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Case–control study to estimate the performance of dual-energy computed tomography for anterior cruciate ligament tears in patients with history of knee trauma

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Abstract

Objective

Computed tomography (CT) is used to assess for fracture after knee trauma, but identification of ligamentous injuries may also be beneficial. Our purpose is to assess the potential of dual-energy computed tomography (DECT) for the detection of complete anterior cruciate ligament (ACL) disruption.

Methods

Sixteen patients with unilateral traumatic ACL disruption (average of 58 days following trauma) confirmed by MRI, and 11 control patients without trauma, underwent DECT of both knees. For each knee, axial, sagittal, and oblique sagittal images (with DECT bone removal, single-energy (SE) bone removal, and DECT tendon-specific color mapping) were reconstructed. Four musculoskeletal radiologists randomly evaluated the 324 DECT reconstructed series (54 knees with 6 displays) separately, to assess for ACL disruption using a five-point scale (1 = definitely not torn, to 5 = definitely torn). ROC analysis was used to compare performance across readers and displays.

Results

Sagittal oblique displays (mixed kV soft tissue, SE bone removal, and DECT bone removal) demonstrated higher areas under the curve for ACL disruption (AUC = 0.95, 0.93 and 0.95 respectively) without significant differences in performance between readers (p > 0.23). Inter-reader agreement was also better for these display methods (ICC range 0.62–0.69) compared with other techniques (ICC range 0.41–0.57). Mean sensitivity for ACL disruption was worst for DECT tendon-specific color map and axial images (24 % and 63 % respectively).

Conclusion

DECT knee images with oblique sagittal reconstructions using either mixed  kV or bone removal displays (either DECT or SE) depict ACL disruption in the subacute or chronic setting with reliable identification by musculoskeletal radiologists.

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Acknowledgements

The CT scanner used was provided thanks to a grant from Siemens Healthcare. J.G. Fletcher and Cynthia McCollough receive grant funding from Siemens Healthcare.

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Authors and Affiliations

  1. Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA

    Katrina N. Glazebrook, Shuai Leng, Naveen S. Murthy, B. Mathew Howe, Michael D. Ringler, Cynthia H. McCollough & J. G. Fletcher

  2. Department of Biostatistics, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA

    Rickey E. Carter

  3. Department of Orthopedics, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA

    Peter C. Rhee, Diane L. Dahm & Michael J. Stuart

  4. Department of Radiology, Alberta Health Services South Zone, 960 19 St. S, Lethbridge, Alberta, T1J 1W5, Canada

    Lee J. Brewerton

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  1. Katrina N. Glazebrook
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Correspondence to Katrina N. Glazebrook.

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Glazebrook, K.N., Brewerton, L.J., Leng, S. et al. Case–control study to estimate the performance of dual-energy computed tomography for anterior cruciate ligament tears in patients with history of knee trauma. Skeletal Radiol 43, 297–305 (2014). https://doi.org/10.1007/s00256-013-1784-3

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  • DOI: https://doi.org/10.1007/s00256-013-1784-3

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