CT值直方图鉴别诊断骨巨细胞瘤与动脉瘤样骨囊肿的效能

Efficacy of CT value histogram in differentiating giant cell tumor of bone from aneurysmal bone cyst

目的探讨CT值直方图在骨巨细胞瘤(GCT)与动脉瘤样骨囊肿(ABC)中的鉴别诊断价值。方法收集接受CT扫描且经病理证实的骨GCT患者34例和ABC患者9例,在病灶最大层面选取ROI,获取CT值直方图,并记录平均CT值、峰值CT值、偏度值及峰度值,采用两独立样本t检验分析GCT和ABC各参数的差异,并对有统计学差异的指标采用ROC确定最佳诊断阈值,并计算曲线下面积、敏感度、特异度和准确率。结果GCT平均CT值和峰值CT值均显著高于ABC(t=-5.62,-5.81,P均<0.05),ABC偏度值和峰度值大于GCT,但差异无统计学意义(t=1.58,0.75,P均>0.05)。诊断GCT的平均CT值和峰值CT值的ROC曲线下面积分别为0.96和0.95(P均<0.01),最佳诊断阈值分别为36.67 HU和36.85 HU,此时其敏感度、特异度、准确率分别为94.12%(32/34),88.89%(8/9)、93.02%(40/43)和97.06%(33/34)、88.89%(8/9)、95.35%(41/43)。结论 CT值直方图对GCT和ABC的鉴别诊断具有较高的临床应用价值,平均CT值和峰值CT值在两者的鉴别诊断中均具有较高的诊断准确率。

Objective To investigate the value of CT value histogram in differential diagnosis of giant cell tumor of bone（GCT） and aneurysmal bone cyst（ABC）.Methods Thirty-four patients with GCT and nine patients with ABC confirmed by histopathology underwent CT examinations were enrolled.ROI at the largest slice of the lesion was setted,and the CT value histogram,average CT value,peak CT value,skewness value and kurtosis value were obtained.The independentsamples t test was used to compare the differences in GCT and ABC,and the optimum cut-off value of the parameters were achieved by ROC if the parameters had significant difference between GCT and ABC,and the area under the cure（AUC）,sensitivity,specificity and accuracy were calculated.Results The average CT value and peak CT value of GCT were significantly higher than those of ABC（t=-5.62,-5.81,both P〈0.05）.The skewness and kurtosis value of ABC were higher than those of GCT group,but there was no significant difference（t=1.58,0.75,both P〉0.05）.According to the ROC analysis,the AUC of average CT value and peak CT value were 0.96 and 0.95 respectively（both P〈0.01）,the cutoff value were 36.67 HU and 36.85 HU respectively,the diagnostic sensitivity,specificity and accuracy were 94 12%（32/34）,88.89%（8/9）,93.02%（40/43） and 97.06%（33/34）,88.89%（8/9）,95.35%（41/43）,respectively.Conclusion CT value histogram plays an important clinical role in differential diagnosis of GCT and ABC,average CT value and peak CT value both have high diagnostic accuracy in differentiating GCT and ABC.