The utility of dual-energy CT collagen material decomposition technique for the visualization of tendon grafts after knee ligament reconstruction

Abstract

Objective: The purpose of this article is to assess whether dual-energy CT (DECT) collagen material decomposition technique could reliably depict graft integrity in patients with knee ligament reconstruction. Methods: Seventy patients (mean age, 29.8 years; age range, 15-57 years; 61 men, 9 women) who underwent knee DECT, from June 2016 to January 2018, after knee ligament reconstruction were included in our study. A total of 92 intact tendon grafts (autograft, n = 37; allograft, n = 50), confirmed by MRI and clinical assessment or second-look arthroscopy of the operated knee, were evaluated. The type and number of reconstructed ligaments were as follows: anterior cruciate ligament (ACL) (n = 30), posterior cruciate ligament (PCL) (n = 20), medial collateral ligament (MCL) (n = 12), lateral collateral ligament (LCL) (n = 10), posterolateral ligamentous complex (PLC) (n = 7), anterolateral ligament (ALL) (n = 6), and medial patellofemoral ligament (MPFL) (n = 7). All DECT tendon-specific color mapping images were analyzed by two radiologists independently. Each reconstructed ligament was divided into proximal, middle, and distal portion and rated separately using a three-point scale (0 = absent 'dual-energy color staining'; 1 = partial 'dual-energy color staining, 2 = full 'dual-energy color staining'). Results: The mean of total visualization scores of reconstructed ligaments were 5 or more out of 6 points (PCL: 5.0 +/- 0.8; MCL: 5.4 +/- 0.7; LCL: 5.5 +/- 0.5; PLC: 5.4 +/- 1.0; ALL: 5.3 +/- 0.6; MPFL: 5.8 +/- 0.5), except for ACL (4.3 +/- 1.7). No significant difference was observed in the mean of total visualization scores between the autografts and allografts (p > 0.05). The frequency of the score 0 was greater than 10% for the ACL group (15.7%), while less than 5% or 0% for the other groups. Overall, substantial to almost perfect interobserver agreement (range 0.71-0.93) was found for all types of ligaments. Conclusion: DECT collagen material decomposition technique could be a valuable tool to qualitatively display tendon grafts in the patients with knee ligament reconstruction, but more caution would be needed to assess ACL graft.