双能CT检测创伤性椎体骨髓水肿的诊断准确性:与MRI在一级创伤中心的前瞻性比较研究。

IF 2.6 3区 医学 Q2 CLINICAL NEUROLOGY
Thomas Beyer, Erik Volmer, Patrick Gahr, Marc-André Weber
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引用次数: 0

摘要

背景:外伤性椎体骨折是急诊诊断的一大挑战。磁共振成像(MRI)在检测骨髓水肿方面表现出色,但在急性创伤护理中面临实际限制。本前瞻性研究评估了双能计算机断层扫描(DECT)在I级创伤中心环境中检测创伤性椎体骨髓水肿的诊断准确性。方法:2020年5月至2023年7月,对291例疑似或确诊脊髓损伤的成年患者进行了DECT检查。其中233个(80.1%)符合分析质量标准。亚组47例患者接受了额外的MRI作为参考标准,其中44例(93.6%)提供了可诊断的图像。两名委员会认证的放射科医生独立评估椎体骨髓水肿的存在,采用盲法,随机评估两种方式。分析了诊断参数、检查次数、辐射暴露和成本效益。结果:与MRI相比,DECT检测椎体骨髓水肿的总体敏感性为82.9%,特异性为96.6%。胸腰椎连接处灵敏度最高(L3为91.7%)。DECT检查时间为7.2分钟(含后处理),MRI为12分钟,MRI比DECT多66.7%的时间。与常规CT相比,DECT辐射暴露显示平均剂量-长度乘积仅增加3%。身体质量指数对DECT的可解释性(p=0.196)或诊断准确性没有显著影响,除了孤立的节段(L3, T11)。成本效益分析显示,采用基于ect的诊断途径,每个脊柱节段可节省49.1%(104.40欧元)。结论:与MRI相比,DECT在诊断外伤性椎体骨髓水肿方面具有较高的准确性,且具有明显的时间和成本优势。该技术在急性创伤环境中显示出特殊的价值,同时承认主要由医疗设备引起的人为因素(19.9%的病例)的局限性。这些发现支持实施DECT作为脊髓创伤诊断MRI的有效替代。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Diagnostic accuracy of Dual-Energy CT in detecting traumatic vertebral bone marrow edema: a prospective comparative study with MRI in the context of a level I trauma center.

Background: Traumatic vertebral fractures present a significant diagnostic challenge in emergency settings. Magnetic resonance imaging (MRI) excels in detecting bone marrow edema but faces practical limitations in acute trauma care. This prospective study evaluates the diagnostic accuracy of Dual-Energy Computed Tomography (DECT) in detecting traumatic vertebral bone marrow edema within a Level I trauma center environment.

Methods: Between May 2020 and July 2023, 291 DECT examinations were performed on adult patients presenting with suspected or confirmed spinal injury. From these, 233 (80.1%) met quality criteria for analysis. A subgroup of 47 patients underwent additional MRI as reference standard, with 44 (93.6%) providing diagnostically evaluable images. Two board-certified radiologists independently assessed vertebral bone marrow edema presence in blinded, randomized evaluations using both modalities. Diagnostic parameters, examination times, radiation exposure, and cost-efficiency were analyzed.

Results: DECT demonstrated an overall sensitivity of 82.9% and specificity of 96.6% for detecting vertebral bone marrow edema compared to MRI. The thoracolumbar junction showed highest sensitivity (91.7% for L3). DECT examination time was 7.2 minutes (including post-processing) versus 12 minutes for MRI, meaning MRI required 66.7% more time than DECT. DECT radiation exposure showed a mean dose-length product increase of only 3% compared to conventional CT. Body mass index showed no significant influence on DECT interpretability (p=0.196) or diagnostic accuracy except in isolated segments (L3, T11). Cost-benefit analysis revealed potential savings of 49.1% (€104.40) per spinal segment with DECT-based diagnostic pathways.

Conclusion: DECT offers high diagnostic accuracy for detecting traumatic vertebral bone marrow edema with substantial time and cost advantages compared to MRI. The technique demonstrates particular value in acute trauma settings, while acknowledging limitations from artifacts (19.9% of cases) primarily caused by medical devices. These findings support implementing DECT as an efficient alternative to MRI in spinal trauma diagnostics.

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来源期刊
Neuroradiology
Neuroradiology 医学-核医学
CiteScore
5.30
自引率
3.60%
发文量
214
审稿时长
4-8 weeks
期刊介绍: Neuroradiology aims to provide state-of-the-art medical and scientific information in the fields of Neuroradiology, Neurosciences, Neurology, Psychiatry, Neurosurgery, and related medical specialities. Neuroradiology as the official Journal of the European Society of Neuroradiology receives submissions from all parts of the world and publishes peer-reviewed original research, comprehensive reviews, educational papers, opinion papers, and short reports on exceptional clinical observations and new technical developments in the field of Neuroimaging and Neurointervention. The journal has subsections for Diagnostic and Interventional Neuroradiology, Advanced Neuroimaging, Paediatric Neuroradiology, Head-Neck-ENT Radiology, Spine Neuroradiology, and for submissions from Japan. Neuroradiology aims to provide new knowledge about and insights into the function and pathology of the human nervous system that may help to better diagnose and treat nervous system diseases. Neuroradiology is a member of the Committee on Publication Ethics (COPE) and follows the COPE core practices. Neuroradiology prefers articles that are free of bias, self-critical regarding limitations, transparent and clear in describing study participants, methods, and statistics, and short in presenting results. Before peer-review all submissions are automatically checked by iThenticate to assess for potential overlap in prior publication.
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