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MRI及放射影像对全髋关节置换术后植入体松动判别的价值对比
作者:杜鉴铭 
单位:首都医科大学附属北京朝阳医院 放射科, 北京 100020
关键词:全髋关节置换 假体松动 核磁共振成像 诊断价值 
分类号:R816.8
出版年·卷·期(页码):2023·51·第一期(44-51)
摘要:

目的: 为探究金属伪影校正技术(SEMAC)能否提高MRI在全髋关节置换(THR)术后无菌性假体松动检测中可靠性,我们以手术结果为金标准来验证SEMAC-MRI对于无菌性松动的诊断效能,并将之与CT和X线的诊断效果进行了对比研究。方法: 回顾性分析2019年5月至2021年5月我院收治的47例THR术后疑似假体松动患者的临床资料,并对比其影像学检查结果,包括MRI、CT和X线。最后,应用受试者工作特征(ROC)曲线分析不同影像学检查方法在髋关节假体无菌性松动中的诊断效能。结果: SEMAC-MRI在髋臼I区和股骨1、7区有良好的显像效果,可更好地判断该区假体松动情况。ROC曲线显示,SEMAC-MRI对于髋臼和股骨假体无菌性松动有更好的诊断价值,其AUC分别为0.836和0.955。同时,SEMAC-MRI预测假体无菌性松动的准确率、灵敏度显著高于X线(P<0.05)。结论: SEMAC-MRI在THR术后假体松动的诊断中具有高灵敏度和准确性,有助于更早地发现无菌性松动,从而避免假体周围骨溶解的进一步加重。因此,SEMAC-MRI技术值得在临床上进一步推广应用。

Objective: To explore whether the slice encoding for metal artifact correction(SEMAC) could improve the reliability of MRI in detecting aseptic loosening after total hip replacement(THR), we validated the diagnostic efficacy of SEMAC-MRI for aseptic loosening using surgical findings as the gold standard and compared it with CT and X-ray.Methods: The clinical data of 47 patients with suspected prosthetic loosening after THR admitted to our hospital from May 2019 to May 2021 were analyzed retrospectively, and their imaging findings were compared, including MRI, CT, and X-ray. Finally, receiver operating characteristic(ROC) curve was applied to analyze the diagnostic efficacy of different imaging methods in aseptic loosening of hip prosthesis.Results: SEMAC-MRI had a good imaging effect in the acetabular I area andfemur area 1 and 7, which could better judge prosthesis loosening in this area. The ROC curve showed that SEMAC-MRI had better diagnostic value for aseptic loosening of the acetabular and femoral prosthesis, with an AUC of 0.836 and 0.955, respectively. Meanwhile, the accuracy and sensitivity of SEMAC-MRI in predicting aseptic loosening of the prosthesis was significantly higher than that of X-ray(P<0.05).Conclusion: SEMAC-MRI has high sensitivity and accuracy in the diagnosis of prosthetic loosening after THR, which is helpful to detect early aseptic loosening, thus avoiding further aggravation of periprosthetic osteolysis. Therefore, the SEMAC-MRI technique is worthy of further clinical application.

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