Valid and reliable diagnostic performance of dual-energy CT in anterior cruciate ligament rupture

Author:

Liu Di,Hu Ping,Cai Zi-Jun,Lu Wen-Hao,Pan Lin-Yuan,Liu Xu,Peng Xian-Jing,Li Yu-Sheng,Xiao Wen-Feng

Abstract

Abstract Objectives To determine whether dual-energy CT (DECT) can be used to accurately and reliably detect anterior cruciate ligament (ACL) rupture. Materials and methods Participants with unilateral ACL rupture were prospectively enrolled, and the bilateral knees were scanned by DECT. A tissue-specific mapping algorithm was applied to improve the visualization of the ACLs. The 80-keV CT value, mixed-keV CT value, electron density (Rho), and effective atomic number (Zeff) were measured to quantitatively differentiate torn ACLs from normal ACLs. MRI and arthroscopy served as the reference standards. Results Fifty-one participants (mean age, 27.0 ± 8.7 years; 31 men) were enrolled. Intact and torn ACLs were explicitly differentiated on color-coded DECT images. The 80-keV CT value, mixed-keV CT value, and Rho were significantly lower for the torn ACLs than for the intact ACLs (p < 0.001). The optimal cutoff values were an 80-keV CT value of 61.8 HU, a mixed-keV CT value of 60.9 HU, and a Rho of 51.8 HU, with AUCs of 98.0% (95% CI: 97.0–98.9%), 99.2% (95% CI: 98.6–99.7%), and 99.8% (95% CI: 99.6–100.0%), respectively. Overall, DECT had almost perfect reliability and validity in detecting ACL integrity (sensitivity = 97.1% [95% CI: 88.1–99.8%]; specificity = 98.0% [95% CI: 89.5–99.9%]; PPV = 98.0% [95% CI: 93.0–99.8%]; NPV = 97.1% [95% CI: 91.7–99.4%]; accuracy = 97.5% [95% CI: 94.3–99.2%]). There was no evidence of a difference between MRI and DECT in the diagnostic performance (p > 0.99). Conclusion DECT has excellent diagnostic accuracy and reliability in qualitatively and quantitatively diagnosing ACL rupture. Clinical relevance statement DECT could validly and reliably diagnose ACL rupture using both qualitative and quantitative methods, which may become a promising substitute for MRI to evaluate the integrity of injured ACLs and the maturity of postoperative ACL autografts. Key Points • On color-coded DECT images, an uncolored ACL was a reliable sign for qualitatively diagnosing ACL rupture. • The 80-keV CT value, mixed-keV CT value, and Rho were significantly lower for the torn ACLs than for the intact ACLs, which contributed to the quantitative diagnosis of ACL rupture. • DECT had an almost perfect diagnostic performance for ACL rupture, and diagnostic capability was comparable between MRI and DECT.

Funder

National Key R&D Program of China

National Natural Science Foundation of China

Provincial Clinical Medical Technology Innovation Project of Hunan

National Clinical Research Center for Geriatric Disorders

National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation

Innovation-Driven Project of Central South University

Wu Jieping Medical Foundation

CMA▪Young and Middle-aged Doctors Outstanding Development Program-Osteoporosis Specialized Scientific Research Fund Project

Key Program of Health Commission of Hunan Province

Fundamental Research Funds for the Central Universities of Central South University

Publisher

Springer Science and Business Media LLC

Subject

Radiology, Nuclear Medicine and imaging,General Medicine

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