代谢性及内分泌性骨病椎体骨密度的影像学研究

Imaging investigation of metabolic and endocrine bone disease of vertebral density

目的探讨代谢性及内分泌性骨病椎体骨密度变化的影像学表现及夹心椎椎体骨小梁区域性分布的特征。方法选取在影像学上椎体骨密度异常者36例,其中具夹心椎者12例行腰椎CT扫描。32例健康志愿者亦行腰椎CT扫描,对2组椎体不同部位骨量进行比较分析。22例行双能X线吸收测量仪(dual energy X-ray absorptiometry,DXA)检查,1例行骨组织形态计量学检查。结果骨密度异常包括骨密度减低和骨密度增高。骨密度增高分弥漫性及夹心椎2种。夹心椎组椎体上、中、下层的CT值分别为(259.94±18.08)、(182.96±34.85)、(270.34±19.40)HU,对照组椎体上、中、下层CT值分别为(191.08±30.35)、(190.50±20.53)、(201.12±30.72)HU,夹心椎组椎体上层和下层CT值均大于对照组。夹心椎组椎体上层和下层区组间CT值差异无统计学意义(F值分别为0.457、0.462,P值均>0.05),中层区组间CT值差异有统计学意义(F=4.539,P<0.05)。夹心椎患者骨矿密度(BMD)测值表现多样,骨量增多、正常和减少均可见。结论(1)夹心椎定量CT测量椎体上层和下层更有意义,夹心椎宜视为评估病情变化的影像学指标之一。(2)X线片显示骨软化变形者的骨密度增高并不一定代表骨量增多,其中尚含有正常骨量甚至是骨量减低者。以DXA测量椎体BMD值来区分真性骨硬化和硬化样骨软化是可取的。

Objective To probe vertebral density of metabolic and endocrine bone disease imaging features,characterize the regional distribution of bone trabeculae in sandwich spine. Methods Thirty-six patients who had the bone density abnormality appearance in radiograms were collected in this study. Twelve patients with sandwich spine were perforlned lulnbar CT scan. Thirty-two heulthy volunteers as control group were performed lumbar CT scan too. CT values of two groups were measured from different portions of vertebral body, and then were analysed. Twenty two patients were pefforlned duul-energy x-ray absorptiometyr （DXA）. One patient was performed bone histomorphometry. Results Abnormul density included decreased and increased density. Decreased density was found in different portions of all patients, which divided into general and regional type. increased density was obviously in vertebrae, including diffusely increased density and sandwich spine. The mean CT values of superior,lniddle and itfferior portions of sandwich vertebrul body were （259.94 ± 18.08 ）. （ 182. 96 ± 34. 85 ）. （ 270. 34± 19.40） HU . The mean CT values of both superior and inferior portions of sandwich vertebral body were higher than that of control group. The lnean CT values of superior and inferior portions of sandwich spine were higher than that of lniddle portion. The difference of lnean CT values between superior and inferior portions had no statistical significance. The difference of CT values alnong the regions of superior and inferior portions had no statistical significance（F=0.457, 0.462,P〉0.05）. The difference of CT vulues alnong the regions of lniddle portion had statistical significance（F=4. 539,P 〈 0. 05）. The DXA lneasurelnent of sandwich spine showed high, norlnul and low BMD. Conclusion The sandwich spine is useful to lneasure superior and inferior portions of sandwich vertebral body if QCT would be perforlned. Sandwich spine sign can be used as an ilnaging index of state evaluation, increased density in plain fihn with osteolnulacia deforlnity may be increased, norlnul or decreased bone lnass in DXA lneasurelnent in the latter condition, sclerotoid osteolnulacia lnust be considered, it was desirable to distinguish sclerotoid osteolnulacia froln true sclerosis using vertebral BMD lneasured by DXA.