CT和MRI诊断股骨头坏死的价值比较

Comparison of value of CT versus MRI in diagnosis of femoral head necrosis

目的比较CT和MRI诊断股骨头坏死(FHN)的价值。方法回顾性分析2019年5月至2021年5月新里程安钢总医院收治的疑似股骨头坏死患者180例,其中采用CT诊断65例,采用MRI诊断115例,所有患者均行穿刺活组织检查。以穿刺诊断结果为金标准,比较CT和MRI诊断股骨头坏死的诊断效能、诊断预测值、不同征象检出率。结果采用CT诊断的65例患者中,CT诊断阳性39例,阴性26例;穿刺诊断阳性41例,阴性24例。采用MRI诊断的115例患者中,MRI诊断阳性71例,阴性44例;穿刺确诊阳性73例,阴性42例。MRI诊断灵敏度为90.41%(66/73)、准确度为89.57%(103/115)、特异度为88.10%(37/42),高于CT的相应值(P<0.05);MRI漏诊率为9.59%(7/73)、误诊率为11.90%(5/42),低于CT的相应值(P<0.05);MRI阳性预测值为92.96%(66/71)、阴性预测值为84.09%(37/44),高于CT的相应值(P<0.05)。MRI不同征象检出率高于CT的相应值(P<0.05)。结论MRI诊断股骨头坏死可提高诊断效能和诊断预测值,且征象检出效果高于CT,可为临床股骨头坏死诊疗提供影像学支持。

Objective To compare the value of CT and MRI in the diagnosis of femoral head necrosis(FHN).Methods A total of 180 patients with suspected FHN in Xinlicheng Steel General Hospital from May 2019 to May 2021 were analyzed retrospectively,including 65 patients diagnosed by CT and 115 patients diagnosed by MRI,all patients underwent biopsy.With the result of puncture diagnosis as the gold standard,the diagnostic efficacy,diagnostic predictive value and detection rate of different signs of FHN were compared between CT and MRI.Results Of the 65 patients diagnosed by CT,39 were positive and 26 were negative;the puncture diagnosis was positive in 41 cases and negative in 24 cases.Of 115 patients diagnosed by MRI,71 were positive and 44 were negative,73 positive cases and 42 negative cases were confirmed by puncture.The sensitivity of MRI diagnosis was 90.41%(66/73),the accuracy was 89.57%(103/115),and the specificity was 88.10%(37/42),which was higher than the corresponding value of CT(P<0.05);the missed diagnosis rate of MRI was 9.59%(7/73),and the misdiagnosis rate was 11.90%(5/42),which was lower than the corresponding value of CT(P<0.05);the positive predictive value of MRI was 92.96%(66/71)and the negative predictive value was 84.09%(37/44),which was higher than the corresponding value of CT(P<0.05).The detection rate of different signs of MRI was higher than the corresponding value of CT(P<0.05).Conclusions MRI diagnosis of FHN can improve the diagnostic efficiency and predictive value,and the sign detection effect is higher than that of CT diagnosis,which can provide imaging support for clinical diagnosis and treatment of FHN.