Digital Tomosynthesis versus Conventional Radiography for Evaluating Osteonecrosis of the Femoral Head

Abstract

Objective The aim of this study was to compare the diagnostic performances of digital tomosynthesis (DTS) and conventional radiography in detecting osteonecrosis of the femoral head (ONFH) using computed tomography (CT), as the reference standard and evaluate the diagnostic reproducibility of DTS. Materials and Methods Forty-five patients (24 male and 21 female; age range, 25–77 years) with clinically suspected ONFH underwent anteroposterior radiography, DTS, and CT. Two musculoskeletal radiologists independently evaluated the presence and type of ONFH. The diagnostic performance of radiography and DTS in detecting the presence of ONFH and determining the types of ONFH were evaluated. The interobserver and intraobserver reliabilities of each imaging modality were analyzed using Cohen's kappa. Results DTS had higher sensitivity (89.4%–100% vs. 74.5%–76.6%) and specificity (97.3%–100% vs. 78.4%–83.8%) for ONFH detection than radiography. DTS showed higher performance than radiography in identifying the subtypes of ONFH with statistical significance in one reader (type 1, 100% vs. 30.8%, p = 0.004; type II, 97.1% vs. 73.5%, p = 0.008). The interobserver agreement was excellent for DTS and moderate for radiography (kappa of 0.86 vs. 0.57, respectively). The intraobserver agreement for DTS was higher than that of radiography (kappa of 0.96 vs. 0.69, respectively). Conclusion DTS showed higher diagnostic performance and reproducibility than radiography in detecting ONFH. DTS may be used as a first-line diagnostic modality instead of radiography for patients suspected of having ONFH.

X-ray, digital tomographic fusion, CT, and MRI in early ischemic necrosis of the femoral head

“…[ 6 , 7 ] Digital tomography fusion (DTS) is used to obtain a clear image of the target area by blurring the image outside the observation area after a one-time scan using an X-ray bulb, and the image is reconstructed using computer post-processing software. [ 8 , 9 ] We analyzed and compared the X-ray, CT, MRI, and DTS imaging performances in diagnosing ANFH at different stages, to evaluate the value of various imaging modalities for ANFH staging and early ANFH.…”