数字化断层融合技术对可疑寰枢椎和骶尾椎骨折诊断价值的ROC曲线评价

ROC Curve Evaluation on Diagnostic Value of Digital Tomosynthesis for Suspected Atlantoaxial and Sacrum and Coccyx Fractures

目的探讨数字化断层融合技术(Digital Tomosynthesis,DTS)在诊断怀疑寰枢椎和骶尾椎骨折中的应用价值。方法对于2010年7月—2013年4月间在山东省医学影像研究所就诊的42例可疑寰枢椎和骶尾椎骨折患者,由两名具有丰富经验的影像学医师(甲、乙)分别对患者的DR(Digital Radiography)与DTS影像结果进行独立分析,以CT结果作为参照标准,绘制DR与DTS的ROC曲线。采用Kappa技术,检验、分析甲和乙阅片的一致性。结果共有15例可疑寰枢椎骨折及27例可疑骶尾椎骨折患者纳入研究。DR与DTS对寰枢椎及骶尾椎隐蔽骨折总体诊断的ROC曲线下面积(Az)分别为0.597±0.020(甲:0.611、乙:0.583)及0.882±0.010(甲:0.889、乙:0.875),两种检查方法差异有统计学意义(t=40.714,P=0.016)。两位阅片者在DR检查的Kappa值为0.488,一致性一般;而DTS的Kappa值为0.919,一致性好。将结果分为寰枢椎及骶尾椎两亚组进行分析时,结果与前相似。结论 DTS对诊断可疑寰枢椎骨折及骶尾椎骨折较DR具有较高的临床应用价值,检查图像可达到作出临床诊断的要求。当平片无法明确诊断时,进一步检查,可选用DTS作为首选方法。

Objective To discuss the application value of digital tomosynthesis in diagnosis of suspected atlantoaxial and sacrum and coccyx fractures. Methods 42 cases of patients with suspected atlantoaxial and sacrum and coccyx fractures treated in the medical imaging restitution in Shangdong Province from July 2010 to April 2013 were selected and the DR and DTS imaging results were independently analyzed by two imaging physicians with rich experience tak- ing CT results as the standards, the ROC curve of DR and DTS was drawn, and. the consistency of radiograph of A and B was tested and analyzed. Results There were 15 cases of patients with suspected aflantoaxial fractures and 27 cases of patients with suspected coccyx fractures included into the research, and the Az of ROC curve of DR and DTS in di- agnesis of atlantoaxial and sacrum and coccyx fractures was respectively 0.597±0.020 （A： 0.611, B： 0.583） and 0.882± 0.010 （A： 0.889, B： 0.875）, and the difference between the two methods had statistical significance（t=40.714, P=0.016）, and the Kappa value of DR examination of the two readers was 0.488, and the consistency was m general, and the Kap- pa value of DTS was 0.919 and the consistency was good. Conclusion The clinical application value of DTS in diagno- sis of suspected atlantoaxial and sacrum and coccyx fractures is higher than DR, and the examination images can reach the requirements of clinical diagnosis, and DTS can be used as the primary method for further examination when the plain film can＇t be definitely diagnosed.