Valid and reliable diagnostic performance of dual-energy CT in anterior cruciate ligament rupture

Category	Detail
Condition	Anterior Cruciate Ligament (ACL) rupture
Key Mechanisms	ACL maintains knee kinematics; rupture leads to instability, secondary injuries, and posttraumatic osteoarthritis
Target Population	Patients over 14 years with unilateral ACL injury and positive physical exams
Care Setting	Orthopedic and radiology clinical settings, including preoperative evaluation

MRI is the gold standard for noninvasive ACL rupture diagnosis but has limitations in acute trauma and contraindicated patients.
Dual-energy CT (DECT) differentiates soft tissues using differential attenuation at various energy levels and color-coding algorithms.
DECT offers advantages over conventional CT including better osseous injury imaging, reduced motion artifacts, shorter acquisition time, and lower cost.

Use MRI as the primary imaging modality for ACL rupture diagnosis when feasible.
Consider DECT as an alternative imaging technique in patients with contraindications to MRI or acute trauma.
Perform DECT scans using dual-source CT scanners with specific protocols (e.g., 80 kV and Sn140 kV tubes, 1.0 mm slice thickness).
Use color-coded postprocessing algorithms to differentiate torn from normal ACLs on DECT images.

Confirm ACL rupture diagnosis arthroscopically during reconstruction surgery.
Use imaging findings to guide surgical reconstruction planning and rehabilitation.

Repeat image evaluation after a time interval (e.g., 2 weeks) to assess diagnostic reliability.
Use contralateral knee imaging as a healthy control reference.

Consider radiation exposure from DECT (approximate dose-length product of 192 mGy·cm).
Be aware of contraindications to CT or MRI including pregnancy and implanted devices.

Patients aged >14 years with unilateral ACL injury, excluding bilateral injuries, multiligament injuries, or revision surgeries.

DECT can be reliably used for ACL rupture diagnosis in patients contraindicated for MRI, aiding timely surgical decision-making.

Ensure blinding of image readers to patient demographics and clinical data to reduce bias.
Use standardized imaging protocols and reconstruction parameters for DECT to optimize image quality.
Employ experienced orthopedic surgeons and musculoskeletal radiologists for image interpretation.
Utilize color-coded DECT images (mono + mode at 80 keV) for improved visualization of ACL integrity.
Correlate imaging findings with arthroscopic confirmation for diagnostic accuracy.

Clinical Scorecard: Assessment of Dual-Energy CT's Diagnostic Accuracy for Anterior Cruciate Ligament Tears