Dual-energy computed tomography may reduce delayed diagnosis of occult hip fractures: Experiences at a single center.

IF 2.3 Q2 MEDICINE, GENERAL & INTERNAL
SAGE Open Medicine Pub Date : 2025-04-27 eCollection Date: 2025-01-01 DOI:10.1177/20503121251336301
Hirotaka Kawakami, Hiromi Sasaki, Junichi Kamizono, Yuki Yasutake, Kana Yamada, Suguru Saho, Takehiro Kawauchi, Noboru Taniguchi
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Abstract

Objectives: Early surgical intervention within 48 h is critical for reducing mortality and morbidity in patients with hip fractures. However, occult hip fractures are often missed, leading to treatment delays. Dual-energy computed tomography allows visualization of bone marrow edema and bone contusions, which are challenging to detect using conventional computed tomography. This study aimed to evaluate the effectiveness of dual-energy computed tomography in diagnosing occult hip fractures.

Methods: Eighteen dual-energy computed tomography scans obtained between May 2018 and March 2024 were analyzed. Magnetic resonance imaging was performed in all cases. A trained musculoskeletal radiologist interpreted the dual-energy computed tomography and magnetic resonance imaging scans, which were then reviewed by two senior orthopedic surgeons. The confirmed diagnoses included 14 femoral trochanteric fractures and 4 femoral neck fractures. Four junior orthopedic surgeons independently reviewed the dual-energy computed tomography scans only and conducted diagnostic examinations. Patients were subsequently categorized into two groups: those with unanimous diagnostic agreement (unanimity group) and those with discrepancies (objection group).

Results: For femoral trochanteric fractures, sensitivity, specificity, accuracy, and Cohen's kappa coefficient were 94%, 81%, 0.91, and 0.75, respectively. For femoral neck fractures, sensitivity, specificity, accuracy, and Cohen's kappa coefficient were 68%, 96%, 0.90, and 0.69, respectively. A significant difference in diagnostic ease was noted (p = 0.04), with agreement achieved for 12 of the 14 femoral trochanteric fractures and one of the four femoral neck fractures. Logistic regression analysis yielded a regression coefficient for femoral trochanteric fractures of 3.05 (p = 0.03), indicating that these fractures were more easily diagnosed than femoral neck fractures.

Conclusions: Dual-energy computed tomography demonstrated high sensitivity and specificity in detecting occult hip fractures, particularly those of the femoral trochanter. However, its sensitivity was lower for femoral neck fractures, indicating limited reliability in their diagnosis. Further investigation and magnetic resonance imaging scans are recommended for suspected femoral neck fractures.

双能计算机断层扫描可减少隐匿性髋部骨折的延迟诊断:单一中心的经验。
目的:早期手术干预在48小时内对降低髋部骨折患者的死亡率和发病率至关重要。然而,隐匿性髋部骨折经常被遗漏,导致治疗延误。双能计算机断层扫描允许骨髓水肿和骨挫伤的可视化,这是传统计算机断层扫描检测的挑战。本研究旨在评估双能计算机断层扫描诊断隐匿性髋部骨折的有效性。方法:对2018年5月至2024年3月期间获得的18张双能计算机断层扫描进行分析。所有病例均行磁共振成像。一位训练有素的肌肉骨骼放射科医生解释了双能计算机断层扫描和磁共振成像扫描结果,然后由两名高级骨科医生检查。确诊为股骨粗隆骨折14例,股骨颈骨折4例。四名初级骨科医生独立审查双能计算机断层扫描,并进行诊断检查。患者随后被分为两组:诊断一致的(一致组)和不一致的(反对组)。结果:股骨粗隆骨折的敏感性、特异性、准确性和Cohen’s kappa系数分别为94%、81%、0.91和0.75。股骨颈骨折的敏感性、特异性、准确性和Cohen’s kappa系数分别为68%、96%、0.90和0.69。在14例股骨粗隆骨折中有12例和4例股骨颈骨折中有1例的诊断容易程度有显著差异(p = 0.04)。经Logistic回归分析,股骨粗隆骨折的回归系数为3.05 (p = 0.03),说明股骨粗隆骨折比股骨颈骨折更容易诊断。结论:双能计算机断层扫描在检测隐匿性髋部骨折,特别是股骨粗隆骨折方面具有很高的敏感性和特异性。然而,其对股骨颈骨折的敏感性较低,表明其诊断的可靠性有限。对于疑似股骨颈骨折,建议进一步检查和磁共振成像扫描。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
SAGE Open Medicine
SAGE Open Medicine MEDICINE, GENERAL & INTERNAL-
CiteScore
3.50
自引率
4.30%
发文量
289
审稿时长
12 weeks
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