双能CT的Water-Hap基物质对图像和伪彩图像显示急性膝关节创伤患者骨髓水肿的诊断价值

The Diagnostic Value of Water Hap Based Substances in Dual Energy CT for Displaying Bone Marrow Edema in Patients with Acute Knee Joint Trauma through Imaging and Pseudocolor Imaging

摘要: 目的：比较双能CT物质分离技术的水–羟基磷灰石(Water-Hap)基物质对图和伪彩图在显示急性膝关节创伤患者骨髓水肿中的诊断价值。方法：选取行双能CT和MRI检查的急性膝关节外伤患者31例，双能CT扫描数据传输到AW4.7工作站进行后处理，以MRI图像作为参考标准，由2位影像诊断医生分别利用Water-Hap基物质对图像和伪彩图像评估是否存有骨髓水肿，分别计算Water-Hap基物质对图和伪彩图诊断膝关节骨髓水肿区域的灵敏度、特异度、阳性预测值、阴性预测值，并比较二者的诊断效能。结果：31例膝关节外伤，MRI显示骨髓水肿区域124处，两位医生在Water-Hap基物质对图像上评估骨髓水肿的诊断灵敏度(真阳性率)分别为38.6%、40.9%，特异度分别为95%、95%，阳性预测值分别为81%、81.8%，阴性预测值分别为73.8%、74.5%，约登指数分别为33.6%、35.9%。两位医生在伪彩图像上评估骨髓水肿的诊断灵敏度分别为34.1%、34.1%，特异度分别为100%、98.7%，阳性预测值分别为100%、93.8%，阴性预测值分别为73.4%、73.1%，2位医生对Water-Hap基物质对图像和伪彩图像视觉评估的kappa值分别为0.972和0.963，具有高度的一致性。结论：与伪彩图像相比，Water-Hap基物质对图像上评估骨髓水肿有更高的灵敏度，和更高的假阳性率(误诊率)，双能CT物质分离技术在诊断急性膝关节创伤患者骨髓水肿有应用于临床的潜力。

Abstract: Objective: To compare the diagnostic value of water-hydroxyapatite (Water-Hap)-based material alignment and pseudo-color image in patients with acute knee trauma by dual-energy CT material separation technology. Methods: A total of 31 patients with acute knee trauma who underwent dual-energy CT and MRI examinations were selected, and the dual-energy CT scan data were transmitted to the AW4.7 workstation for post-processing, and the MRI images were used as the reference standard. Two imaging diagnostic doctors evaluated the presence of bone marrow edema in the images and pseudocolor images using Water Hop based substances, and calculated the sensitivity, specificity, positive predictive value, and negative predictive value of the water Hop based substances for diagnosing the bone marrow edema area in the knee joint on the images and pseudocolor images, respectively. The diagnostic efficacy of the two was compared. Results: In 31 cases of knee trauma, MRI showed 124 areas of bone marrow edema, and the diagnostic sensitivity (true positive rate) of the two doctors was 38.6% and 40.9%, the specificity was 95% and 95%, the positive predictive values were 81% and 81.8%, the negative predictive values were 73.8% and 74.5%, and the Youden index was 33.6% and 35.9%, respectively. The diagnostic sensitivity and specificity of the two doctors were 34.1% and 34.1%, the specificity was 100% and 98.7%, the positive predictive values were 100% and 93.8%, and the negative predictive values were 73.4% and 73.1%, respectively, and the kappa values of the two doctors for the visual evaluation of Water-Hap-based substances and pseudocolor images were 0.972 and 0.963, respectively, which were highly consistent. Conclusion: Compared with pseudo-color images, Water-Hap-based substances have higher sensitivity and higher false positive rate (misdiagnosis rate) for the assessment of bone marrow edema on images, and dual-energy CT material separation technology has the potential to be applied in clinical practice in the diagnosis of bone marrow edema in patients with acute knee trauma.