病变水肿区纵行分布的对称性在骨化性肌炎鉴别诊断中的价值

Value of the longitudinal distribution symmetry assessment of the edema zone in the differential diagnosis of myositis ossificans

目的探讨病变水肿区纵行分布的对称性在骨化性肌炎鉴别诊断中的应用价值。方法回顾性分析2008年3月至2012年6月,北京积水潭医院经手术或穿刺病理证实的15例早、中期骨化性肌炎和17例骨、软组织肿瘤及感染性病变,划分为骨化性肌炎组与非骨化性肌炎组,32例平均年龄(33.1±17.5)岁。分别测量病灶中心与周围水肿区上缘(远地端)/水肿区下缘(近地端)距离的比值,并进行统计学分析。采用非参数法构建受试者作用曲线,并计算早、中期骨化性肌炎的敏感度和特异度。结果在15例早、中期骨化性肌炎组病变中,病变中心与周围水肿区上/下缘距离的比值为0.62±0.24,偏离1;17例非骨化性肌炎组病变中,病变中心与周围水肿区上/下缘距离的比值为0.99±0.06,接近1;两组组间比较,差异有统计学意义(P<0.001)。以0.855为临界点,诊断早、中期骨化性肌炎,敏感度为86.7%,特异度为100%。结论早、中期骨化性肌炎病灶中心与病变水肿区上、下边缘距离比值偏离1,病变水肿区纵行分布不对称,在早、中期骨化性肌炎的鉴别诊断中具有一定的参考价值,有助于提高定性诊断正确率。

Objective To investigate the value of the longitudinal distribution symmetry assessment of the edema zone in the differential diagnosis of myositis ossiifcans （ MO ）.Methods From March 2008 to June 2012, 15 patients with early or medium-term MO and 17 patients with bone or soft tissue tumors and infectious diseases conifrmed by surgical pathology or biopsy were adopted, whose clinical data were retrospectively analyzed. All the patients were divided into two groups, including the MO group （n=15 ） and the non-myositis ossificans （ NMO ） group （n=17 ）. The superior and posterior fringes of the edema zone were identiifed, and the ratio of their distances from the center of the ossiifed focus was measured. All the data were analyzed statistically. A nonparametic method was employed to generate a receiver operating characteristic （ ROC ） curve.Results The ratios of the superior and posterior fringes of the edema zone were 0.62±0.24 in the MO group and 0.99±0.06 in the NMO group. All the data were analyzed between the two groups by independent samplest-test, and the differences were statistically signiifcant （P〈0.001 ）. With 0.855 as the critical point, the sensitivity was 86.7% and the speciifcity was 100% in the diagnosis of early and medium-term MO.Conclusions The ratio of the superior and posterior fringes of the edema zone from the center of the ossiifed focus is not equal to 1 in the patients with early and medium-term MO. The longitudinal distribution symmetry assessment of the edema zone may supply some referential information for the differential diagnosis of early and medium-term MO, which is helpful to improve the accuracy of qualitative diagnosis.