The Diagnosis Value Of Digital Tomosynthesis In The Osteonecrosis Of The Femoral Head

ObjectiveThe aim of this investigation is to compare the difference detection rate of osteonecrosis of the femoral head(ONFH) and the difference detection rate of early osteonecrosis of the femoral head between digital tomosynthesis(DTS) and digital X-ray photography(DR). To explore the application value of DTS in early diagnosis and staging of ONFH.MethodSelected 30 patients underwented Magnetic Resonance Imaging(MRI), DTS, DR at the same day who were all confirmed osteonecrosis of the femoral head(ONFH) with MRI,coming with hip pain and discomfort presented in orthopaedics department of the hospital of Shanxi medical university from March 2014 to March 2016. MRI was the gold standard on assessing ONFH.Clinical history including hip pain, trauma, long-term usage of high dose corticostero, alcoholism and so on, were collected and recorded of 30 patients. Two experienced physicians of radiologists conducted analyses of images of DR and DTS with double blind method. If the conclusions were not consistent, they would reach an agreement after discussion.Result1.In 30 patients, 45 hips were involved including unilateral in 15 cases and bilateral in15 cases. The imaging manifestation of ONFH including blurred and disordered bone trabecula which DR found 2 hips, DTS found 10 hips; bone density decreased and mixed which DR found 25 hips, DTS found 28 hips;cortex of bone collapsed which DR found 15 hips, DTS found 18 hips; and joint space narrowing to osteoarthritis which DR found 9hips, DTS found 11 hips. According to ARCO stage, stage 0 in 0 hips, stage I in 17 hips,stage II in 8 hips, stage III in 9 hips, stage IV in 11 hips. The DR detection rate of ONFH is60%(27/45), wherein the early(stage I-II) detection rate is 48%(12/25); the DTS detection rate is 84.4%(38/45), and the early detection rate is 80%(20/25).2.The detection rate of DTS in the ONFH was higher than DR, and the difference was statistically significant(P < 0.05);3.The early detection rate of DTS in the ONFH was higher than X-ray plain film, and the difference was statistically significant(P < 0.05).Conclusion1. DTS detection rate of ONFH was higher than DR, it can be further examination after DR.It is cheaper, more convenient and less contraindications than MRI,it can be used for diagniosis and staging diagnosis of osteonecrosis of the femoral head and providing the basis for the choice of clinical treatment.2. As the early detection rate of DTS in ONFH was different from DR, DTS could find early ONFH which DR couldn’t find, especially the early sensitivity of bone destruction is higher than DR, which has the important value to the early ONFH. DTS can be used as an important means for early clinical diagnosis, and provide imaging for treatment and following up examinations.