摘要
目的探讨能谱CT技术诊断椎间盘骨化与钙化的临床应用价值。方法回顾性分析因椎管内硬膜外硬质占位性病变行手术治疗并取得病灶病理结果病人43例临床资料,其中23例根据术后病理结果分为椎间盘钙化病人4例,椎间盘/后纵韧带骨化病人19例,术前均给予常规CT、MRI检查,加做能谱CT对病灶进行鉴别诊断,获得能谱曲线。并随机选取同期主动脉(15例)、冠状动脉(11例)、肝脏(7例)、脑(12例)钙化灶形成病人进行能谱CT钙化灶扫描分析,绘制能谱曲线,比较椎间盘钙化与骨化的原子序数直方图、钙-水基图像钙密度散点图等。结果椎间盘钙化灶与骨化灶病理差异主要是钙的沉积方式,其中钙化灶主要是无定型沉积方式,骨化灶为定型沉积。主动脉、冠状动脉、脑、肝脏的钙化灶70keV处关注视野窗显示视野(DFOV)能谱均值相比较,差异有显著意义(F=116.1,P<0.05),其中肝脏钙化灶DFOV能谱低于其他部位钙化灶。骨化组与钙化组8%像素处钙原子序数分布密度中位数分别为251.0、59.5 mg/cm^(3),两组比较差异具有统计学意义(Z=2.70,P<0.01);骨化组总体钙盐平均密度拟合曲线斜率(0.87)较钙化组(1.31)低,但骨化组钙盐平均密度分布高于钙化组(Z=1.90,P<0.05)。结论能谱CT可辨别病灶钙化合物种类,原子序数直方图可判定钙绝对含量值及钙分布规律,钙-水基图像散点图可明确钙定型沉积方式,在椎管致压物不能明确质地情况下,可以为脊柱手术提供有效参考。
Objective To investigate the clinical value of spectral computed tomography(CT)in the diagnosis of ossification and calcification of intervertebral disc. Methods A retrospective analysis was performed for the clinical data of 43 patients with intraspinal epidural hard space-occupying lesions who underwent surgical treatment and obtained pathological results of lesions,and according to the postoperative pathological results,they were divided into intervertebral disc calcification group with 4 patients and intervertebral disc/posterior longitudinal ligament ossification group with 19 patients.Routine CT and MRI examinations were performed before surgery,and spectral CT was performed for lesions to make a differential diagnosis and obtain the spectral curve.Spectral CT was performed for calcified lesions in 15 patients with aortic calcification,11 patients with coronary artery calcification,7 patients with liver calcification,and 12 patients with brain calcification,and spectral curves were plotted.Atomic number histogram and scatter plots of calcium density based on calcium-water images were compared between calcification and ossification of intervertebral disc. Results The pattern of calcium deposition was the main pathological difference between calcified and ossified lesions of intervertebral disc;amorphous deposition was mainly observed in calcified lesions,while formed deposition was mainly observed in ossified lesions.There was a significant difference in mean display field of view(DFOV)value at70 keV between the calcified lesions in the aorta,coronary artery,brain,and liver(F=116.1,P<0.05),and the calcified lesions in the liver showed a significantly lower DFOV value than those in the other positions.The median density of calcium atomic number distribution at 8% pixel was 251.0 mg/cm3 in the ossification group and 59.5 mg/cm3 in the calcification group,with a significant difference between the two groups(Z=2.70,P<0.01).Compared with the calcification group,the ossification group had a lower slope of the fitt
作者
钟鑫
丛文斌
钟延国
张国庆
相宏飞
段峰
ZHONG Xin;CONG Wenbin;ZHONG Yanguo;ZHANG Guoqing;XIANG Hongfei;DUAN Feng(School of Basic Medicine,Qingdao University,Qingdao 266071,China)
出处
《青岛大学学报（医学版）》
2021年第5期685-690,共6页
Journal of Qingdao University(Medical Sciences)
基金
国家自然科学基金项目(81802190,81772412)
山东省自然科学基金项目(ZR2019BH084)
中国博士后基金项目(2019M652329)
泰山学者青年专家工程资助项目(tsqn201909190)。
关键词
椎间盘
钙质沉着症
骨化
异位性
体层摄影术
X线计算机
光谱分析
诊断
intervertebral disc
calcinosis
ossification,heterotopic
tomography,X-ray computed
spectrum analysis
diagnosis
