超声造影和股骨头髋侧循环动脉多普勒超声联合诊断早中期非创伤性股骨头坏死的研究

Evaluation of the value and accuracy of the combined application of TIC curve analysis and MFCA Doppler ultrasound in the diagnosis of early and mid stage non traumatic osteonecrosis of the femoral head

摘要:

目的 评估超声造影（CEUS）和股骨头髋侧循环动脉多普勒超声联合应用对早中期股骨头坏死诊断的价值与准确性。方法 回顾性分析2021年10月—2023年10月在海安市中医院确诊的105例非创伤性股骨头坏死的患者的临床资料。依据国际骨循环研究学会（ARCO）分期标准对患者进行分期，其中Ⅰ期67例，Ⅱ期38例。采用CEUS观察增强区域形态、灌注缺陷和增强的均匀性，并进行时间-强度曲线（TIC）定量分析，观察CEUS定量参数［增强强度（EI）、平均渡越时间（MTT）、上升斜率（AS）及下降斜率（DS）］；采用股骨头髋侧循环动脉多普勒超声测量股骨头髋侧循环动脉的收缩期峰值流速（PSV）、舒张末期流速（EDV）、平均流速（Vmean）、搏动指数（PI）、阻力指数（RI）等，计算出血流量（Q），评估股骨头的供血情况。采用受试者工作特征（ROC）曲线分析CEUS与股骨头髋侧循环动脉的多普勒超声联合对早中期非创伤性股骨头坏死的诊断价值。结果 CEUS结果显示，与Ⅱ期患者相比，Ⅰ期患者的增强区域形态更加清晰，灌注缺陷较少，增强的均匀性较好，TIC定量分析也呈现了一致结果；股骨头髋侧循环动脉多普勒超声检查结果显示，Ⅰ期患者的PSV、EDV、Vmean和Q值均高于Ⅱ期患者，而PI和RI均低于Ⅱ期患者。ROC曲线分析结果显示，CEUS诊断早中期非创伤性股骨头坏死的敏感性为84.2%（95% CI：0.687，0.940），特异性为88.1%（95% CI：0.778，0.947）；股骨头髋侧循环动脉多普勒超声诊断早中期非创伤性股骨头坏死的敏感性为86.8%（95% CI：0.719，0.956），特异性为79.1%（95% CI：0.674，0.881）；两者联合诊断的敏感性为94.7%（95% CI：0.823，0.994），特异性为91.0%（95% CI：0.815，0.966）。结论 CEUS和股骨头髋侧循环动脉多普勒超声联合诊断可以提高早中期非创伤性股骨头坏死的诊断准确性，优于单一成像技术。

Abstract:

Objective To evaluate the value and accuracy of contrast-enhanced ultrasound (CEUS) and Medial Femoral Circulatory Artery (MFCA) Doppler ultrasound combined in the diagnosis of non traumatic osteonecrosis of the femoral head (NONFH) in the early and middle stages.Method From October 2021 to October 2023, imaging data of 105 patients diagnosed with non traumatic femoral head necrosis through MRI examination at Hai'an Traditional Chinese Medicine Hospital were collected. According to the staging criteria of the Association Research Circulatory Osseous (ARCO), non traumatic femoral head necrosis patients were classified into stages, with 67 cases in the Phase I group and 38 cases in the Phase Ⅱ group. CEUS observes the morphology of the enhanced area, perfusion defects, and uniformity of enhancement, and conducts quantitative analysis of the Time Intensity Curve (TIC) curve to observe the quantitative parameters of contrast-enhanced ultrasound (Enhancement Intensity (EI), Mean Transit Time (MTT), Ascending Slope (AS), and Descending Slope (DS)). Further Doppler ultrasound examination of MFCA is performed on patients, and the peak systolic velocity (PSV) and end diastolic velocity (End Dia) of MFCA are measured. Stolic Velocity (EDV), Mean Velocity (Vmean), Pulsatile Index (PI), Resistive Index (RI), etc., calculate Blood Flow Volume (Q), and evaluate the blood supply to the femoral head. The receiver operating characteristic curve (ROC) was used to analyze the accuracy of combining the observation indicators of CEUS and the Doppler ultrasound indicators of MFCA in the early and mid stage diagnosis of non traumatic osteonecrosis of the femoral head.Result The contrast-enhanced ultrasound (CEUS) results showed that compared with stage Ⅱ patients, stage Ⅰ patients had a clearer morphology of the enhanced area, fewer perfusion defects, and better uniformity of enhancement. The quantitative analysis of the TIC curve also showed consistent results; The Doppler ultrasound examination results of MFCA showed that PSV, EDV, and Vmean were higher in stage I patients than in stage Ⅱ patients, while PI and RI were higher in stage II patients; The blood flow (Q) of stage Ⅰ patients is higher than that of stage Ⅱ patients; ROC curve analysis indicated that the sensitivity of CEUS for diagnosing early and mid-stage NONFH was 84.2% (95% CI: 0.687, 0.940) and specificity was 88.1% (95% CI: 0.778, 0.947). The sensitivity of MFCA Doppler ultrasound blood flow indicators for diagnosing early and mid-stage non traumatic osteonecrosis of the femoral head was 86.8% (95% CI: 0.719, 0.956) and specificity was 79.1% (95% CI: 0.674, 0.881). The combined use of both methods yielded a sensitivity of 94.7% (95% CI: 0.823, 0.994) and specificity of 91.0% (95% CI: 0.815, 0.966) in diagnosing early and mid-stage non traumatic osteonecrosis of the femoral head.Conclusion The combined application of CEUS and MFCA Doppler ultrasound examination in the early and mid stage diagnosis of non traumatic femoral head necrosis can significantly improve the accuracy of diagnosis, showing better sensitivity and specificity than single imaging techniques.