rendering(VR), to show Achilles tendon, dual-energy CT virtual decalcification imaging for diagnosis of ankle bone edema, calculation of tear and normal tendon CTD, CTD=CTmean135-CTmean80. Results 99 KeV soft tissue image window combined with MPR can diagnose the complete rupture of Achilles tendon. The sensitivity and specificity of diagnosis of complete rupture of Achilles tendon were 100% and 100%, respectively.The sensitivity and specificity of diagnosis of partial rupture of Achilles tendon were 81.8% and 100%, respectively, on VR imaging, the sensitivity and specificity of diagnosis of complete rupture of Achilles tendon were 100% and 100%, respectively. The sensitivity and specificity of diagnosis of complete rupture of Achilles tendon were 63.6% and 100%, respectively, on virtual calcium removal imaging, the sensitivity and specificity of diagnosis of bone edema were 77.5% and 80% respectively. The sensitivity and specificity of MRI diagnosis of complete and partial Achilles tendon rupture and bone edema patients were 100% and 100%, respectively. The sensitivity and specificity of bone fracture patients were 40% and 100%, respectively. Conclusion Dual-energy CT imaging can effectively diagnose complete Achilles tear and partial Achilles rupture, and its performance of finding fracture was better than MRI, while finding bone edema was worse than MRI.
Objective To investigate the application value of low-dose single-source dual-energy CT and MRI in diagnosis of Achilles tendon rupture. Methods A total of 42 patients with suspected Achilles tendon rupture underwent dual-energy CT and MRI scanning.36 cases of Achilles tendon rupture and 6 cases of normal patients were tested. In 36 cases of Achilles tendon rupture patients, 25 patients with complete Achilles tendon rupture were diagnosed by MRI. 11 patients with partial rupture, 7 patients were diagnosed by follow-up MRI, 4 patients were diagnosed by operation and MRI. 6 patients with normal tendons were diagnosed as calcaneal fracture, the fracture line involved the attachment of the Achilles tendon. The operation was clear and no rupture of Achilles tendon was observed in operation. Two-dimensional and three-dimensional image post processing, such as multiplanar reconstruction(MPR), tendon 3 D volume rendering(VR), to show Achilles tendon, dual-energy CT virtual decalcification imaging for diagnosis of ankle bone edema, calculation of tear and normal tendon CTD, CTD=CTmean135-CTmean80. Results 99 KeV soft tissue image window combined with MPR can diagnose the complete rupture of Achilles tendon. The sensitivity and specificity of diagnosis of complete rupture of Achilles tendon were 100% and 100%, respectively.The sensitivity and specificity of diagnosis of partial rupture of Achilles tendon were 81.8% and 100%, respectively, on VR imaging, the sensitivity and specificity of diagnosis of complete rupture of Achilles tendon were 100% and 100%, respectively. The sensitivity and specificity of diagnosis of complete rupture of Achilles tendon were 63.6% and 100%, respectively, on virtual calcium removal imaging, the sensitivity and specificity of diagnosis of bone edema were 77.5% and 80% respectively. The sensitivity and specificity of MRI diagnosis of complete and partial Achilles tendon rupture and bone edema patients were 100% and 100%, respectively. The sensitivity and specificity of bone fracture patients were 40% and 100%, respectively. Conclusion Dual-energy CT imaging can effectively diagnose complete Achilles tear and partial Achilles rupture, and its performance of finding fracture was better than MRI, while finding bone edema was worse than MRI.
引文
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[11]彭文献,彭天舟,夏顺仁,等.X线管电压对生物组织C T值影响的实验研究[J].放射学实践,2013,28(11):1102-1104.
[12]杨炎炎,黄仲奎.腹部水模不同管电压、管电流CT扫描的研究[J].医学影像学杂志,2018,(4):678-682.
[13]许霄,黄求理,朱雪君,等.双能CT不同能量组合、重建算法及ROI选择对家兔肝铁定量测量的影响[J].放射学实践,2018,(4):344-348.
[2]高汝斌,仇红,辛红梅.手足软组织良性肿瘤MRI分析[J].实用放射学杂志,2016,6:982-984
[3]肖梦强,张萌,刘金丰,等.迭代算法低剂量CT诊断椎间盘突出[J].中国医学影像技术,2017,33(3):458-461.
[4]丰川,钱伟亮,周丹静,等.极低辐射剂量扫描结合模型迭代重建技术在下肢CTA中应用研究[J].中国CT和MRI杂志,2018,16(3)117-120.
[5]郭世绂.骨科临床解剖学[M],济南:山东科学技术出版社,2000:982.
[6]Ulmar B,Simon S,Eschler A,et al.Rupture of the Achilles tendon[J].Unfall-chirurg,2014,117(10):921-937.
[7]Clanton TO,Haytmanek CT,Williams BT,et al.A biomechanicalcomparison of an open repair and 3 minimally invasive percutaneous Achilles Tendon repair techniques during a simulated,progressive rehabilitation protocol[J].Am JSports Med,2015,43(8):1957-1964,
[8]张勇,朱明生,杨林,等.断端重叠间断横向缝合修复跟腱马尾状撕裂型损伤[J].中国骨与关节损伤杂志,2016,31(6):617-619.
[9]燕树林.全国医用设备(CT、MR、DSA)使用人员上岗考试指南[M].北京:中国人口出版社,2005:5.
[10]杨炎炎,黄仲奎.腹部水模不同管电压、管电流CT扫描的研究[J].医学影像学杂志,2018(4):678-682.
[11]彭文献,彭天舟,夏顺仁,等.X线管电压对生物组织C T值影响的实验研究[J].放射学实践,2013,28(11):1102-1104.
[12]杨炎炎,黄仲奎.腹部水模不同管电压、管电流CT扫描的研究[J].医学影像学杂志,2018,(4):678-682.
[13]许霄,黄求理,朱雪君,等.双能CT不同能量组合、重建算法及ROI选择对家兔肝铁定量测量的影响[J].放射学实践,2018,(4):344-348.