摘要
目的 分析双能量CT虚拟去钙(VNCa)技术与磁共振成像(MRI)对椎体新鲜骨折患者的诊断价值.方法 回顾性选取2021年1月至2023年1月三二○一医院收治的86例椎体新鲜骨折患者进行研究,分别采用MRI、双能量CT对患者进行检查,并以MRI结果作为诊断金标准,分析常规CT、VNCa图主观评价和CT差值评价在椎体新鲜骨折骨髓水肿(BME)中的诊断效能及其检查结果与MRI的Kappa检验一致性;另测量常规CT图和VNCa图椎体新鲜骨折患者真阳性区和真阴性区的CT值,并采用双变量Spearman相关性检验VNCa CT值与常规CT值的相关性.结果 MRI检查结果显示,86例患者T0～L5水平中共420个椎体,其中260个BME(胸椎64个,腰椎96个);1、2、3、4级信号分别有160、98、76、86个.常规CT评价椎体新鲜骨折BME与MRI成像的Kappa系数为0.715,一致性较强;真阳性、真阴性、假阳性、假阴性分别为241、145、15、19例.VNCa图主观评价椎体新鲜骨折BME与MRI成像的Kappa系数为0.835,一致性很强;真阳性、真阴性、假阳性、假阴性分别为255、157、3、5例.CT差值评价椎体新鲜骨折BME与MRI成像的Kappa系数为0.859;真阳性、真阴性、假阳性、假阴性分别为257、158、2、3例.椎体新鲜骨折真阳性区常规CT值和 VNCa CT 值分别为 278.56±20.64、-72.65±10.12,均高于真阴性区(197.54±20.54、-90.58±10.25),差异均有统计学意义(P＜0.05).椎体新鲜骨折患者的骨髓VNCa CT值与常规CT值呈负相关(P＜0.05).常规CT对椎体新鲜骨折患者BME的诊断价值一般,AUC值0.784;VNCa CT和CT差值对椎体新鲜骨折患者BME的诊断价值较高,AUC值分别为0.867、0.874.结论 双能量VNCa在鉴别诊断椎体新鲜骨折中具有较为可靠的准确性,且与MRI的一致性较高,有利于为后续治疗提供科学的参考依据.
Abstract
Objective To analyze the diagnostic value of dual-energy CT virtual nomcalcium(VNCa)technology and magnetic reso-nance imaging(MRI)in patients with fresh vertebral fractures.Methods A total of 86 patients with fresh vertebral fractures admitted to 3201 Hospital from January 2021 to January 2023 were retrospectively selected for the study.MRI and dual-energy CT were used to examine the pa-tients,and the MRI results were used as the diagnostic gold standard.The diagnostic efficacy of conventional CT,VNCa subjective evaluation and CT difference evaluation in bone marrow edema(BME)of fresh vertebral fractures and the consistency of the results with MRI Kappa test were an-alyzed.In addition,the CT values of the true positive area and the true negative area of patients with fresh vertebral fractures in conventional CT images and VNCa images were measured,and the correlation between VNCa CT value and conventional CT value was tested by bivariate Spearman correlation.Results The results of MRI examination showed that there were 420 vertebral bodies at T0-L5 level in 86 patients,including 260 BME(64 thoracic vertebrae and 96 lumbar vertebrae).There were 160,98,76 and 86 signals of grade 1,2,3 and 4,respectively.The Kappa coefficient of BME and MRI imaging of fresh vertebral fractures evaluated by conventional CT was 0.715,and the consistency was strong.The true positive,true negative,false positive and false negative were 241,145,15 and 19 cases,respectively.The Kappa coefficient of VNCa image sub-jective evaluation of fresh vertebral fracture BME and MRI imaging was 0.835,and the consistency was strong.The true positive,true negative,false positive and false negative were 255,157,3 and 5 cases,respectively.The Kappa coefficient of CT difference evaluation of fresh vertebral fracture BME and MRI imaging was 0.859.The true positive,true negative,false positive and false negative were 257,158,2 and 3 cases,re-spectively.The conventional CT value and VNCa CT value of the true positive area of fresh vertebral fracture were 278.56±20.64,-72.65± 10.12,which were higher than those of the true negative area(197.54±20.54,-90.58±10.25),and the differences were statistically signifi-cant(P＜0.05).The CT value of bone marrow VNCa in patients with fresh vertebral fractures was negatively correlated with the conventional CT value(P＜0.05).The diagnostic value of conventional CT for BME in patients with fresh vertebral fractures was general,and the AUC value was 0.784.The diagnostic value of VNCa CT and CT difference for BME in patients with fresh vertebral fractures was high,and the AUC values were 0.867 and 0.874,respectively.Conclusion Dual-energy VNCa has a reliable accuracy in the differential diagnosis of fresh vertebral fractures,and has a high consistency with MRI,which is conducive to providing a scientific reference for subsequent treatment.
维普
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