目的：探讨早期成人股骨头缺血坏死(femoral head necrosis，FHN)的MR、CT、SPECT和X线平 片4种影像学检查的成本效益比，寻找较好的成本效益的检查方法。方法：分析和总结82例129 髋随访和病理证实或具有典型影像学表现的早期(ARCO I~II期)成人FHN病人的髋关节影像学资 料。全部病例均同期行MRI、CT、单光子发射计算机体层摄影(single photon emission computed tomography，SPECT)和X线平片检查。采用成本效果分析法(cost-effectiveness analysis，CEA)，对 4种影像学检查诊断效率研究中的数据进行分析，比较其正确检出费用(cost of accurate diagnosis， CAD)。结果：4种影像学检查方法的诊断差异有显著性意义。早期诊断成人FHN的检出费用最低 的是X线平片，对于X线平片确诊组和诊断可疑组，MRI检出费用并无太大变化，而CT费用最低； 对于X线平片诊断阴性组，MRI 诊断的敏感性和准确性综合比较高于CT 和SPECT，且诊断费用也 最低。结论：X线适合早期股骨头坏死的筛选，而MRI诊断的敏感性和准确性综合比较高于CT和 SPECT，而且应当作为X线诊断阴性的可疑股骨头坏死患者进一步诊断的首选。
Cost-effective analysis for the imaging diagnosis of early femoral head necrosis
Objective: To evaluate the cost-effective analysis of MRI, CT, SPECT and X-ray in the adult early femoral head necrosis, and investigate the more effective way for diagnosis. Methods: Eighty-two cases (129 hips) with early FHN in adult (ARCO stage I~II) proved by follow-up studies, pathology, or typical imageologic manifestations were analyzed. All the patients underwent MRI, CT, SPECT and X-ray in the same period. With cost-effective analysis, compare the cost of accurate diagnosis (CAD) of the 4 diagnosis. Results: There were statistical differences in diagnosing early FHN in adults by MRI, CT, SPECT and X-ray. The smallest cost for accurate diagnosis was X-ray. When X-ray made a certain or suspicious diagnosis, the diagnosis cost of MRI was nearly the same, CT had the smallest CAD. When X-ray diagnosed negative, MRI was the most sensitive and accurately way, also had the smallest CAD. Conclusion: X-ray can be used to screen early femoral head necrosis, MRI is the most sensitive and accurately way, especially the first choice of previous diagnosis when X-ray’s result is negative.