CAJ | 학술논문

目的：比较tomosynthesis-shimadzumetalartefactreductiontechnology(T-SMART)断层融合成像( tomosynthesis，TOMOS )、计算机 X 线断层扫描( computed tomography，CT )与数字化 X 线摄影( digital radiography，DR)显示髋关节假体及其周围结构的能力。方法连续选取进行单侧或双侧髋关节置换术( total hip arthroplasty，THA )，且已行术后 DR、CT 及 TOMOS 三项影像学复查的患者20例，男12例，女8例，年龄36～82岁，平均年龄61.0岁。调阅并分析这20个病例的TOMOS、CT及DR影像资料，由3名高年资主治医师读片，并进行主观评分，评分标准为：假体周围结构观察清晰，图像评为“优”，记2分；因轻微伪影或受限于图像分辨率等原因，图像清晰度受影响，但基本不影响观察，评为“中”，记1分；因金属伪影大等因素，图像清晰度差，严重影响观察，评为“差”，记0分。评分结果以广义估计方程进行统计学分析。结果应用TOMOS观察髋臼(含髋关节间隙)的图像质量频率分布为：2分55%，1分40%，0分5%，观察股骨上段假体周围组织的图像质量频率分布为：2分75%，1分25%，0分5%；应用CT观察髋臼(含髋关节间隙)的图像质量频率分布为：2分5%，1分60%，0分35%，观察股骨上段假体周围组织的图像质量频率分布为：2分5%，1分55%，0分40%，TOMOS的评分高于CT，差异有统计学意义( P＜0.001)，应用DR检查观察髋臼(含髋关节间隙)的图像质量频率分布为：2分25%，1分75%，0分0%；观察股骨上段假体周围组织的图像质量频率分布为：2分50%，1分50%，0分0%，DR的评分高于CT，差异有统计学意义(P＝0～0.0077)。结论髋关节假体TOMOS成像质量比CT图像好，又克服了DR不能分层薄层观察的缺点，在髋关节假体复查中有应用价值。
목적：비교tomosynthesis-shimadzumetalartefactreductiontechnology(T-SMART)단층융합성상( tomosynthesis，TOMOS )、계산궤 X 선단층소묘( computed tomography，CT )여수자화 X 선섭영( digital radiography，DR)현시관관절가체급기주위결구적능력。방법련속선취진행단측혹쌍측관관절치환술( total hip arthroplasty，THA )，차이행술후 DR、CT 급 TOMOS 삼항영상학복사적환자20례，남12례，녀8례，년령36～82세，평균년령61.0세。조열병분석저20개병례적TOMOS、CT급DR영상자료，유3명고년자주치의사독편，병진행주관평분，평분표준위：가체주위결구관찰청석，도상평위“우”，기2분；인경미위영혹수한우도상분변솔등원인，도상청석도수영향，단기본불영향관찰，평위“중”，기1분；인금속위영대등인소，도상청석도차，엄중영향관찰，평위“차”，기0분。평분결과이엄의고계방정진행통계학분석。결과응용TOMOS관찰관구(함관관절간극)적도상질량빈솔분포위：2분55%，1분40%，0분5%，관찰고골상단가체주위조직적도상질량빈솔분포위：2분75%，1분25%，0분5%；응용CT관찰관구(함관관절간극)적도상질량빈솔분포위：2분5%，1분60%，0분35%，관찰고골상단가체주위조직적도상질량빈솔분포위：2분5%，1분55%，0분40%，TOMOS적평분고우CT，차이유통계학의의( P＜0.001)，응용DR검사관찰관구(함관관절간극)적도상질량빈솔분포위：2분25%，1분75%，0분0%；관찰고골상단가체주위조직적도상질량빈솔분포위：2분50%，1분50%，0분0%，DR적평분고우CT，차이유통계학의의(P＝0～0.0077)。결론관관절가체TOMOS성상질량비CT도상호，우극복료DR불능분층박층관찰적결점，재관관절가체복사중유응용개치。
Objective To compare the capacity of tomosynthesis ( TOMOS ), computed tomography ( CT ) and digital radiography ( DR ) in imaging hip prostheses and their surrounding structures.Methods A total of 20 consecutive patients receiving either unilateral or bilateral total hip arthroplasty ( THA ) were enrolled, including 12 males and 8 females. Their mean age was 61.0 years old ( range: 36-82 years ). All the patients underwent TOMOS, CT and DR after THA. The TOMOS, CT and DR images of the 20 patients were reviewed and subjectively scored by 3 senior attending radiologists. The evaluation standard was stated as following. The clear image of the structures around the prostheses was rated as “excellent”, with the score of 2 points. The sharpness of the image was affected by minor artifacts or lower resolution, but the basic observation wasn’t affected. Such images were rated as “mid”, with the score of 1 point. If the image deifnition was seriously affected by metal artifacts or other factors, it was rated as “poor”, with the score of 0 point. The scores calculated would be statistically analysed via Generalized Estimating Equations.Results The score frequency distribution of TOMOS imaging for the acetabulum ( including the hip joint space ) was 55% ( 2 points ), 40% ( 1 point ), and 5% ( 0 point ). The score frequency distribution of TOMOS imaging for the proximal femoral peri-prothesis region was 75% ( 2 points ), 25% ( 1 point ), and 0% ( 0 point ). The score frequency distribution of CT imaging for the acetabulum ( including the hip joint space ) is 5% ( 2 points ), 60%( 1 point ), and 35% ( 0 point ). The score frequency distribution of CT imaging for the proximal femoral peri-prothesis region was 5% ( 2 points ), 55% ( 1 point ), and 40% ( 0 point ). TOMOS was superior to CT in image quality, and the differences in the scores were statistically signigicant (P<0.001 ). The score frequency distribution of DR imaging for the acetabulum ( including the hip joint space ) was 25% ( 2 points ), 75% ( 1 point ), and 0% ( 0 point ). The score frequency distribution of DR imaging for the proximal femoral peri-prothesis region was 50% ( 2 points ), 50%( 1 point ), and 0% ( 0 point ). The image deifnition of DR was better than that of CT, and the differences in the scores were statistically signigicant (P=0-0.0077 ).Conclusions The TOMOS imaging quality of hip prostheses is better than that of CT, with the advantage of layering and thin-slice observation over DR. Thus, TOMOS is a promising imaging modality in the follow-up after THA .