能谱CT在急性肩锁关节脱位患者喙锁韧带损伤诊断中的意义

Diagnosis of coracoclavicular ligament injury in acute acromioclavicular dislocations by energy spectrum CT

目的研究能谱CT在评估肩锁关节脱位患者喙锁韧带损伤中的诊断价值。方法回顾性分析2020年1月至2021年10月,在我院经治的186例创伤患者的肩关节双能量CT图像。其中40例CT诊断无肩锁关节骨折及脱位(即喙锁韧带完整)病例作为对照组,12例CT诊断肩锁关节脱位病例作为研究组,利用能谱CT虚拟单能级图像分别测量对照组斜方、锥状韧带锁骨足印区中心距锁骨肩锁关节面距离、韧带体部宽度、同侧锁骨长度及韧带体部CT值。肩锁关节脱位患者测量喙锁韧带体部区CT值。用独立样本t检验比较肩锁关节脱位患者与对照组喙锁韧带CT值的差异。随后以MRI为参考标准,利用能谱CT虚拟单能级图像评估肩锁关节脱位患者喙锁韧带损伤。结果与对照组比较,肩锁关节脱位患者虚拟单能级图像测量斜方韧带体部区CT值增加[(72.1±33.0)HU vs.(47.7±14.8)HU],锥状韧带体部区CT值增加[(67.7±22.3)HU vs.(47.4±14.9)HU],差异均有统计学意义(t=4.29、4.12,P均=0.001)。能谱CT诊断肩锁关节脱位患者斜方、锥状韧带断裂的灵敏度分别为90.0%、88.9%;特异度均为100.0%。结论能谱CT虚拟单能级图像重建,可以显示喙锁韧带走行及足印区、显示韧带CT特征,对诊断肩锁关节脱位患者斜方、锥状韧带断裂具有很好的灵敏度及高度特异性。

Objective To study the value of energy spectrum CT in evaluating coracoclavicular ligament injury in patients with acromioclavicular joint dislocation.Methods We retrospectively searched 186 dual energy CT images of shoulder joints in trauma patients from January 2020 to October 2021.Forty cases without acromioclavicular joint fracture and dislocation diagnosed by CT were set as the control group,and 12 cases of acromioclavicular joint dislocation diagnosed by CT and MRI as the study group.The distance from the center of footprint of the trapezoid and conoid ligament to the clavicular acromioclavicular joint surface,the body width and CT value were measured respectively by virtual mono-energetic images in control group.In patients with acromioclavicular joint dislocation,only the CT value of coracoclavicular ligament was measured.The CT value of coracoclavicular ligament area in acromioclavicular dislocation patients was compared with control group by independent sample t-test.Subsequent MRI served as a reference standard,virtual mono-energetic images were used to evaluate the coracoclavicular ligament injury in patients with acromioclavicular joint dislocation.Results Compared with control group,the CT values of trapezoid ligament and conoid ligament area in acromioclavicular dislocation patients by virtual mono-energetic images were increased[(72.1±33.0)HU vs.(47.7±14.8)HU;(67.7±22.3)HU vs.(47.4±14.9)HU].The differences were statistically significant(t=4.29,4.12,both P=0.001).With MRI as reference,the sensitivity of energy spectrum CT to diagnose the rupture of trapezoid and conoid ligaments in patients with acromioclavicular dislocation were 90.0%and 88.9%,respectively;Both specificity was 100.0%.Conclusions Virtual mono-energetic images of energy spectrum CT can not only clearly show the course and footprints of coracoclavicular ligament,but also has good sensitivity and high specificity in the diagnosis of the rupture of trapezoid and conoid ligaments in patients with acromioclavicular joint dislocation,which provides a reference for the accurate clinical classification of acromioclavicular joint dislocation.