摘要
目的探讨双能量计算机断层扫描(computed tomography,CT)检查对骨质疏松性椎体压缩性骨折(osteoporotic vertebral compression fracture,OVCF)患者的临床应用价值。方法选取2017年1月至2019年11月陆军军医大学第二附属医院收治的196例椎体压缩性骨折患者为研究对象,对患者伤椎行双能量CT检查,分别通过虚拟非对比度、虚拟去钙技术进行图像后处理,收集钙CT值、钙浓度、骨髓CT值和脂肪含量占比等参数。将双能X射线吸收法测定的骨密度和脊柱磁共振成像(magnetic resonance imaging,MRI)检查结果分别作为骨质疏松和骨髓水肿的诊断“金标准”,评估双能量CT检查对椎体压缩性骨折患者骨质疏松和骨髓水肿的诊断效能。结果根据骨密度仪检测结果,将196例患者分为骨质疏松组(66例)和非骨质疏松组(130例),双能量CT检查结果显示:骨质疏松组患者椎体的钙CT值、钙浓度均显著低于非骨质疏松组(均P<0.05)。根据MRI检查结果,将骨质疏松组患者分为骨髓水肿组(19例)和非骨髓水肿组(47例),双能量CT检查结果显示:骨髓水肿组患者的骨髓CT值显著高于非骨髓水肿组(P<0.05),骨髓脂肪含量占比显著低于非骨髓水肿组(P<0.05)。骨质疏松组与非骨质疏松组、骨髓水肿组与非骨髓水肿组患者的性别构成和年龄比较差异均无统计学意义(均P>0.05)。受试者操作特征曲线(receiver operator characteristic curve,ROC曲线)表明,椎体的钙CT值、钙浓度对骨质疏松具有较高的诊断价值,ROC曲线下面积(area under the curve,AUC)分别为0.853、0.838,二者联合能提高诊断价值,AUC和约登指数分别为0.883和0.686。骨髓CT值、脂肪含量占比对骨髓水肿具有较高的诊断价值,AUC分别为0.880、0.893,二者联合能提高诊断价值,AUC和约登指数分别为0.919和0.820。结论双能量CT检查能评估OVCF患者椎体骨密度和骨髓状况,对骨质疏松和骨髓水肿具有较高的诊断价值,
Objective To investigate the effect of dual-energy computed tomography(CT)examination in patients with osteoporotic vertebral compression fracture(OVCF).Method 196 patients with vertebral compression fracture who were admitted to Second Affiliated Hospital,Army Medical University of the People's Liberation Army from January 2017 to November 2019 were selected as the research objects.The injured vertebrae were scanned by dual-energy CT,and virtual non-contrast and virtual non-calcium technology were performed for post-processing of image,and the parameters such as calcium CT value,calcium concentration,bone marrow CT value and fat content ratio were collected.Bone mineral density measured by dual-energy X-ray absorptiometry and magnetic resonance imaging(MRI)of spine were used as the"gold standard"for the diagnosis of osteoporosis(OP)and bone marrow edema(BME)respectively,and the diagnostic efficacy of dual-energy CT for OP and BME were evaluated.Result All 196 patients were divided into OP group(66 cases)and non-OP group(130 cases)according to the result of bone mineral density.The dual-energy CT parameters such as calcium CT value and calcium concentration in OP group were significantly lower than those in non-OP group(all P<0.05).66 patients in OP group were divided into BME group(19 cases)and non-BME group(47 cases)according to the result of MRI.The bone marrow CT value of BME group was significantly higher than that of non-BME group(P<0.05),and the proportion of bone marrow fat was significantly lower than that of non-BME group(P<0.05).There were no significant differences in baseline data including gender and age between OP group and non-OP group,BME group and non-BME group(all P>0.05).The result of receiver operator characteristic curve(ROC curve)showed that calcium CT value and calcium concentration of vertebral body had high diagnostic value for OP[area under the curve(AUC)were 0.853 and 0.838 respectively],and the combination of them could improve the diagnostic value(AUC and Youden index were 0.883 and
作者
陈娇
张义
Chen Jiao;Zhang Yi(Department of Radiology,Second Affiliated Hospital,Army Medical University of the People's Liberation Army,Chongqing 400038,China)
出处
《中国医学前沿杂志（电子版）》
2020年第5期136-140,共5页
Chinese Journal of the Frontiers of Medical Science(Electronic Version)
关键词
双能量计算机断层扫描
椎体压缩性骨折
骨质疏松
骨髓水肿
诊断
Dual-energy computed tomography
Vertebral compression fracture
Osteoporosis
Bone marrow edema
Diagnosis
