Diagnostic performance of dual-energy computed tomography in detecting anterior cruciate ligament injuries: a systematic review and meta-analysis

Abstract

OBJECTIVE: Anterior cruciate ligament (ACL) injuries are common and lead to significant physical limitations. While MRI is the diagnostic gold standard, its use is restricted in acute trauma cases due to contraindications and longer imaging times. Dual-energy computed tomography (DECT) has emerged as a potential alternative. This meta-analysis evaluates the diagnostic accuracy of DECT for ACL injuries. MATERIALS AND METHODS: Following PRISMA guidelines, a comprehensive literature search was conducted using PubMed, Web of Science, Scopus, and Embase for studies published up to June 2024. Studies that provided diagnostic accuracy data for DECT in ACL ruptures were included. Metrics of diagnostic accuracy were aggregated using a bivariate random effects model. RESULTS: The meta-analysis, which included five studies with a total of 191 patients, found that DECT had a pooled sensitivity of 88.1 (95 CI, 78.0-93.9) and a specificity of 82.0 (95 CI, 62.0-92.7) for diagnosing ACL ruptures, with an AUC of 0.92 (95 CI, 0.72-0.96). For complete ruptures, sensitivity was 83.2 (95 CI, 68.2-92.0), and specificity was 94.9 (95 CI, 92.2-96.7), with an AUC of 0.96 (95 CI, 0.81-0.98). In acute/subacute settings, sensitivity was 89.4 (95 CI, 76.8-95.6), and specificity was 82.1 (95 CI, 56.2-94.2), with an AUC of 0.93 (95 CI, 0.71-0.97). CONCLUSION: Our findings suggest that DECT is a valuable diagnostic tool for ACL injuries, particularly as an adjunct or alternative when MRI is unavailable or contraindicated, enabling timely and accurate diagnosis.